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SAQ Flashcards

1
Q

Charcot’s neurological triad + associated disease

A
  • Dysarthria (Slurred/ slowed speech due to impaired muscles)
  • Nystagmus (Involuntary side to side, up-down, rhythmic movement of eyes)
  • Intention tremor (Tremor during intentional, visually guided movement)

Associated with Multiple Sclerosis

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2
Q

Risk factors for infective endocarditis

A
  • Rheumatic fever
  • Sepsis
  • Poor oral hygiene
  • Regurgitative valve
  • Prosthetic valves
  • IV drug use
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3
Q

Signs of infective endocarditis on hands

A

Janeway lesions
Oslers nodes
Splinter haemorrhage

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4
Q

Scoring system for Infective Endocarditis

A

Duke’s criteria.
2 major, 1 minor. 1 major, 3 minor. 5 minor.

Major - blood culture for endocarditis. Positive evidence ie echocardiogram for IE, abscess, new valve regurgitation.

Minor - Predisposing heart condition, IV drug use, fever, vascular signs (Janeway lesion, aneurysm etc), immunological signs (Oslers nodes, roths spots, rheumatoid factor)

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5
Q

PVD in leg. Site of pain and artery

A

Buttocks - iliac or lower aorta
Thigh - iliac or femoral
Calf - popliteal
Foot - tibial or peritoneal

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6
Q

6 signs of limb ischaemia (6 Ps)

A 
Perishingly Cold
Pain
Pulseless
Pale
Paralysis
Paraesthesia
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7
Q

Investigations for PVD

A
  • Ankle-brachial pressure index: systolic BP recorded with appropriately sized cuff in both arms and posterior tibial, dorsalis pedis and peroneal arteries. 0.5-0.9 claudication (mild-moderate)
    <0.5 critical limb ischaemia.
    Absence on lower extremity - acute limb ischaemia.
  • Duplex ultrasound
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8
Q

Beck’s triad

A
  • Hypotension
  • Distended jugular veins (and raised JVP in heart failure)
  • Muffled heart sounds

Associated with Cardiac Tamponade

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9
Q

Charcot’s triad

And what can it progress to

A
  • Fever
  • Jaundice (raised bilirubin)
  • RUQ Pain

Associated with acute biliary obstruction (cholangitis)

Can progress to Reynold’s Pentad

  • Charcot’s triad +
    - Confusion
    - Hypotension

Associated with Obstructive ascending cholangitis

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10
Q

Virchows Triad

A
  • Hypercoagulability (cancer, surgery, oestrogen, sepsis)
  • Venous stasis (Recent surgery, long-haul travel)
  • Endothelial damage

Factors that contribute to venous thrombosis

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11
Q

Kidney cancer (all types) triad

A

Haematuria, flank pain, abdominal mass

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12
Q

How might you differentiate an arterial ulcer from a venous ulcer?

A

Arterial: Distal extremities. absence of hair, pale/ necrotic wound tissue, skin shiny pale taut, minimally exudative

Venous: Gaiter area, lower calf to medial malleolus. Irregular shape, granular appearance, more exudative, firm odoema, thick skin.

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13
Q

What symptoms might be experienced by a patient with chronic limb ischaemia?

A

Hair loss, ulcers, foot numbness, absent distal pulses, atrophic skin, brittle/slow growing nails, intermittent claudication.

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14
Q

Name 2 investigations used to diagnose Cystic Fibrosis

A
  • Guthrie heel prick - check for serum immunoreactive trypsinogen in foetuses
  • Sweat test. >60mmol/L diagnostic
  • Genetic testing
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15
Q

Lifestyle advices to patients with Cystic Fibrosis

A
  • No smoking
  • High calorie high fat diet
  • Regular flu vaccination
  • Exercise regularly
  • Do chest physiotherapy
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16
Q

ECG changes for atrial fibrillation

A 
Absent P waves
Irregularly irregular rhythm
Absent isoelectric baseline
Fibrilatory waves
QRS <120ms
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17
Q

What is BNP and when would it be raised

A

BNP (B- type Natriuretic Peptide) is raised when cardiac muscles are stretched beyond normal range. High means heart overloaded with blood beyond normal capacity to pump properly.

Raised in:
Heart failure
Tachycardia
Sepsis
Pulmonary embolism
Renal impairment
COPD
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18
Q

What is Sepsis 6

A
  1. Administer oxygen
  2. Give IV fluids
  3. Give IV antibiotics (ceftriaxone)
  4. Take blood culture
  5. Check serum lactates
  6. Measure urine output
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19
Q

Red flags for sepsis 6

A 
Confusion
Unresponsive
Hypotension
Tachycardia
High respiratory rate
Hypoxic
Not passing urine
High lactate
Recent chemotherapy
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20
Q

Exudate vs Transudate

A

Exudate - Inflammatory fluid release, due to changes in capillary permeability

  • High protein
  • Coagulates
  • Contains inflammatory cells

Transudate - Non inflammatory (pressure gradients)

  • Low protein
  • Doesnt coagulate
  • No inflammatory cells
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21
Q

What microbes cause CAP and what causes HAP

A

CAP - Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus Influenzae

HAP - Pseudomonas aeruginosa

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22
Q

Nephritic vs Nephrotic

A

Nephritic - Haematuria, Hypertension, Oedema.

Nephrotic - Proteinuria (>3.5g/24h), Hypoalbuminaemia, Oedema, with or without hypertension

(Nephrotic has >3.5g protein, nephritic has <3.5g protein)

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23
Q

Histology of Coeliac

A

Endoscopy and duodenal biopsy

Villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes, lamina propria infiltration with lymphocytes

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24
Q

Histology of Crohns

A

Transmural inflammation, granulomas, goblet cells present

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25
Q

Histology of Ulcerative Colitis (4)

A

Psuedopolyps, crypt abscesses, goblet cell depletion. Inflammation limited to mucosa + submucosa

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26
Q

Crohns vs Colitis vs Coeliac Histology

A

Crohns - Transmural inflammation, granulomas, goblet cells present
Colitis - pseudopolyps, goblet cell depletion, crypt abscesses. Inflammation is mucosa/sub only
Coeliac - Villous atrophy, crypt hyperplasia, intraepithelial lymphocytes, lamina propria infiltration with lymphocytes

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27
Q

Coeliac investigations

A

IgA- Anti tTG (tissue transglutaminase)
- Anti EMA (East mids airport (but also Endomysial))

IgG- Anti DGP (Deaminated gliadin peptide)

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28
Q

Supportive treatments with examples

A

IV fluids
Analgesia (Paracetamol)
Antiemetics
Preoperative antibiotics (ceftriaxone)

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29
Q

GORD vs Achalasia

A 
Achalasia has:
Regurgitation rather than reflux
Dysphagia affects solids more than liquids
No apparent underlying cause
Trialled PPIs dont help
Achalasia has dilated oesophagus
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30
Q

1 pathogenic, 1 non infectious cause, 1 not related to disease. Causes of diarrhoea

A

Pathogenic - norovirus, rotavirus, staph aureus, e coli
Non pathogenic - IBS, IBD, Bowel cancer
Not related to disease - stress, medication side effect, toxin ingestion

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31
Q

Action of penicillin and clarithromycin

A

Penicillin - inhibits bacterial cell wall synthesis

Clarithromycin - Inhibits protein synthesis by bacteria

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32
Q

ECG in hyper/hypokaleaemia

A

Hyperkalaemia - Tall T waves, broad QRS, flat P waves, short QT
Hypokalaemia - flat T wave, U wave present, prolonged PR

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33
Q

Which cancers metastasise to bone

A 
Breast
Prostate
Lung 
Kidney
Thyroid
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34
Q

Complications of CKD

A
  • Hyperkalaemia
  • Hypocalcaemia (less vit D activation by kidney) -> secondary hyperparathyroidism -> - - Bone osteodystrophy
  • Hypertension (renin secretion)
  • Anaemia (Erythropoietin release decreases)
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35
Q

Primary vs secondary vs tertiary hyperparathyroidism

A

Primary hyperparathyroidism - Uncontrolled PTH due to tumour
Secondary hyperparathyroidism - Insufficient vit D or chronic renal failure so low absorption of calcium from intestines and kidneys.
Tertiary - Hyperparathyroidism continues for long time leading to hyperplasia of parathyroid glands.

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36
Q

Hyperparathyroid treatment

A

Primary - Avoid thiazide diuretic, high Ca2+ intake.
- Surgical removal of tumour
Secondary - Correct vit D or transplant kidney.
Phosphate binder
Tertiary - Remove parathyroid tissue

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37
Q

How do you know if a UTI is complicated?

A

If it affects:

  • a man
  • a pregnant lady
  • baby
  • the immunocompromised
  • it is recurrent
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38
Q

First line for an uncomplicated UTI

A

Trimethoprim (TERATOGENIC) and nitrofurantoin for 3 days

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39
Q

Pre Renal, Intrinsic and post renal causes of AKI

A

Pre renal: inadequate supply
Dehydration, Hypotension, Heart failure

Intrinsic: Disease causes reduced filtration
glomerulonephritis
acute tubular necrosis
interstitial nephritis

Post renal: Obstruction to outflow of kidney
Kidney stones, ureteral stricture, cancer in abdomen or pelvis, enlarged prostate or prostate cancer

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40
Q

Lower Urinary Tract symptoms

A
  • Storage (frequency, urgency, nocturia)

- Voiding (straining, hesitancy, incomplete emptying, poor flow)

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41
Q

lower urinary tract symptoms - investigations

A

1) Urine dipstick and culture
2) PSA
3) Assess symptoms International Prostate Symptom Score

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42
Q

Treatments for moderate-severe lower urinary tract symptoms

A

1) Alpha-1-blockers (tamsulosin) - relaxes muscles in bladder to reduce resistance to bladder flow
2) 5-alpha-reductase-inhibitors (finasteride) - inhibit conversion of testosterone to dihydrotestosterone to reduce prostate size.

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43
Q

Tamsulosin side effects

A

hypotension, retrograde ejaculation

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44
Q

Stages of CKD

A

eGFR used to stage CKD

  1. > 90
  2. 60-89
    3a. 45-59
    3b. 30-44
  3. 15 to 29
  4. <15
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45
Q

Microbial causes of UTI

A 
KEEPS 
K-klebsiella
E- E Coli
E- Enterococci 
P-proteus spp
S-staphylococcus
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46
Q

Gold Standard investigation for Cystitis

A

midstream urine dipstick sample showing nitrates, leukocyte and haematuria

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47
Q

4 types of nephritic syndromes

A

IgA nephropathy, post strep glomerulonephritis, Good Pasture’s, SLE

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48
Q

3 types of nephrotic syndrome

A

minimal change, amyloidosis, diabetic nephropathy

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49
Q

TB drugs and their side effects

A

R- rifampicin –> red urine/sweat
I- isoniazid –> peripheral neuropathy
P- pyrazanamide –> gout
E- ethambutol –> optic neuritis

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50
Q

Hidden places where psoriasis can be found on the body

A

soles of the feet and the scalp

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51
Q

common cancers that can metastasis to the bone

A

breast, lung, prostate, kidney, thyroid

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52
Q

antibodies found in SLE and how sensitive/specific they are

A

ANA antibodies - sensitive

double stranded DNA antibodies- specific

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53
Q

treatment and drug class for osteoporosis

A

drug class- bisphosphonates

example- alendronate/alendronic acid 70mg once weekly taken on an empty stomach

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54
Q

two signs of osteoarthritis

A

Heberden’s Nodes- small bony nodules on DIP joints

Bouchard’s Nodes- swelling in PIP join

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55
Q

two investigations for giant cell arteritis

A

temporal artery biopsy- showing multinucleated giant cells present and granulomatous inflammation
FBC- ESR and CRP raised. WBC normal. may show anaemia

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56
Q

treatment for GCA

A

high dose prednisolone, methylprednisolone if visual problems. aspirin daily

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57
Q

Diagnostic criteria for GCA

A
  1. new onset headache
  2. temporal artery biopsy
  3. elevated ESR
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58
Q

Symptoms and Signs of GCA

+association

A

unilateral and severe headaches, vision loss if ophthalmic artery affected, scalp pain when brushing hair, jaw pain, fever, symptoms of polymyalgia rheumatica- shoulder/joint pain

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59
Q

von willebrand

A

is a cunt

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60
Q

Name three inflammatory arthropathies

A

Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis

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61
Q

Name the three HLA-B27 positive arthropathies

A

psoriatic arthritis, ankylosing spondylitis, reactive arthritis

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62
Q

ACS complications

A

Heart failure

Thrombocytopenia due to anticoagulation treatment

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63
Q

X ray changes in heart failure

A 
A - Alveolar oedema (bat wing opacities)
B - Kerley B lines
C - Cardiomegaly
D - Dilated upper lobe vessels
E - Pleural effusion
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64
Q

Left vs right sided heart failure

A

Left - Tachypnoea, tachycardia. Third heart sound (S3). Peripheral cyanosis, Displaced apex sound

Right - Raised JVP, Pitting Oedema, Hepatosplenomegaly, Ascites

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65
Q

Well’s score

A

Predicts DVT
Highly sensitive but not very specific

DVT likely 2 points
DVT unlikely 1 point or less

Some point factors include:

  • pitting oedema
  • active cancer
  • calf swelling
  • previous DVT
  • localised tenderness
  • recent bedriddenness

If alternative diagnosis equally likely take 2 from points

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66
Q

Sensitivity vs specificity

A

Sensitivity - number of true positives

Specificity - number of true negatives

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67
Q

Alcohol units equation

A

(alcohol % by volume * volume of liquid in ml)/1000

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68
Q

Systolic vs diastolic heart failure

A

Systolic - ejection fraction reduced (ventricles dont contract properly)
Diastolic - ejection fraction preserved (ventricles do not relax properly)

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69
Q

What do raised ALT and ALP mean?

A

Raised ALT - hepatocellular injury
Raised ALP - Cholestasis (when raised with GGT - without GGT can suggest pathology that causes bone breakdown)

If ALT raised less than 10 fold and ALP raised more than 3 fold, it still suggests cholestasis, and vice versa for hepatocellular injury

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70
Q

Normal ALT and ALP but raised bilirubin. Diagnosis:

A

Gilbert’s syndrome OR haemolysis

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71
Q

AST/ALT ratio

A

ALT>AST - Chronic liver disease

AST>ALT - Cirrhosis and acute alcoholic hepatitis

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72
Q

HTN staging

A 
Normal: 120/80
Stage 1: 140/90
Stage 2: 160/100
Stage 3: 180/120
(On clinical readings - slightly less for ambulatory)
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73
Q

PVD Treatment

A

Conservative - exercise, weight loss
Antiplatelet - clopidogrel
Statin - atorvastatin
surgical - stent/endovascular angioplasty

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74
Q

4 short term effects of chemotherapy

A

Alopecia, nausea, vomiting, sexual dysfunction, fatigue, neutropenia, immunosuppression, anaemia

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75
Q

2 long term effects of chemotherapy

A

Hearing loss, infertility, heart failure

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76
Q

Signs of ascites on physical examination

A

Abdominal distension, shifting dullness, fluid in flanks

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77
Q

What is the buergers test

A

Test for PVD.
Raise patient’s legs 45 degrees. Pallor after 1-2 mins suggests PVD. Next, have them sit over the edge of a bed with their legs hanging. In normal patient legs will remain pink. In PVD patient, legs will go blue (as ischaemic tissue deoxygenates blood) and then dark red (due to vasodilation in response to waste products of anaerobic respiration)

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78
Q

Graves disease.

Pathology, signs/symptoms, investigations, management

A

Pathology: Hyperthyroidism when TSH receptor stimulating antibodies bind to TSH receptors in thyroid, causing release of T3/T4, resulting in hyperthyroidism.

Signs/symptoms: Tremor, Heart rate increase, Yawning, Restless, Oligomenorrhea, Irritability, Intolerance to heat, Sweating, Muscle wasting (weight loss) [THYROIDISM]
- (specific to graves) Thyroid bruit, pretibial myxoedema, opthalmoplegia (muscle paralysis around eyes)

Investigations: TFT: Raised T3/T4, reduced TSH

Management: Carbimazole (1st line) in mild
Radioiodine if severe

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79
Q

Give the risk factors for osteomyelitis and septic arthritis

A

> 80years old, DM, recent penetrating trauma, prosthetic joints, recent surgery

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80
Q

Treatment for ankylosing spondylitis

A
  1. NSAIDs
  2. steroids during flares
  3. Anti TNF eg infliximab
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81
Q

The antibodies found in SLE

A

ANA antibodies

double stranded DNA antibodies

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82
Q 
State the class of drugs which is the first line medication for osteoporosis
Give an example
Give brief instructions for how this class of drug should be taken
A
  • bisphosphonates
  • alendronic acid/alendronate
  • 70mg once weekly, taken orally with a large glass of water and to remain upright for half an hour after consuming
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83
Q

Name 3 characteristic deformities of the hands in rheumatoid arthritis.

A

Swan neck deformity, boutonniere deformity and z thumb deformity

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84
Q

Pharmacological treatment and prevention of gout

A

treatment- colchicine plus NSAIDs

prevention- allopurinol

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85
Q

what are the X-Ray changes in Rheumatoid Arthritis

A 
LESP
loss of joint space
erosion of bone
soft tissue swelling 
pariarticular osteopenia
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86
Q

Graves disease.

Pathology, signs/symptoms, investigations, management

A

Pathology: Hyperthyroidism due to TSH receptor stimulating antibodies bind to TSH receptors in thyroid, causing release of T3/T4, resulting in hyperthyroidism.

Signs/symptoms: Tremor, Heart rate increase, Yawning, Restless, Oligomenorrhea, Irritability, Diarrhoea, Intolerance to heat, Sweating, Muscle wasting (weight loss) [THYROIDISM]
- (specific to graves) Thyroid bruit, pretibial myxoedema, opthalmoplegia.

Investigations: TFT: Raised T3/T4, reduced TSH

Management: Carbimazole (1st line) in mild
Radioiodine if severe

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87
Q

What is De Quervains Thyroiditis

A

Transient hyperthyroidism from acute inflammation of the gland after an infection. To be treated with only aspirin.

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88
Q

ECG changes in pericarditis

A 
PeRicariTiS 
- Saddle shaped ST elevation
- PR depression
followed by T wave flattening and eventual inversion.
- low QRS if effusion
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89
Q

ECG in pericardial effusion

A

low QRS complex voltage

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90
Q

What is dressler’s

A

Pericarditis following MI

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91
Q

Causes of peritonitis

A 
AEIOU
A- Appendicitis
E- Ectopic pregnancy
I- Infection
O- Obstruction
U- Ulcers
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92
Q

Ascites - fluid investigations

A
  • Ascitic tap
  • Serum ascites-albumin gradient

High SAAG - tranudate (high portal pressure)
Low SAAG - exudate (low portal pressure)

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93
Q

Describe first degree AV heart block

A

occurs where there is delayed atrioventricular conduction through the AV node but every atrial impulse leads to a ventricular contraction

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94
Q

Describe second degree type 1 AV heart block

A

atrial input becomes gradually weaker until it does not pass through the AV node. After failing to stimulate a ventricular contraction the atrial impulse returns to being strong

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95
Q

Describe second degree type 2 AV heart block

A

Disease of the His-Purkinje system. Results in missing QRS complexes

96
Q

Describe third degree AV heart block

A

complete heart block. There is no observable relationship between P waves and QRS complexes

97
Q

Major Dukes criteria

A 
Two positive blood cultures
Or enodcardial involvement on echocardiogram
- Endocardial vegetation
- Perialvular abscess
- New prosthetic valve
- New valve regurgitation
98
Q

Why does cardiac tamponade lead to hypotension?

A

Compression of heart causes decrease in stroke volume and cardiac output, leading to hypotension and tachycardia

99
Q

Mitral stenosis sounds

A

Loud S1 snap w/ mid diastolic murmur

100
Q

Mitral regurgitation sounds

A

Pansystolic murmur w/ mid systolic click and additional S3 sound

101
Q

Aortic stenosis

A

Ejection systolic murmur w/ ejection click and S4 sound

102
Q

Aortic regurgitation

A

Early decrescendo murmur, water hammer pulse, soft S1 and S2

103
Q

Mitral stenosis and regurgitation and

Aortic stenosis and regurgitation sounds

A

Mitral stenosis: Loud S1 snap w/ mid diastolic murmur
Mitral regurgitation: Pansystolic murmur w/ mid systolic click and additional S3 sound
Aortic stenosis: Ejection systolic murmur w/ ejection click and S4 sound
Aortic regurgitation: Early decrescendo murmur, water hammer pulse, soft S1 and S2

104
Q

In ACS,

Aspirin + what?

A

Aspirin + clopidogrel if undergoing PCI

Aspirin + Ticagrelor if not

105
Q

Symptoms of Hypercalcaemia

A

Painful bones
Renal stones
Abdominal groans (nausea,vomiting,constipation,indigestion)
Psychiatric moan (lethargy, fatigue, memory loss, depression)

106
Q

Signs of osteoarthritis

A

Joint pain, effusion, stiffness, mechanical locking
Herbeden’s and Bouchard’s nodes.

No morning pain, pain worse with activity

107
Q

Signs of rheumatoid arthritis

A

Boutonniere: PIP flexion and DIP hyperextension
Swan neck: DIP flexion and PIP hyperextension.
Rheumatoid nodules, popliteal cysts.
Starts small joints and progresses larger.

108
Q

Pain in hands worse in morning and improves through day. Osteo or rheumatoid?

A

Rheumatoid. Osteo gets worse throughout day.

109
Q

Lifestyle advice in gout

A

Low purine foods, lose weight, avoid alcohol

110
Q

Risk score for stroke after Atrial fibrillation

A

CHADS VASc

Congestive heart failure
Hypertension
Age>75 (2pts)
Diabetes Mellitus 
Stroke/TIA/Thromboembolism (2pts)
Vascular disease
Age 65-74
Sex (female)
111
Q

What is Reiter’s Syndrome?

A

Reactive arthritis
“Cant pee, see climb up a tree”

Conjunctivitis, urethritis and arthritis

112
Q

What is Behcet’s syndrome

A

oral ulcers, genital ulcers, eye inflammation

113
Q

Benign vs malignant neoplasm of glandular tissue

A

Adenoma vs adenocarcinoma

114
Q

Benign vs malignant neoplasm of squamous epithelium

A

papilloma vs squamous cell carcinoma

115
Q

Benign vs malignant neoplasm of fat

A

lipoma vs liposarcoma

116
Q

Benign vs malignant of smooth muscle

A

leiomyoma vs leiomyosarcoma

117
Q

small bowel obstruction vs large bowel obstruction

X ray first for both

A

Large bowel has slower onset of symptoms

Pain lower higher in SBO (periumbilical)

Nausea and vomiting early in SBO late in LBO

Pain intermittent in SBO, constant in LBO

X ray first line investigation for both

118
Q

Salbutamol side effects

A 
fine tremor
headache
dry mouth
palpitations
nervousness
119
Q

Duodenal vs gastric ulcer

A

Duodenal is relieved by eating, worse a few hours later

Gastric made worse by eating

120
Q

What does P-ANCA suggest

A

Vasculitis or PSC

121
Q

Signs of chronic liver disease on hands

A

Spider angioma, palmar erythema, leukonychia (white nails), Dupuytren’s contractures (thickening of palm skin)

122
Q

Signs of decompensated liver disease

A

Encephalopathy, ascites, jaundice, splenomegaly, variceal bleeding

123
Q

Liver biopsy in chronic hepatitis

A

Mallory bodies, large mitochondria, fibrosis, extracellular matrix proteins

124
Q

Primary sclerosing cholangitis vs primary biliary cholangitis

A

PSC is P ANCA positive
PSC associated with UC
PBC has anti mitochondrial and anti nuclear antibodies

125
Q

What does aldosterone to do kidneys?

A

Increases sodium reabsorption and potassium and H+ secretion by kidney. Causes hypokalaemia and metabolic alkalosis

126
Q

Primary biliary cholangitis antibodies

A

Anti mitochondrial antibodies

Anti nuclear antibodies

127
Q

Murphy’s sign

A

Palpate gallbladder and ask patient to exhale then inhale. On inhalation, patient will feel a sharp shooting pain.

Positive = cholecystitis
Negative = biliary colic  (or like normal life too i guess)
128
Q

Risk factors for gallstones

A

4Fs

Female, fat, fourties, fertile (pregnancy)

129
Q

Jaundice types and urine/stool presentation

A

Prehepatic - unconjugated bilirubin - normal urine/stool

Hepatic - Both conjugated and unconjugated - Dark urine/ normal stools

Post hepatic - Conjugated bilirubin - dark urine pale stools

130
Q

What drug given in alcohol withdrawal?

A

Chlordiazepoxide

131
Q

Murphy’s sign

A

Palpate gallbladder and ask patient to exhale then inhale. On inhalation, patient will feel a sharp shooting pain.

Positive = cholecystitis
Negative = biliary colic  (or like normal life too i guess)
132
Q

Risk factors for gallstones

A

4Fs

Female, fat, fourties, fertile (pregnancy)

133
Q

Jaundice types and urine/stool presentation

A

Prehepatic - unconjugated bilirubin - normal urine/stool

Hepatic - Both conjugated and unconjugated - Dark urine/ normal stools

Post hepatic - Conjugated bilirubin - dark urine pale stools

134
Q

What drug given in alcohol withdrawal?

A

Chlordiazepoxide

135
Q

Antibodies in autoimmune hepatitis

A
  • Antinuclear antibody (ANA),
  • Anti smooth muscle antibody (ASMA),
  • Anti-soluble liver antigen/liver-pancreas antibody (anti-SLA/LP)
  • Anti-liver cytosol 1 antibody (anti-LC1)
136
Q

Symptoms of hypoglycaemia

A

Blood sugar below 70mg/dL

  • sweating, tired, dizziness, shaking, mood swings, anxiety, pallor, palpitations,
  • can progress to weakness, confusion, blurred vision, fits, collapsing
137
Q

Scoring system for stroke after TIA

A

ABCD2

Age>60
BP > 140/90
Clinical features (Speech +1, w weakness +2)
Duration (10-59 mins +1, 60+ mins +2)
Diabetes history (+1)
138
Q

Where are renal stones most likely to get stuck?

A

ureteropelvic junction, ureterovesical junction, ureteral crossing of the iliac vessels

139
Q

What are the risk factors for osteoporosis

A 
SHATTERED. 
S- steroids
H- hyperthyroidism
A- alcohol and tobacco 
T- thin 
T- testosterone
E- early menopause
R- renal failure 
E- erosive bone disease
D- dietary calcium low
140
Q

What is the potentially life threatening complication of rheumatoid arthritis? And how does it present?

A

Felty’s Syndrome

  • rheumatoid arthritis
  • splenomegaly
  • neutropenia
141
Q

What is the main cause of pneumonia in HIV patients?

A

pneumocystis jirovecii

142
Q

Common cause of pneumonia if you have been abroad eg to Spain

A

Legionella pneumophilia

143
Q

Cauda Equina causes, S+S, Management and treatment

A

Cauda Equina Syndrome=
S+S- bilateral lower limb weakness, reduced sensation, reduced perianal sensation/tone, lower back pain, saddle anaesthesia, bladder and bowel dysfunction, leg weakness + difficulty walk
Investigations- urgent spine MRI (gold standard)
management
Management- emergency spinal cord decompression

144
Q

Calcium channel blocker MOA

A

Dihydropyridines (amlodipine) are more vascular selective (decrease vascular resistance and BP)
Non-dihydropyridines (Verapamil) are more myocardial selective and tend to reduce the heart rate

145
Q

How does calcium gluconate protect heart?

A

stabilizing the cardiac cell membrane against undesirable depolarization

146
Q

Ankylosing spondylitis extra articular manifestations

A 
5 A's: 
Anterior uveitis, 
Autoimmune bowel disease, 
Apical lung fibrosis, 
Aortic regurgitation, 
Amyloidosis.
147
Q

Test for spine mobility

A

Schober’s test:
Have patient stand. Locate L5 vertebrae. Mark 10cm above and 5cm below. Ask patient to bend forward as far as possible and measure distance between 2 points. <20cm distance = reduced lumbar movement.

148
Q

Asthma exacerbation scale

A

Moderate - PEFR 50-75% w/normal speech

Acute severe - 33-50% or inability to complete sentences in one breath, oxygen saturation>92%.

Life threatening - <33% or oxygen<92% or altered consciousness

Treatment: SABA, SAMA nebuliser and Steroid
(Salbutamol, Ipratropium Bromide nebuliser, Oral prednisolone or IV hydrocortisone)

149
Q

Raise in ALP, but other LFT normal

150
Q

Adrenaline MOA

A

Beta adrenergic receptor agonist

151
Q

Restrictive vs obstructive pulmonary disease

With examples

A 
Obstructive: COPD/Asthma etc
Reduced FEV1 (<80%) and lesser reduced FVC
FEV1:FVC <0.7

Restrictive: Pulmonary fibrosis, bronchiectasis, other causes of decreased breath
Reduced FEV1 (<80%) reduced FVC (<80%)
FEV1:FVC >0.7

152
Q

GCA what arteries affected

A
  • Headache, scalp pain - Superficial temporal artery
  • Jaw claudication - Mandibular artery
  • Eye problems - Retinal ischaemia
153
Q

Histology of Alzheimers

A

Senile plaques and neurofibrillary tangles.

154
Q

Epilepsy vs Syncope

A

Syncope caused by emotional distress or from getting up too quick. No post ictal symptoms

155
Q

Kernigs sign

A

Inability to straighten leg when hip flexed to 90 degrees

Suggests Meningitis

156
Q

Teratology of Fallot

A

Ventricular septal defect
Overriding aorta
RV hypertrophy
Pulmonary stenosis

157
Q

Treatment of Cluster headache and Migraine

A

Sumatriptan (triptan)

158
Q

COPD x ray

A

hyperinflation,
flat hemidiaphragm,
bullae,
barrel chest

159
Q

Causes of microcytic anaemia <80 fL

A 
TAILS
Thalassaemia
Anaemia of chronic disease
Lead poisoning
Sideroblastic
160
Q

Causes of normocytic anaemia 80-95 fL

A 
3A 2H
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic (sickle cell, G6PD, spherocytosis)
Hypothyroidism
161
Q

Macrocytic anaemia >95 fL

A

B12 and folate defficiency

162
Q

Alcohol withdrawal drug

A

Chlordiazepoxide

side effects: Drowsy, diarrhoea, weakness, tiredness

163
Q

Bisphosphonates. Example, how to take, side effects.

A

Alendronic acid. Given in osteoporosis. To be given on empty stomach, first thing in the morning with a full glass of water. Stay upright for 30 mins after taking and dont eat or drink for 30 mins after.

Side effects: Oesophagitis, oesophageal ulcers, osteonecrosis of jaw

164
Q

Multiple myeloma cells

A

Rouleaux formation

165
Q

G6PD Blood film

A

Heinz bodies and bite cells

166
Q

How to take infective endocarditis culture

A

3 different sites 3 different times (1 hour apart each)

167
Q

Gout vs Pseudogout crystals

A
  • Gout: Needle shaped, negative birefringence

- Pseudogout: Rhomboid shaped, positive birefringence

168
Q

2 causes of reactive arthritis

A

STI (chlamydia)
Gastroenteritis (gram negative (e.g. salmonella, e.coli, shigella, campylobacter))

tissues of synovium, urethra, conjunctiva affected 2-3 weeks after initial infection

169
Q

HLA B27 associated diseases

A

Reactive arthritis,
psoriasis/psoriatic arthritis,
ankylosing spondylitis
ulcerative colitis

170
Q

Reiter’s syndrome triad

A

Inflammation of synovium, urethra, conjunctiva (eyes)

171
Q

What is meant by seronegative spondyloarthropathy

A

Rheumatoid factor negative, HLA-B27 associated, can affect axial skeleton

172
Q

Conn’s triad

A

Hypokalaemia, refractory hypertension, metabolic alkalosis, hypernatraemia.

Due to effect of aldosterone on kidney

173
Q

Signs in osteoarthritis

A 
Herbeden's nodes (DIP)
Bouchard's nodes (PIP)
Squaring at base of thump at carpo-metacarpal joint
Weak grip
Reduced range of motion
174
Q

Signs in rheumatoid arthritis

A 
Z shaped thumb deformity
Swan neck deformity (hyperextended PIP, flexed DIP)
Boutonnieres deformity (hyperextended DIP, flexed PIP)
Ulnar deviation of fingers at MCP joints
175
Q

Biochemistry of Paget’s

A

Raised ALP (other LFT normal)
Normal calcium
Normal phosphate

176
Q

X ray in Paget’s

A 
Bone enlargement and deformity
Osteolytic lesions (osteoporosis circumscripta)
Cotton wool appearance of skull
V shaped defects of long bones
177
Q

Risk factors for osteoporosis

A 
Women > 65
Men > 75
Low BMI (<18.5kg/m^2)
Long term corticosteroids
Reduced mobility
178
Q

What is the FRAX tool?

A

Prediction of fragility fracture (hip or major osteoporotic) over next 10 years.

Age, sex, weight, height, previous fracture, smoking, glucocorticoids, alcohol >3 units/day, femoral neck BMD.

179
Q

Giant cell arteritis diagnostic criteria

A
  • Age>50
  • New onset headache
  • Temporal artery abnormality (tender on palpitation, decreased pulsation)
  • Elevated ESR
  • Abnormal temporal artery biopsy
180
Q

Sjogren’s. Tell me what it is, test for it and how to treat it

A

Autoimmune condition affecting exocrine glands, leads to dry mucous membranes (dry mouth, eyes, vagina)

Can be primary or secondary (SLE, rheumatoid arthritis)

Schirmer test - strip of filter paper left under eyelid for 6 mins, moisture distance measured. Tears should travel 15mm in healthy young adult, less than 10 significant.

Anti-Ro, anti-La antibodies

hydroxychloroquine

181
Q

What blood tests done for vasculitis

A

CRP/ESR
ANCA (Anti neutrophil cytoplasmic antibodies)
p-ANCA (aka anti-PR3) - Wegener’s granulomatosis
c-ANCA (aka anti-MPO) - microscopic polyangiitis

182
Q

antibodies in SLE

A 
ANA - Sensitive
Anti-dsDNA - Specific
Anti-Smith - most specific but low sensitivity
Anti histone - Drug induced
Anti-Ro, Anti-La - Sjogrens
183
Q

What is Schirmer test

A

strip of filter paper left under eyelid for 6 mins, moisture distance measured. Tears should travel 15mm in healthy young adult, less than 10 significant.

Check for sjorgrens

184
Q

Causes of peripheral neuropathy

A 
A - Alcohol
B - B12 deficiency
C - Cancer/CKD
D - Diabetes and Drugs (isonazid, cisplatin)
E - Every vasculitis
185
Q

What antibodies in hashimoto’s

A

Anti TPO (thyroid peroxidase) - degeneration of thyroid gland

186
Q

Antibodies in graves

A

Anti TSH receptor - causes release of T4

187
Q

Bronchiectasis CT

A

signet ring

188
Q

Typical Multiple Myeloma symptoms

A 
CRAB
C - hypercalcaemic >2.75mmol/L
R - renal impairment (creatinine)
A - Anaemia
B - Bone lesions
189
Q

Bone signs in multiple myeloma

A

Pepper pot skull, cord compression, back pain

190
Q

Malaria causing bacteria

A

P. falciparum - most common and severe and highest mortality rate. Africa
P. Vivax - Also causes severe disease, less contribution to global burden. Asia and South America

191
Q

Signs of malaria

A

“warm and cold”
recent travel
diarrhoea
abdominal pain

192
Q

Treatments alongside chemo for Leukaemia

A

CML - Imatinib (tyrosine kinase inhibitor)
CLL - Ibrutinib (bruton kinase inhibitor)
- Rituximab (monoclonal antibody)

193
Q

Immune thrombocytopenia purpura (ITP) signs

A

Easy bruising
Epistaxis (nose bleeds)
Menorrhagia (abnormally heavy bleeding)
Purpura (Purple spots caused by bleeding under skin)

194
Q

Diagnostic criteria for Multiple Myeloma

A

Bench jones protein in urine
Lytic bone lesions
Excess plasma cells in bone marrow (>10% infiltration)

195
Q

Multiple Myeloma investigations (5)

A

Urine electrophoresis: Bence jones proteins in urine (immunoglobulin light chains)
Serum electrophoresis: Monoclonal paraprotein band, IgG or IgA
Bone marrow aspiration: >10% plasma cell infiltration
Blood film: Rouleaux formations
X ray: Raindrop skull due to lytic lesions

196
Q

Multiple myeloma treatment

A

Bortezomib, dexamethasone, thalidomide

If under 70, or poor performance status
Bortezomib, prednisolone, melphalan

Stem cell transplant.

Blood tests repeated every few months and bortezomib monotherapy following relapse

197
Q

Poor prognostic factors for Myeloma

A

Raised LDH, raised beta 2 microglobulin

198
Q

Alzheimers biopsy findings

A

Biopsy performed after death

  • Senile plaques (beta amyloid) outside of neurones
  • Neurofibrillary tangles (hyperphosphorylated tau protein aggregations) Inside neurones
199
Q

Hyperthyroidism Symptoms

A

Tremor, Heart rate increase, Yawning, Restless, Oligomenorrhea, Irritability, Diarrhoea, Intolerance to heat, Sweating, Muscle wasting (weight loss) [THYROIDISM]

200
Q

Hyperparathyroid signs

A

Bones, stone, (abdominal) groans, (psychiatric) moans.

Bone pain
Renal stones
Constipation etc
Mood/behaviour changes

201
Q

Hyperparathyroid biochemistry

A

Primary - Raised PTH, raised Ca, low phosphate
Secondary - Raised PTH, low calcium and phosphate
Tertiary - Raised PTH, calcium and phosphate

202
Q

Microcytic anaemias (TAILS)

A 
TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficient
Lead poisoning
Sideroblastic anaemia
203
Q

Normocytic anaemia (AAAHH)

A 
AAAHH
Acute blood loss
Anaemia of chronic disease
Aplastic
Hypothyroidism
Haemolytic (spherocytosis, G6PD deficiency, Sickle cell)
204
Q

Macrocytic anaemia

A

B12 deficiency

Folate deficiency

205
Q

Brown Sequard vs cauda equina

A

BS: Ipsilateral loss of position, light touch and vibration sessions at level of lesion.
Ipsilateral muscle weakness
Contralateral loss 0of pain and temperature below lesion

Cauda equina: Bilateral leg weakness, flaccid, areflexic (LMN signs)

206
Q

Causes of pancreatitis

A 
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune conditions
Scorpion venom
Hyperlipidaemia/calcaemia
ERCP
Drugs (Furosemide, NSAIDs)
207
Q

Vitamin K dependent clotting factors

A

10,9,7,2 (1972)

208
Q

Warfarin MOA

A

Vit K antagonist (clotting factors 10,9,7,2)

209
Q

Signs of pneumothorax

Spontaneous and Tension

A

Spontaneous: Ipsilateral Hyperresonance, ipsilateral reduced breath sounds, cyanosis, tachycardia.

Tension: Ipsilateral hyperextension, ipsilateral reduced breath sounds, contralateral tracheal deviation, hypotension

210
Q

Heparin MOA

A

Binds to antithrombin, increasing its activity.

Inactivates thrombin and factor 10a

211
Q

What can rapid correction of sodium cause?

A

Central pontine myelinolysis - demyelination of nerve cells. When Na+ raised by >10mmol/L in 24 hours.

212
Q

Hypothyroidism signs and symptoms

A

goitre, bradycadia, myoedema, hair loss, weight gain, cold intolerance, lethargy, menorrhagia, oligomenorrhoea

213
Q

Action of PTH

A

Calcium absorption from bone
Kidneys reabsorb more calcium
Kidneys synthesise vit D which causes calcium absorption in GI tract

214
Q

Complications of Acromegaly

A

Cardiomyopathy, heart failure, type 2 diabetes, obstructive sleep apnoea, carpal tunnel syndrome.

Hyperprolactinaemia.

215
Q

Signs/symptoms of acromegaly

A

Bitemporal hemianopia, spade like hands, sweaty palms, large tongue, protruded jaw

216
Q

Prolactinoma S+S

A

Men: Gynaecomastia, erectile dysfunction
Women: Galactorrhoea, amenorrhoea, vaginal dryness, brittle bones (RISK OF FRACTURE)

General: Loss of libido, infertility,

217
Q

RAAS system explained

A

Juxtaglomerular cells in afferent arteriole of kidney sense low BP and release renin. which converts liver secreted angiotensin to angiotensin I which is converted to angiotensin II in lungs using ACE. Angiotensin II causes release of aldosterone which causes sodium reabsorption and potassium and hydrogen excretion, raising BP.

218
Q

What causes secondary hyperaldosteronism

A

When BP is lower in kidneys than in rest of body (renal artery stenosis, obstruction or heart failure), resulting in renin secretion

219
Q

What causes primary hyperaldosteronism

A

Conn’s

Caused by adrenal adenoma releasing aldosterone from zona glomerulosa.

220
Q

Hyperaldosteronism S+S

A

Refractory hypotension, hypokalaemia, hypernatraemia, metabolic alkalosis

Polyuria, nocturia, lethargy, mood disturbance

221
Q

Causes of SIADH

A 
Small cell carcinoma
brain injury
infection
Prostate cancer
pancreatic cancer
lymphoma
222
Q

What does cutting off corticosteroid therapy cause

A

Secondary adrenal insufficiency

223
Q

Hyperkalaemia symptoms

A 
Tachycardia
Paresthesia
Light headedness
Muscle weakness
Diarrhoea/constipation (muscle cramps - e.g. GI)
224
Q

Hypokalaemia symptoms

A 
Hypotonia
Hyporeflexia
Fatigue
Generalised weakness
Light headedness
Palpitations
Constipation
225
Q

Addison’s investigations

A 
SynACTHen test (ACTH stimulation test)
Give ACTH and see if cortisol goes up in 30 then 60 mins. If not, addisons.

Check serum ACTH, if high - addisons
If low, secondary hypoadrenalism

226
Q

Addison’s signs and symptoms

A

Postural hypotension, hyperpigmentation, vitiligo, hair loss.

Tanned, tired, tearful, toned
Hyperpigmentation, fatigue, depression, weight loss

227
Q

Lofgren’s triad

A

Erythema nodosum, bilateral hilar lymphadenopathy, polyarthralgia/pain in more than one joint

Suggest specific type of sarcoidosis

228
Q

AKI Criteria

A

Rise in creatinine > 26 mmol/L in 48 hours
Rise in creatinine >1.5x baseline
Urine output <0.5ml/kg/hour

229
Q

Antibiotics in gonococcal arthritis or gram negative infection

A

Cefotaxime or ceftriaxone

230
Q

Subarachnoid haemorrhage S+S

A 
Thunderclap headache
Nuchal rigidity (neck stiffness)
Face droop
Arm weakness
Speech difficulty
Time
231
Q

Extra articular manifestations of RA

A

Felty’s syndrome (arthritis, neutropenia, splenomegaly)
Anaemia
Secondary amyloidosis

232
Q

Meningitis CSF

A

Bacterial - Cloudy, neutrophils, with proteins and reduced glucose
Viral - Clear, lymphocytes, proteins in CSF
Fungal - cloudy/fibrin web, protein elevated

233
Q

Treatments for Meningitis

A

IM or IV benzylpenicillin if suspected meningococcal
Ciprofloxacin prophylaxis for contacts

Dexamethasone to reduce inflammation

Antiviral - aciclovir

Supportive

234
Q

Investigations for Meningitis

A

lumbar puncture and CSF analysis
Blood culture
Glasgow consciousness scale - intubate if <8
CT head to check for damage, haemorrhage or tumor

235
Q

Side effects of Epilepsy treatment

A

Focal Carbamazepine - Agranulocytosis, aplastic anaemia

Sodium valproate - Teratogen, liver damage, hair loss
Ethosuximide - Night terrors, rash

236
Q

Triggers of migraine

A 
CHeese
Oral contraceptive pill
Caffeine
Alcohol
Anxiety
Travel
Exercise

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