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SBA tips Flashcards

1
Q

In an SBA what is ‘Dominant V (c or v) waves’ usually indicating?

A

Tricuspid Regurgitation

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2
Q

In an SBA what is ‘Dominant A waves’ usually indicating?

A

Tricuspid Stenosis or Pulmonary Hypertension

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3
Q

In an SBA what is ‘Prominent x descent + Prominent y descent’ usually indicating?

A

Constrictive Pericarditis

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4
Q

In an SBA what is ‘Prominent x descent + Absent y descent’ usually indicating?

A

Cardiac Tamponade

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5
Q

In an SBA on chest pain what is ‘sweating, nausea and vomiting’ is usually indicating?

A

Myocardial Infarction

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6
Q

In an SBA what is ‘72hours post MI’ usually indicating?

A

VSD

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7
Q

In an SBA what is ‘mid-diastolic click’ usually indicating?

A

Mitral Valve prolapse.

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8
Q

In an SBA what is ‘continous murmur through systole and diastole’ or ‘machinery murmur’ usually indicating?

A

Patent Ductus Arterious

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9
Q

In an SBA what would be linked with ‘inferior MI’

A

Bradycardia

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10
Q

In an SBA what is ‘diffuse apex beat’ usually indicating?

A

Left Ventricular Aneurysm

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11
Q

In an SBA what is ‘Ballooned apex’ usually indicating?

A

Takotsubo’s cardiomyopathy

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12
Q

What are the 6 A’s in Ankylosing Spondylitis?

A 
AV node block
Aortic regurgitation
Apical Fibrosis
AA amyloidosis
Achilles Tendonitis
Anterior Uveitis
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13
Q

What is neoplasm causes sclerotic bone lesions

A

Prostate Metastatic disease

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14
Q

What are the 5 main causes of massive splenomegaly?

A 
Chronic Myeloid leukaemia
Malaria
Leishmaniasis
Myelofibrosis
Gaucher's dIsease (Lysosomal storage disease)
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15
Q

What are the three pathognomic signs of cushings?

A

Rapid weight gain (Striae)
Proximal myopathy
Increased ease of bruising

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16
Q

What are some causes of a high anion gap metabolic acidosis?

A

MUDPILES

Methanol
Uraemia
Diabetic ketoacidosis
Phenytoin, paracetamol OD, Paraldehyde
Iron, isoniazid, inborn errors of metabolism
Lactic Acidosis
Ethanol (Alcoholic ketoacidosis/lactic acidosis), Ethylene glycol
Salicylates(Aspirin)
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17
Q

What is gradual swelling of the knee implying?

A

Meniscal Tear

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18
Q

What is rapid swelling of the knee implying?

A

ACL PCL tear

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19
Q

What comprises the modified Glasgow score for pancreatitis severity?

A

PANCREAS

PaO2 less than 8kPa
AGE over 55
Neutrophilia WBC over 15
Calcium less than 2
Renal function urea over 15
Enzymes LDH over 600 AST over 200
Albumin less than 32
Sugar glucose over 10
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20
Q

Describe Dukes classification of colorectal cancer

A

Dukes A - Tumour confined to mucosa (90% 5yr-survival)
Dukes B - Tumour invading bowel wall (70%)
Dukes C - Lymph node metastases (45%)
Dukes D - Distant Metastases (6%-20%if resectable)

B and C can be further classified into 1 + 2 depending on if the tumour invades the wall partially or through it into the subserosal fat

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21
Q

In an SBA contradicting O2 sats and PaO2 is indicative of what cause?

A

Carbon monoxide poisoning

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22
Q

In an SBA the pathological change ‘alveolar hyaline membrane formation’ is indicative of what cause?

A

Acute Respiratory Distress syndrome

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23
Q

Sclerodermal renal crisis is associated with which autoantibody most commonly?

A

Anti-RNA polymerase III

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24
Q

In an SBA ‘Owl’s eye inclusion bodies’ on a histology report is indicative of what cause?

A

Cytomegalovirus

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25
In an SBA an 'ejection systolic murmur heard loudest over the scapula' is indicative of what cause?
Coarctation of the aorta
26
In an SBA on renal biopsy 'nodular gomerulosclerosis' is indicative of what cause?
Diabetic nephropathy
27
What are the antibodies Anti-GD1a and anti-GD3 associated with?
Rare form of Guillian-barre acute motor axonal neuropathy
28
What is Anti-GM1 associated with?
Post campylobacter jejune infection e.g. In Guillian-barre syndrome
29
What is anti-GQ1B associated with?
Miller-Fisher syndrome a variant of Guillian-barre characterised by the triad of ataxia, opthalmoplegia, and areflexia
30
Which gene is affected in Familial Adenomatous Polypsosis?
APC
31
Which gene is affected in Heriditary Non-polyposis Colorectal Cancer?
MSH2
32
What are the signs of hypothyroidism?
``` BRADYCARDIC Reflexes relax slowly Ataxia (cerebellar) Dry thin hair/skin Yawning/drowsy/coma Cold hands, hypothermia Ascites +/- non-pitting oedema +/-pericardial/pleural effusion Round puffy face, double chin, obese Defeated demeanour Immobile +/- Ileus CCF also neuropathy, myopathy, goitre. ```
33
What is the CURB-65 score?
``` 1 point for each: Confusion (AMTS less than or equal to 8) Urea ( over 7) RR over 30 BP systolic under 90mmhg or diastolic under 60mmHg 65 age ``` 0-1 home management possible 2 hospital therapy 3 or more severe pneumonia ITU indicated Associated Mortality 1 3 15 20 40 60
34
Describe Lights criteria in context of pleural effusion
Pleural Protein less than 25g/l = Transudate Pleural Protein over 35g/L = exudate Pleural protein 25-35g/L = Lights Criteria Lights Criteria: 1 of the following indicates Exudate - pleural fluid protein to Serum protein ratio over 0.5 - pleural LDH to Serum LDH ratio over 0.6 - pleural LDH is 2/3 over serum upper value of normal - serum albumin-pleural albumin is less than 1.2g/dL
35
What are the causes of hypoglycaemia?
EXPLAIN ``` EXogenous drugs e.g. Insulin, hypoglycaemic Pituitary insuffiency Liver failure Addison's disease Insulinoma Non-pancreatic neoplasms ```
36
What are the red flag symptoms in dyspepsia?
ALARM Symptoms ``` Anaemia (iron-deficiency) Loss of weight Anorexia Rapid onset/progressive symptoms Malaena/haematemesis Swallowing difficulty ```
37
What is the ABCD2 Score?
Post TIA stroke predictor score ``` Age over 60 (1point) Blood pressure over 140/90 (1point) Clinical Features -unilateral weakness (2 points) -speech disturbance without weakness (1 point) Duration of symptoms -symptoms over 1hr (2 points) -symptoms 10-59mins (1 point) Diabetes (1 point) ``` 4 or more require assessment by specialist within 24hr And all other must be seen within 7 days
38
What are the signs of Delirum?
DELIRIUM ``` Disordered thinking Euphoric, fearful, depressed or angry Language impaired Illusions/delusions/hallucinations Reversal of sleep-awake cycle Inattention Unaware/disorientated Memory deficits ```
39
What are the side-effects of sodium valproate?
``` VALPROATE Appetite increase (weight gain) Liver failure (monitor LFTs) Pancreatitis Reversible hair loss Oedema Ataxia Teratogenicity, Tremor, Thrombocytopaenia Encephalopathy (hyperammonaemia) ```
40
What are the features of cerebellar syndrome?
DASHING ``` Dysdiadochokinesis and Demetria (past-pointing) Ataxia Slurred Stoccato speech Hypotonia Intention tremor Nystagmus Gait abnormality (wide based) ```
41
What are the causes of mononeuritis multiplex?
WARDS PLC ``` Wegners (Granulmatosis with polyangitis) AIDs/Amyloidosis Rheumatoid Diabetes Sarcoidosis ``` Polyarteritis nodosa Leprosy Carcinomatosis
42
What are the causes of carpal tunnel syndrome?
MEDIAN TRAPS ``` Myxoedema (hypothyroidism) Enforced flexion (e.g. Colles' splint) Diabetic neuropathy Idiopathic Acromegaly Neoplasms e.g. Myeloma ``` ``` Tumours benign e.g. Lipoma, neurofibromata Rheumatoid arthritis Amyloidosis Pregnancy/premenstrual oedema Sarcoidosis ```
43
What are the X-ray features of osteoarthritis?
Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts
44
What are the X-ray features of RA?
Loss of joint space Osteopaenia (juxta-articulate) Soft-tissue swelling Erosions
45
What are the features of limited cutaneous systemic sclerosis?
CREST syndrome ``` Calcinosis Raynauds Esophageal and gut dysmotility Sclerodactyly Telangiectasia ```
46
What are the diagnostic criteria for melanoma?
ABCDE ``` Asymmetry Border - irregular Colour - non-uniform Diameter over 7mm Elevation, evolving ```
47
What are the causes of acute pancreatitis?
GET SMASHED ``` Gallstones Ethanol Trauma Steroids Mumps Autoimmune (PAN) Scorpion venom Hypertriglyceridaemia, hypothermia, hypercalcaemia ERCP Drugs ```
48
What are the symptoms of acute limb ischaemia?
``` Pale Pulseless Painful Perishingly cold Paraesthetic Paralysed ```
49
What are the features of hypocalcaemia?
SPASMODIC Spasms carpopedal (trousseau's sign) Perioral paraesthesia Anxious/irritable/irrational Seizures Muscle tone increased in smooth muscle hence colic wheeze and dysphagia Orientation impaired and confusion Dermatatitis Impetigo Herpetiformis (hypocalcaemia and pustules in pregnancy) Chovsteks sigg, choreoathetosis, cataract, cardiomyopathy ((long QT)
50
What are the risk factors for osteoporosis?
SHATTERED Steroid use Hyperthyroidism, hyperparathyroidism, hypercalciuria Alcohol and tobacco use Thin BMI under 22 Testestorone low e.g. Antiandrogen in prostate cancer Early menopause Renal or liver failure Erosive/inflammatory bone disease (myeloma/RA) Dietary calcium low, malabsorption, type 1 diabetes.
51
What are the causes of upper lobe fibrosis?
``` Berylliosis, siliocosis (pneuoconiosis) Radiation Extrinsic allergic alveolitis Ankylosing spondylitis Sarcoidosis Tuberculosis ```
52
What are the causes of lower lobe fibrosis?
RA/SLE connective tissues disease Asbestosis Idiopathic Drugs e.g. Amiodarone, nitrofuratoin, bleomycin, methotrexate
53
What are the histological features of asthma?
Curschmann's spirals (whirls of shed respiratory epithelium that form within mucous plugs seen in sputum of patients with asthma) Charcot-Leyden crystals granules produced by eosinophils.
54
In an SBA histoligical feature 'red and grey hepatisation' is indicative of what cause?
Pneumonia
55
Which drugs are contraindicated in Raynaud's?
Beta-blockers
56
What are the features of Multiple Endocrine Neoplasia type 1?
3 P's Parathyroid, Pituitary, Pancreas (e.g. Insulinoma, gastrinoma) most common presentation is Hypercalcaemia
57
What are the features of Multiple Endocrine Neoplasia type 2a?
Medullary Thyroid Cancer | 2 P's Parathyroid, Phaemochromocytoma
58
What are the features of Multiple Endocrine Neoplasia type 2b?
Medullary thyroid cancer 1 P phaeochromocytoma Marfinoid body habitus Neuromas
59
What are some causes of dupuytren's contracture?
Manual labour Phenytoin treatment Alcoholic liver disease Trauma to hand
60
Describe the salter Harris classification of physical fractures.
SALTER ``` Type 1 - S - Straight across Type 2 - A - Above Type 3 - L - Lower or beLow Type 4 - T - Two or Through Type 5 - ER - ERasure of the growth plate or cRush ```
61
What are the causes of Dysphagia?
Mechanical (Solids before liquids): - Malignant stricture e.g. Oesophageal, gastric, pharyngeal cancer - Benign stricture e.g. Oesophageal web, peptic stricture - extrinsic pressure e.g. Lung cancer, mediastinal lymph nodes, retrosternal gotire, aortic aneurysm, left atrial enlargement - pharyngeal pouch Motility (Solids and liquids): - achalasia - diffuse oesophageal spasm - systemic sclerosis - neurological e.g. Bulbar/pseudobulbar palsy, wilson's Parkinson's, syringobulbia, Chagas' disease, myasthenia gravis
62
What is the most likely finding on echocardiogram in a patient with HOCM?
Asymmetric septal enlargement.
63
Which antibodies are associated with Autoimmune Hepatitis type 1?
Anti-smooth muscle
64
Which autoantibodies are most associated with Autoimmune Hepatitis type 2?
Anti Liver/Kidney Microsomal type I (Anti-LKM1)
65
Which autoantibodies are most associated with polymyositis?
Anti-Jo1
66
Which autoantibodies are most commonly associated with Primary Biliary Cirrhosis?
Anti-mitochondrial
67
In an SBA histology findings 'multiple areas of cystic degeneration, fibrous stroma, numerous giant cell' is indicative of which cause?
Describes Brown tumour aka osteitis fibrosa Cystic a rare but well-recognised complication of longstanding primary hyperparathyroidism.
68
In an SBA histological findings 'basophilic intracellular vacuoles' on muscle biopsy is indicative of what cause?
Inclusion body myositis
69
What are the paraneoplastic associations of Squamous cell lung carcinoma?
PTH
70
What are the paraneoplastic associations of small cell lung carcinoma?
ACTH, LEMS, SIADH
71
In an SBA 'String of beads' appearance on CT angiogram is indicative of what cause?
Fibromuscular Dysplasia
72
Which leads and coronary artery correspond to the anterolateral anatomical location?
I, aVL, V4-V6 Left main stem
73
Which leads and coronary artery correspond to the anteroseptal anatomical location?
V1-V4 Left anterior descending
74
Which leads and coronary artery correspond to the inferior anatomical location
II,III, aVF Right coronary
75
Which leads and coronary artery correspond to the lateral anatomical location?
I, aVL +/- V5-V6 Left circumflex.
76
Which leads and coronary artery correspond to the posterior anatomical location?
Tall R waves in V1 + V2 + horizontal ST depression | Usually left circumflex but can be right coronary.
77
In an SBA 'non-caseating granuloma' on lung biopsy is indicative of which cause?
Sarcoidosis
78
In an SBA 'panacinar emphysema' on lung biopsy is indicative of which cause?
Alpha-1 antitrypsin deficiency.
79
What are the histological findings in Lewy body dementia?
Cytoplasmic aggregations of alpha-synuclein
80
What histological findings are associated with MND?
Cytoplasmic TDP-43 is associated with hereditary and non-heriditary motor neuron disease Cytoplasmic SOD1 is asscoatied with hereditary forms of motor neuron disease.
81
What histological findings are associated with Alzheimer's disease?
Aggregation of cytoplasmic tau protein and extra cellular beta-Amyloid plaques.
82
What are the classical features in Normal Pressure Hydrocephalus?
Triad of: Gait disturbance Urinary Incontinence Dementia
83
What are the symptoms of lithium toxicity?
CARD CASH ``` Collapse Anorexia Renal failure D+V Coarse tremor Ataxia (Cerebellar signs) Sleepy/Drowsiness Hypokalaemia ```
84
What are the differentials for anterior mediastinal mass?
5 T's ``` Thymus Teratoma Thoracic Aortic Anuerysm Thyroid Terrible Lymphadenopathy ```
85
In an SBA 'mozzarella and tomato' appearance of fundoscopy is indicative of which cause?
CMV Retinitis
86
What are the major causes of high-output heart failure?
BS TAPS ``` Beriberi (Vitamin B1/Thiamine deficiency) Severe chronic anaemia Thyrotoxicosis AV fistula and AV malformation Paget's disease Septicaemia ```
87
In an SBA 'magenta-coloured acid-schiff positive macrophages' is indicative of what cause?
Whipple's disease
88
What are the main causes of dilated cardiomyopathy?
Vascular e.g. HTN Inflammatory/Infectious e.g. Post-myocarditis, Chagas' disease Metabolic: Beriberi (Vitamin B1 defiency), thyrotoxicosis Inherited/idiopathic e.g. Muscular dystrophy, Haemochromatosis Drugs: Alcohol Doxorubicin
89
What are some causes of SIADH?
Vascular: Stroke, SAH Inflammatory/infectious: Meningoencephalitis, Abscess, TB, pneumonia, aspergillosis, HIV Trauma: Head injury, neurosurgery, Abdominal surgery Autoimmune: SLE, GBS Metabolic: hypothyroidism Inherited: Acute intermittent porphyria Neoplastic e.g. Lung small cell, pancreas, prostate, thymus, lymphoma Drugs e.g. Sulfonylureas, SSRIs, tricyclics, carbamazepine, vincristine, cyclophosphamide.
90
What are the post-operative complications of surgery?
Can be categorised into general and specific. General: - from anaesthesia e.g. Respiratory depression, atelectasis, anaphylaxis, difficult intubation, aspiration - from surgery in general e.g. Wound infection, haemorrhage, neurovascular damage, DVT/PE, cardiac compromise Specific to the procedure: e.g. Failure, local nerves, regional pain
91
What are the causes of nephrogenic diabetes inspidus?
PC DIM ``` Post-obstructive Uropathy CKD Drugs e.g. Lithium Demeclocycline Inherited e.g. AVPR2 mutation Metabolic e.g. Hypokalaemia, hypercalcaemia ```
92
What are the causes of cranial diabetes insipidus?
Vascular e.g. Intracranial Haemorrhage Infection/Inflammatory e.g. Sarcoidosis, histiocytosis, Meningoencephalitis Trauma e.g. Hypophysectomy or neurosurgery Autoimmune e.g. Autoimmune hypophysitis Metabolic e.g. Thyroiditis Idiopathic/inherited e.g. Idiopathic, Defects in ADH gene (DIDMOAD aka wolframs) Neoplastic e.g. Craniopharyngioma, mets, pituitary tumour
93
What are the complications of stomas?
Early: - Haemorrhage - stoma ischaemia (progresses to dusky grey to black) - high output (can lead to hypokalaemia consider loperamide +/- codeine to thicken output) - Obstruction secondary to adhesions - Stoma retraction Delayed: - Obstruction - dermatitis - stoma prolapse - stomal intusseception - stenosis - parastomal hernia - fistulae - psychological problems.
94
What are the four clinical patterns of Motor neuron disease?
Amyotrophic lateral sclerosis Progressive bulbar palsy Progressive muscular atrophy Primary lateral sclerosis
95
What are the features and causes of IIIrd CN palsy?
Features: Ptosis, dilated pupil, eye down and out Causes: - Medical (pupil sparing) e.g. Diabetes, HTN, GCA, Syphilis, Idiopathic - Surgical (early pupil involvement) e.g. Posterior communicating artery aneurysm, raised ICP, tumours.
96
What are the features and causes of a spastic hemiparesis?
Features: Unilateral increased tone, reduced power, brisk reflexes, upgoing plantar. Causes: Stroke, SOL, MS.
97
What are the features and causes of a IVth CN palsy?
Features: Unilateral Abducted eye inability to adduct, diplopia on look down and in (noticed on descending stairs) Causes: -Trauma
98
What are the features and causes of a sensory-motor peripheral neuropathy?
Features: Normal tone, reduced power bilaterally distal more than proximal, reduced reflexes, reduced sensation in length-dependent distribution Causes: ABCDE - Alochol - B12/Folate deficiency - CKD - Diabetes - Everything else e.g. Vasculitis, HIV
99
Describe the features and causes of cerebellar syndrome?
Features: DANISH - Dysdiadochokinesis - Ataxia wide based gait - Nystagmus - Intention tremor with past pointing - slurred stoccato speech - Hypotonia Causes: PASTRIES - Posterior fossa tumour - Alcohol - Sclerosis (Multiple) - Trauma - Rare e.g. Lithium - Inherited e.g. Friedrich's ataxia - Epilepsy medications e.g. Phenytoin, carbamazepine - Stroke
100
What are the features and causes of a motor peripheral neuropathy?
Features: Normal tone, reduced power bilaterally distal more than proximal, reduced reflexes, bilateral foot drop/wrist drop. Causes: - Guillian-Barre - Chronic Inflammatory Demyelinating Polyneuropathy - Lead-poisoning - Charcot-Marie-Tooth
101
Describe the features and causes of lateral medullary syndrome?
Features: Unilateral cerebellar syndrome, reduce pain sensation, Horner's , contralateral limb sensory loss. Causes: Stroke, Harmorrhage
102
What are the features and causes of a spastic paraparesis?
Features: Increased tone bilaterally, reduced power bilaterally, brisk reflexes. Causes: - Demyelination e.g. MS - Cord Compression: Trauma, tumour - Parasagittal meningioma - Tropical spastic paraparesis - Transverse myelitis e.g. HIV - Syringomyelia - Hereditary spastic paraplegia - Osteoarthritis of the cervical spine
103
What are the features and causes of a UMN 7th CN palsy?
Features: Unilateral facial droop with preserved facial markings, unilateral weakness, normal sensation, normal hearing. Causes: Stroke, Haemorrhage, MS
104
What are the features and causes of Parkinsonism?
Features: Increased tone bilaterally with evidence of synkinesis. Asymmetrical resting tremor made worse with distraction. Bradykinesia, festinating gait with reduced arm swing. ``` Causes: Idiopathic Parkinson's Parkinson's plus Drugs Vascular Parkinson's ```
105
What are the features and causes of a VIth CN palsy?
Features: Unilateral adducted unable to abduct eye. Causes: Stroke, Raised ICP, MS
106
What are the features and causes of a Vth, VIIth, VIIIth CN palsy?
Features: unilateral sided facial droop with preserved forehead markings, unilateral sided facial weakness, reduced facial pain sensation, reduced hearing Causes: Cerebellopontine angle tumour e.g. Acoustic neuroma Stroke, haemorrhage.
107
What are the causes of a mixed UMN and LMN lesion?
Fred's Tabby Cat Seeks Mice ``` Friedrich's Atacia Tabes Dorsalis Cervical spondylosis Subacute degeneration of the cord MND ```
108
What are the features and causes of a LMN VIIth CN palsy?
Features: Unilateral facial drop with reduced forehead markings, unilateral facial weakness, normal sensation and hearing. Causes: - Bells Palsy - Parotid neoplasm - Infection VZV/Lyme - Guilliam Barre.
109
What are some causes of an acute single episode headache?
- With Meningism e.g. meningitis, encephalitis, SAH - Head injury - Venous sinus thrombosis - sinusitis - tropical illness - low pressure headache - acute glaucoma
110
What are the causes of recurrent acute headaches?
- Migraine - Cluster headaches - Trigeminal neuralgia - Recurrent (Mollarets) Meningtitis
111
What are some causes of chronic headache?
- tension headache - raised ICP - Medication-overuse headache
112
What are some causes of seizures?
Vascular e.g. AV Malformation, stroke Infection/Inflammatory e.g. Cortical Scarring, Sarcoidosis, PAN Trauma e.g. Haemorrhage. Autoimmune e.g. SLE, Autoimmune encephalitis Metabolic e.g. Hypoxia, Hypo/Hypernatraemia, Hyper/Hypoglycaemia, Hypocalcaemia, Hyperuraemia. Idiopathic/Inherited e.g. Idiopathic (60%), Pseudoseizures, Tuberous sclerosis Neoplastic e.g. SOL, raised ICP Drugs e.g. Alcohol/ BZD withdrawal
113
What are some causes of nystagmus?
Horizontal: maybe peripheral (vestibular) or Cental (Cerebellar) If it occurs more in eye abducting cause may be MS (?INO), also deafness and tinnitus may point to peripheral cause. Vertical: Upbeat nystagmus, classically occur sin lesions of midbrain, and downbeat nystagmus occurs in foramen magnum lesion.
114
What are the features and causes of bulbar palsy?
Features: Flaccid, fasciculations tongue, jaw jerk absent or normal, speech is quiet or nasally, gag reflex is absent Causes: MND, Syringobulbia, Guillain-Barre, poliomyelitis, central pontine myelinolysis, brainstem tumours, myasthenia gravis.
115
What are the features and causes of pseudobulbar palsy?
Features: Increased tone, slow tongue movements, increased jaw jerk, increased gag reflex, Donald Duck speech, pseudobulbar affect causing weeping unprovoked or sudden giggling Causes: Bilateral CVAs of internal capsule, MS, MND, high brainstem tumours, head injury
116
What are the causes of lobar collapse?
Bronchiogenic tumour Mucous plug Foreign body Hilar lymph nodes.
117
What are the Ottawa ankle rules?
X-ray patients if: - unable to weight-bear immediately after and during examination - tenderness over the posterior aspect of the distal 6cm of the lateral or medial malleolus - tenderness over the navicular, calcaneum, or base of 5th metatarsal Have lower threshold for young, elderly or intoxicated patients
118
What are the causes of CKD?
Causes: - Diabetes (20%) - hypertension or renovascular disease - glomerulonephritis (commonly IgA nephropathy also SLE, Vasculitis) - Unknown - reflux nephropathy - inherited disorders e.g. ADPKD, alports, Fabrys.
119
What features on fundoscopy would you expect to find in hypertensive retinopathy?
Hard Exudates Cotton wool spots Flame haemorrhages Papilloedema
120
In an SBA 'Fibrinoid necrosis' is a histological trademark of what cause?
Malignant Hypertension
121
What are the causes or QT prolongation?
- Drugs e.g. Amiodarone, TCA's, many antibiotics, fluconazole, erythromycin, metoclopramide, quinidine, haloperidol, droperidol, methadone, ondansetron, SSRI's - Genetic due to cardiac ion channel mutations e.g. Romano-ward - myocardial disease e.g. MI, RF, Complete heart block, cardiomyopathy, - Metabolic e.g. hypocalcaemia, hypokalaemia, hypomagnesaemia
122
What are the Beta-blockers used in Heart failure?
My Cardiac Blockers Metoprolol Carvedilol Bisoprolol
123
In an SBA 'HLA B27' is indicative of what cause?
Seronegative Arthropathy
124
In an SBA 'HLA B51' is indicative of what cause?
Behcets
125
In an SBA 'HLA DQ2/DQ8' are indicative of what cause?
Coeliacs
126
In an SBA 'HLA DR4/DR8' is indicative of what cause?
T1DM
127
What are the diagnostic features of SLE?
MD SOAP BRAIN ``` Malar rash Discoid Rash Serositis - pleurisy, pericarditis Oral ulcer - usually painless Arthritis - nonerosive Photosensitivity Blood disorders e.g. Leukopenia, lymphopenia, thrombocytopenia, haemolytic anaemia Renal involvement ANA +ve Immune markers e.g. DsDNA Anti-smith Neurological disorder e.g. Seizures, or psychosis ```
128
Which autoantibody is associated with anti-phospholipid syndrome?
Anti-cardiolipin.
129
What are the causes of lymphadenopathy?
Reactive or infiltrative Reactive: - Infective e.g. Bacterial (pyogenic, TB, Brucella, syphillis), Viral (EBV, HIV, CMV, Hepatitis), Others Chagas' toxoplasmsosis - non-infective e.g. Sarcoidosis, amyloidosis, berylliosis, connective tissue disease (RA, SLE) dermatological e.g. Eczema, psoriasis, drugs (phenytoin) Infiltrative: - Benign: histiocytosis castlemans - Malignant: lymphoma, leukaemia, metastatic spread.
130
What are the causes of clubbing?
Resp: Bronchiogenic carcinoma, emphysema, abscess, bronchiectasis, cystic fibrosis, fibrosis, mesothelioma, TB GI: MILC, Malapbsorption e.g. Coeliacs, IBD, GI lymphoma, Cirrhosis Cardiac: Cyanotic congenital heart disease, endocarditis, atrial myxoma, aneurysm, infected grafts Rare: Thyroid acropachy, familial
131
What are the chief non-GI causes of vomiting?
ABCDEFGHI ``` AKI, addisons Brain Raised ICP Cardiac MI DKA Ears (labyrinthitis, menieres) Foreign substances (alcohol, drugs e.g. Opiates) Gravidity (hyperemesis gradivdarum) Hypercalcaemia/hyponatraemia Infection e.g. UTI, meningitis. ```
132
What are the causes of hepatomegaly?
Malignancy: Metastatic or primary (usually craggy irregular edge) Hepatic congestion: Right heart failure, may be pulsatile in tricuspid regurgitation. Hepatic vein thrombosis (Budd-chiari syndrome) Anatomical: Riedal's lobe (normal varient), cyst Infection: infective mononucleosis, hepatitis, malaria, schistosomiasis, amoebic abscess Haematological: Leukaemia, lymphoma, myeloproliferative (myelofibrosis) sickle-cell, haemolytic anaemia Others: Fatty liver, porphyria, amyloidosis, glycogen storage disease.
133
What are the causes of bilateral Hilar lymphadenopathy?
Sarcoidosis Infection e.g. TB Malignancy e.g. Lymphoma, carcinoma, mediastinal tumours Organic dust disease e.g. Silicosis, berylliosis Extrinsic allergic alevolitis Histocytotosis
134
What are the cause of goitre?
Diffuse vs nodular Diffuse: physiological, Graves, Hashimoto's thyroiditis, subacute dequervains thyroiditis (painful) Nodular: multinodular goitre, adenoma, carcinoma
135
What are the causes of gastritis?
``` Alcohol NSAIDs H.Pylori Hiatus hernia Atrophic gastritis Granulomas (sarcoid, crohns) CMV Zollinger-Ellison syndrome Menetriers disease ```
136
What are the causes of cirrhosis?
Chronic alcohol abuse Chronic HBC or HCV Haemochromatosis/ wilsons, alpha-antitrypsin deficiency Hepatic vein thrombosis (budd-chiari) Non-alcoholic steatohepatitis Autoimmune: PBC, PSC, Autoimmune hepatitis Drugs e.g. Amiodarone methyldopa, methotrexate
137
Which autoantibodies are associated with Autoimmune Hepatitis type 3?
Soluble liver antigen (SLA) or Liver-pancreas antigen (LPA)
138
What are the causes of bone pain?
``` Trauma/Fracture Myeloma and other primaries e.g. Sarcoma Secondaries e.g. Breast, lung, prostate Osteonecrosis Osteomyelitis Hydatid cyst Osteosclerosis e.g. From Hepatitis C Paget's disease Sickle cell anaemia Renal Osteodystrophy CREST syndrome, sjrogrens Hyperparathyroidism ```
139
What are the nerve roots supply the main muscle groups of the Upper limb?
Shoulder: - Abduction = C5 - Adduction = C5-C7 Elbow: - Flexion = C5,C6 - Extension = C7 Wrist: - Flexion = C7 C8 - Extension = C7 Fingers: - Flexion = C8 - Extension = C7 - Adduction = T1
140
What are the nerve roots supply the main muscle groups of the lower limb?
Hip: - Flexion = L1,L2 - Extension = L5,S1 - Adduction = L2,L3 Knee: - Flexion = L5,S1 - Extension = L3,L4 Ankle: - Plantarflexion = S1, S2 - Dorsiflexion = L4 - Eversion = L5, S1 Big Toe: -Extension = L5
141
What are the red flags for back pain?
``` Age less than 20 or over 55 Acute onset in elderly Constant or progressive pain Nocturnal pain Worse pain on being supine Fever, night sweats, weight loss History or malignancy Abdominal mass Thoracic back pain Morning stiffness Bilateral or alternating leg pain Neurological disturbance Sphincter disturbance Current or recent infection Immunosuppresion Leg calculation or exercise related leg weakness. ```
142
What are the causes of a right iliac fossa mass?
``` Appendix mass/abscess Caecal carcinoma Crohn's disease Pelvic mass Intussception TB mass Amoebic mass Actinomycosis Transplanted kidney Kidney malformation Tumour in an undescended testes ```
143
What are the causes of a pelvic mass?
Foetus Fibroids Bladder Ovarian cysts
144
What are the causes of ascites?
``` Malignancy Infection e.g. TB CCF or pericarditis Nephrotic syndrome Hypothyroidism Pancreatitis Cirrhosis Budd-chiari ```
145
What are the causes of hepatosplenomegaly?
``` Infection e.g. Hepatitis, EBV Amyloidosis Malignancy Sickle-cell Leukaemia Leishmaniasis Paraproteinaemia CML Gaucher's syndrome Portal hypertension ```
146
What are the causes of splenomegaly with fever?
``` Hepatitis EBV Malaria TB CMV HIV Sarcoidosis Malignancy ```
147
What are the cause of splenomegaly with lymphadenopathy?
Glandular fever Leukaemia/lymphoma Sjrogren's syndrome
148
What are the causes of splenomegaly with purpura?
Septicaemia, typhoid DIC, Amyloid Meningococcaemia
149
What are the causes of splenomegaly with arthritis?
Sjogren syndrome RA, SLE Infection e.g. Lyme Vasculitis/ behcets
150
What are the causes of splenomegaly with ascites?
Carcinoma Portal hypertension P
151
What are the causes of splenomegaly with a murmur?
Infective endocarditis Rheumatic fever Hypereosiniphilia Amyloid
152
What are the causes of splenomegaly with anaemia?
``` Sickle-cell Thalassaemia Leishmaniasis Leukaemia Pernicious anemia ```
153
What are the causes of splenomegaly with weight loss and CNS signs?
Cancer/ lymphoma TB arsenic poisoning Paraproteinaemia
154
What are the causes of rectal bleeding?
``` Diverticulitis Colorectal cancer Haemorrhoids Crohn's/UC Perianal disease Angiodysplasia Ischaemic colitis Variceal bleeds ```
155
What is they formula for calculated plasma osmalility?
2(Na + K) + Ur + Glu
156
What is the formula for creatinine clearance?
CrCL = F x (140-Age) x Weight/Creatinine Where F = 1.04 if female and 1.23 in males
157
In an SBA 'Subtotal villous atrophy and intraepithelial lymphocytes' is indicative of what cause?
Coeliac disease
158
What is the management of Extended Spectrum Beta Lacatamase Bacterium?
Carbopenems or Colistin (Polymyxin antibiotic)
159
In an SBA ' Ground glass hepatocytes' is indicative of what causes?
HBV
160
In an SBA 'Smudge Cells' are indicative of what cause?
CLL
161
In an SBA 'Atypical lymphocytes' is indicative of what cause?
EBV/Glandular fever
162
What is the management of patient found to be MRSA positive?
Nose swab +ve = mupirocin 2% in white soft paraffin TDS 5days Skin swab +ve = chlorhexidine gluconate OD 5days Active infection: Vancomycin, teicoplanin, linezolid Isolation will be neccesary
163
What are some side-effects of common DMARDs?
- Methotrexate e.g. pneumonitis, oral ulcers, hepatotoxicity - Sulfasalazine e.g. Rash, oligospermia, oral ulcers - Hydroxychloroquine e.g. Irreversible retinopathy - Leflunomide e.g. Teratogencity (in mailers and females) , oral ulcers, hypertension, hepatoxicity
164
What are the some side-effects of biological agents?
- Serious infection - TB and hepatitis B Reactivation - worsening Heart failure - hypersensitivity - blood disorders
165
What is triple therapy for H.pylori?
Omeprazole Clarithromycin Amoxicillin
166
What is the Rutherford classification of PAD?
Stage 0 - Asymptomatic Stage 1 - Mild claudication more than 200m Stage 2 - Moderate claudication less than 200m Stage 3 - Severe Claudication less than 50m Stage 4 - rest pain Stage 5 - Ischaemic ulceration not exceeding ulcer of the digits of the foot Stage 6 - severe ischaemic ulcers or frank gangrene.
167
What are the grades of hypertensive retinopathy?
Grade 1: Tortuous arteries with thick shiny walls (silver or copper wiring) Grade 2: A-V nipping (narrowing where arteries cross veins) Grade 3: Flame haemorrhages and cotton-wool spots Grade 4: Papilloedema
168
What are the grades of diabetic retinopathy?
- Non-proliferate diabetic retinopathy e.g. Signs include micro aneurysms, blot haemorrhages, hard exudates (yellow patches), engorged tortuous veins, cotton wool spots, large blot haemorrhages (the late 3 are signs of significant ischaemia) - preproliferative diabetic retinopathy e.g. Venous beading, venous loops, multiple deep round blot haemorrhages. - proliferative diabetic retinopathy e.g. Fine new vessels appear on the optic disc, retina and can cause vitreous haemorrhage - maculopathy e.g. Leakage of vessels close to macula cause oedema and can significantly threaten vision
169
What is the management of warfarin in the context of major bleeding?
Stop warfarin Give IV Vitamin K 5mg Prothrombin complex concentrate (if unavailable then FFP)
170
What is the management of warfarin in the context of INR over 8 and minor bleeding?
Stop Warfarin IV Vitamin K 1-3mg Repeat IV if INR still too high at 24hrs Restart warfarin when INR less than 5
171
What is the management of warfarin in the context of INR over 8 and no bleeding?
Stop warfarin Give Vitamin K 1-5mg PO using intravenous prep Repeat dose of Vitamin K if INR still too high at 24hrs Restart when INR less than 5
172
What is the management of warfarin in the context of INR 5-8 and minor bleeding?
Stop Warfarin IV Vitamin K 1-3mg Restart when INR less than 5
173
What is the management of warfarin when INR is 5-8 and no bleeding
Withhold 1-2 doses of warfarin | Reduce subsequent maintenance dose.
174
What are the causes of warm autoimmune haemolytic anaemia?
``` Idiopathic CLL Lymphoma SLE RA (unique) Drugs e.g. Methyldopa (unique) ```
175
What are the causes of cold autoimmune haemolytic anaemia?
``` Idiopathic CLL Lymphoma EBV (unique) Mycoplasma pneumoniae (unique) HIV (unique) SLE ```
176
Which conditions are most associated with Thyroid Peroxidase antibodies?
``` Hashimoto's Thyroiditis (90%) Graves Disease (75%) ```
177
Which conditions are most associated with Thyroglobulin antibodies?
Thyroid Cancer | Hashimoto's Thyroiditis
178
Which condition are most associated with Thyroid stimulating hormone receptor antibodies?
Graves' disease.
179
What are the boundaries of Hesselbach's triangle?
Medial: Rectus Abdominus Lateral: Inferior epigastric vessels Inferior: Inguinal ligament Hernias occurring within the triangle tend to be direct, and those outside indirect
180
What is the recommended antibiotic for exacerbations of chronic bronchitis?
Amoxicillin or Tetracycline or Clarithromycin
181
What is the recommended treatment for Uncomplicated Community Acquired Pneumonia?
Amoxicillin | Doxycycline or clarithomycin if pen-allergic (add flucloxacillin is staphylococci is suspected e.g. Infleunza)
182
What is the recommended treatment for Pneumonia possibly caused by atypical pathogens?
Clarithromycin
183
What is the recommended treatment for Hospital Acquired Pneumonia?
Within 5 days of admission: Co-Amoxiclav or Cefuroxime More than 5 days after admission: Piperacillin with tazobactam (Tazocin) OR a broad-spectrum cephalosporin e.g. Ceftazidime OR a quinolone e.g. Ciprofloxacin
184
What is the recommended treatment of Lower Urinary tract infection?
Trimethoprim or Nitrofurantoin Alternatively Amoxicillin or Cephalosporin
185
What is the recommended treatment of Acute pyelonephritis?
Broad-spectrum cephalosporin e.g. Ceftazidime or Quinolone e.g. Ciprofloxacin
186
What is the recommended treatment of Acute prostatis?
Quinolone or Trimethoprim
187
What is the recommended management of Impetigo?
Topical Fusidic acid | Oral flucloxacillin or Erythromycin if wide spread.
188
What is the recommended treatment of cellulitis?
Flucloxacillin | Clarithromycin of Clindamycin if pen-allergic
189
What is the recommended treatment of Erysipelas?
Phenoxymethypenicillin | Erythromycin if pen-allergic
190
What is the recommended treatment of animal or human bite?
Co-Amoxiclav | Doxycycline + Metronidazole if pen-allergic
191
What is the recommended treatment of mastitis during breast-feeding?
Flucloxacillin
192
What is the recommended treatment of throat infections?
Phenoxymethylpenicillin | Erythromycin alone if pen-allergic
193
What is the recommended treatment of sinusitis?
Amoxicillin OR doxycycline OR erythromycin
194
What is the recommended treatment of otitis media?
Amoxicillin | Erythromycin if pen-allergic
195
What is the recommended treatment of otitis externa
Flucloxacillin | Erythromycin if pen-allergic
196
What is the recommended treatment for a periodontal abscess?
Amoxicillin
197
What is the recommended treatment for acute necrotising Gingivitis?
Metronidazole
198
What is the recommended treatment of Gonorrhoea?
Intramuscular Ceftriaxone and Oral azithromycin
199
What is the recommended treatment of Chlamydia?
Doxycycline or Azithromycin
200
What is the recommended treatment of pelvic inflammatory disease?
Oral Ofloxacin + Oral Metronidazole OR IM Ceftriaxone and oral doxycycline and oral metronidazole
201
What is the recommended treatment of syphilis?
Benzathine benzypenicilin OR doxycycline OR Erythromycin
202
What is the recommended treatment of Bacterial Vaginosis?
Oral or Topical Metronidazole OR topical Clindamycin
203
What is the recommended treatment for Clostridium Difficle?
First Episode: Metronidazole | Second or subsequent infection: Vancomycin
204
What is the recommended treatment of campylobacter enteritis?
Clarithromycin
205
What is the recommended treatment of salmonella?
Ciprofloxacin
206
What is the recommended management of Shigellosis?
Ciprofloxacin
207
What is are the characteristic side-effects of Amoxicillin?
Rash with infectious mononucleosis
208
What are the characteristic side-effects of Co-Amoxiclav?
Cholestatis
209
What are the characteristic side-effects of Flucloxaciilin
Cholestasis
210
What are the characteristic side effects of erythromycin?
GI upset | Prolongs QT interval
211
What are the characteristic side-effects of ciprofloxacin?
Lower seizure threshold | Tendonitis
212
What are the characteristic side-effects of Metronidazole?
Disulfiram-like reaction following alcohol ingestion.
213
What are the characteristic side-effects of doxycycline?
Photosensitivity
214
What are the characteristic side-effects of trimethoprim?
Rashes including photosensitivity Pruritus Suppression haematopoiesis
215
What are some important history questions to ask a patient with Chest pain?
- SOCRATES - Shortness of breath, Palpitations, Orthopnoea, Paroxysmal nocturnal dyspnoea, Haemoptysis, Sputum production, Calf swelling/pain - Nausea, fever, weight loss, pain, sweating - VTE risk factors recent surgery, long haul flights, foreign travel, previous VTE, family history of clotting
216
In an SBA 'Hill-Sachs lesion' is indicative of what cause?
A posterolateral humeral head compression fracture typically secondary to recurrent Anterior shoulder dislocation, as the humeral head comes to rest against the anteroinferior part of the glenoid.
217
What are the approximate incubation periods for common causes of Gastroenteritis?
1-6hrs: Staph Aureus, Bacillus Cereus 12-48hrs: Salmonella, E.coli 48-72hrs: Shigella, campylobacter Over 7days: Giardiasis, amoebiasis
218
What are some drugs that may exacerbate myasthenia gravis?
``` Penicillamine Quinidine, procainamide Beta-blockers Lithium Phenytoin Antibiotics e.g. Gentamicin, macrolides, quinolones, tetracyclines. ```
219
What are some causes of post-operative pyrexia?
Early e.g. 0-5days - blood transfusion - cellulitis - UTI - Physiological systemic reaction (usually within a day) - Pulmonary atelectasis Late e.g. Over 5 days - VTE - Pneumonia - Wound infection - Anastomotic leak
220
What are the causes of a white-out lesion with the trachea pulled toward the white out?
Pneumonectomy Total lung collapse e.g. Endobronchial intubation Pulmonary hypoplasia
221
What are the causes of a white-out lesion with a central trachea?
Consolidation Pulmonary oedema (usually bilateral) Mesothelioma
222
What are the causes of a white out lesion with the trachea pushed away from lesion?
Pleural effusion Diaphragmatic hernia Large thoracic mass.
223
What are the criteria for LTOT in COPD?
ABG PaO2 less than 7.3 on two occasions at least 3 weeks apart. Or PaO2 7.3-8 and one of the following: - secondary polycythaemia - Nocturnal hypoxaemia - Peripheral oedema - Pulmonary hypertension
224
What are the side-effects of isotretinoin?
``` Teratogenicity Low mood Dry eyes and lips Nose bleeds (dry nose) Raised triglycerides Hair thinning ```
225
In an SBA ' c-myc gene transolcation' is indicative of what cause?
Burkitt's lymphoma
226
What is the most common inherited thrombophilia?
Factor V Leiden
227
What are the monitoring requirements of Statins?
LFTs at baseline, 3 months and 12 months
228
What are the monitoring requirements of ACE inhibitors?
U+E prior to treatment, after increasing dose and annually.
229
What are the monitoring requirements of Amiodarone?
TFT LFT U+E CXR prior to treatment TFT LFT every 6 months
230
What are the monitoring requirements of Methotrexate?
FBC U+E and LFT before treatment, weekly until stabilised and 2-3 months there after
231
What are the monitoring parameters of Azathioprine?
FBC, LFT before treatment FBC weekly for first 4 weeks FBC and LFT every 4 months
232
What are the main monitoring parameters of Lithium?
TFT, U+E before treatment Lithium levels weekly until stabilised then every 3 months TFT, U+E every 6 months
233
What are the main monitoring parameters for Sodium Valproate?
LFT FBC before treatment and LFT periodically during first 6 months
234
What are the monitoring parameters of Glitazones?
LFT before treatment and 'regularly' during treatment
235
Which chromosome is typically affected in Neurofibromatosis type 1?
Chromosome 17
236
Which chromosome is typically affected in Neurofibromatosis type 2?
Chromosome 22
237
Which chromosome is typically affected in Von-hippel lindau?
Chromosome 3
238
Which chromosome is typically affected in tuberous sclerosis?
Chromosome 16
239
Which chromosome is typically affected in adult polycystic kidney disease type 1?
Chromosome 16
240
What are the main live vaccines?
MMR BOY V Measles, Mumps, Rubella, BCG, Oral polio, Yellow fever, Varicella
241
What is the frequency of Fluid therapy in DKA?
``` 1L NS over 1hr 1L NS over 2hr 1L NS over 2hr 1L NS over 4hr 1L NS over 4hr 1L NS over 6hr ``` +/- Potassium (over 5.5 nil, 3.5-5.5 20mmol, less than 3.5 40mmol)
242
What are the Acute Phase Proteins?
``` CRP Procalcitonin Ferritin Fibrinogen Alpha-1 Antitrypsin Caeruloplasmin Serum Amyloid A Serum Amyloid P component Haptoglobin Complement ``` Negative phase proteins include Albumin, Transferrin, Retinal/cortisol binding protein
243
What are the causes of Intravascular Haemolysis?
``` Mismatched blood transfusion G6PD deficiency Red cell fragmentation e.g. Heart valves, TTP, DIC, HUS Paroxysmal Nocturnal Haemoglobinuria Cold autoimmune haemolytic anaemia ```
244
What are the causes of Extravascular haemolysis?
- Haemoglobinopathies e.g. Sickle Cell, thalassaemia - Hereditary spherocytosis - Haemolytic disease of newborn - Warm autoimmune haemolytic anaemia
245
What is the stereotypical history of E. coli Gastroenteritis?
Common amongst travellers Watery stools Abdominal cramps and nausea
246
What is the stereotypical history of Giardiasis?
Prolonged, non bloody diarrhoea
247
What is the stereotypical history of Cholera?
Profuse rice-water diarrhoea Severe dehydration resulting in weight loss Not common amongst travellers
248
What is the stereotypical history of Shigella?
Blood diarrhoea | Vomiting and abdominal pain
249
What is the stereotypical history of Staph Aureus gastroenteritis?
Severe vomiting | Short incubation period
250
What is the stereotypical history of Campylobacter Gastroenteritis?
A flu-like prodome is usually followed by crampy abdominal pains, fever, and diarrhoea which may be bloody, complications include Guillian-Barre syndrome
251
What is the stereotypical history of Bacillus Cereus Gastroenteritis?
Two types of illness are seen - Vomiting within 6 hours, usually due to rice - Diarrhoeal illness occuring after 6 hours.
252
What are the causes of a Canon A wave?
Complete Heart Block | Ventricular Tachycardia
253
What are the main molecular biology techniques?
SNOW DROP South North West blotting DNA, RNA, Protein Also ELISA detects antibodies and antigens e.g. Initial HIV test Western blotting is example of confirmatory HIV test.
254
What is the toxic metabolite of paracetamol?
N-Acetyl-B-benzoquinone imine it forms covalent bonds with cell proteins, denaturing them and leading to cell death. Which is conjugated by Glutathione into non-toxic mercapturic acid. N-acetyl Cysteine is a precursor of glutathione
255
Describe Gell and Coombs Type 1 Hypersensitivity reaction and gives some examples.
Type 1 - Anaphylactic Mechanism - Antigen reacts with IgE bound to mast cells Examples: Anaphylaxis, Asthma, Hay fever, Eczema
256
Describe Gell and Coombs type II hypersensitivity reaction and give some examples
Type II - Cell bound Mechanism - IgG or IgM binds to antigen on cell surface. Examples - autoimmune haemolytic anaemia, ITP, Goodpastures, pernicious anaemia, acute haemolytic transfusion reactions, rheumatic fever, pemphigus vulgaris, bullous pemphigoid
257
Describe Gell and Coombs Type III hypersensitivity reaction and give some examples
Type III - Immune complex Mechanism - Free antigen and antibody (IgG, IgA) combine Examples - serum sickness, SLE, Post-streptococcal glomerulonephritis, Extrinsic allergic alveolitis
258
Describe Gell and Coombs Type IV hypersensitivity reaction and give some examples.
Type IV - Delayed hypersensitivity Mechanism - T-cell mediated Examples - Tuberculosis, Tuberculin skin reaction, Graft vs host disease, allergic contact dermatitis, scabies, Extrinsic allergic alveolitis (chronic phase) Multiple sclerosis, Guillian-Barre syndrome.
259
Describe Gell and Coombs Type V hypersensitivity reaction and give some examples.
Type V Mechanism - Antibodies that recognise and bind to the cell surface receptors, either stimulating or blocking ligand binding Examples - Graves' disease, Myasthenia Gravis
260
What are Gell and Coombs classifications of hypersensitivity?
Type I - Anaphylatic Type II - Cell Bound Type III - Immune Complex Type IV - Delayed Hypersensitivity Type V
261
Which condition is associated with HLA-A3?
Haemochromatosis
262
Which condition is associated with HLA-B5?
Behcet's Disease
263
Which condition is associated with HLA-B27?
Ankylosing Spondylitis Reiter's syndrome Acute anterior uveitis
264
Which condition is associated with HLA-DQ2/DQ8?
Coeliac disease
265
Which condition is associated with HLA-DR2?
Narcolepsy | Goodpasture's syndrome
266
Which condition is associated with HLA-DR3?
Dermatitis herpetiformis Sjögren's syndrome Primary billary cirrhosis
267
Which condition is associated with HLA-DR4?
T1DM | RA
268
What antibodies are responsible for bullous pemphigoid?
Antibodies against hemidesmosomal proteins BP180 and BP230
269
Which antibodies are involved in pemphigus vulgaris?
Antibodies against desmoglein-3 ( a Cadherin-type epithelial cell adhesion molecule)
270
What is the significance of C1q, C1rs, C2, C4 deficiency?
Classical pathway components, deficiency predisposes to immune complex disease e.g. SLE, Henoch-Schonlein Purpura
271
What is the significance of C3 defiency?
A complement defiency leading to recurrent bacterial infections.
272
What is the significance of C5 deficiency?
A complement deficiency that predisposes to Leiner disease, also causes recurrent diarrhoea, wasting and seborrhoeic dermatitis.
273
What is the significance of C5-9 deficiency?
A complement deficiency, the complement encodes the membrane attack complex (MAC) making patients particularly prone to Neisseria Meningitidis infection
274
What are the main causes of Gingival Hyperplasia?
Drugs causes e.g. Phenytoin, Ciclosporin, Calcium Channel blockers (especially nifedipine) Other e.g. Acute myeloid leukaemia (Myelomonocytic and monocytic types)
275
What are the main Classifications of bacteria and some examples?
Gram Positive Cocci: Staph + Strep + Entero Gram Negative Cocci: Neisseria meningitides, Neisseria gonorrhoea, Moraxella Gram Positive Rods: ABCD L Actinomyces, Bacillus Anthracis, Clostridium, Diphtheria, Listeria Monocytogenes. Remaining are Gram negative rods.
276
What are the causes of Renal Papillary Necrosis?
Causes (POSTCARDS): - Pyelonephritis - Obstruction - Sickle Cell Disease - Tuberculosis - Cirrhosis - Analgesic abuse - Renal Vein Thrombosis - Diabetes - Systemic Vaculitidies
277
What is a drug cause of acquired haemophilia A?
Phenytoin
278
Whats the main difference between IgG and IgM?
IgG is a chronic antibody that allows immunity over time IgM is an acute phase antibody
279
What type of genetic disorder is Hereditary hypophosphataemic rickets?
X-Linked Dominant

Medicine (30 decks)

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