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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
Q

In an SBA an ‘ejection systolic murmur heard loudest over the scapula’ is indicative of what cause?

A

Coarctation of the aorta

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26
Q

In an SBA on renal biopsy ‘nodular gomerulosclerosis’ is indicative of what cause?

A

Diabetic nephropathy

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27
Q

What are the antibodies Anti-GD1a and anti-GD3 associated with?

A

Rare form of Guillian-barre acute motor axonal neuropathy

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28
Q

What is Anti-GM1 associated with?

A

Post campylobacter jejune infection e.g. In Guillian-barre syndrome

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29
Q

What is anti-GQ1B associated with?

A

Miller-Fisher syndrome a variant of Guillian-barre characterised by the triad of ataxia, opthalmoplegia, and areflexia

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30
Q

Which gene is affected in Familial Adenomatous Polypsosis?

A

APC

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31
Q

Which gene is affected in Heriditary Non-polyposis Colorectal Cancer?

A

MSH2

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32
Q

What are the signs of hypothyroidism?

A 
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.
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33
Q

What is the CURB-65 score?

A 
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

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34
Q

Describe Lights criteria in context of pleural effusion

A

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
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35
Q

What are the causes of hypoglycaemia?

A

EXPLAIN

EXogenous drugs e.g. Insulin, hypoglycaemic
Pituitary insuffiency
Liver failure
Addison's disease
Insulinoma
Non-pancreatic neoplasms
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36
Q

What are the red flag symptoms in dyspepsia?

A

ALARM Symptoms

Anaemia (iron-deficiency)
Loss of weight
Anorexia
Rapid onset/progressive symptoms
Malaena/haematemesis
Swallowing difficulty
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37
Q

What is the ABCD2 Score?

A

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

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38
Q

What are the signs of Delirum?

A

DELIRIUM

Disordered thinking
Euphoric, fearful, depressed or angry
Language impaired
Illusions/delusions/hallucinations
Reversal of sleep-awake cycle
Inattention
Unaware/disorientated
Memory deficits
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39
Q

What are the side-effects of sodium valproate?

A 
VALPROATE
Appetite increase (weight gain)
Liver failure (monitor LFTs)
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Teratogenicity, Tremor, Thrombocytopaenia
Encephalopathy (hyperammonaemia)
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40
Q

What are the features of cerebellar syndrome?

A

DASHING

Dysdiadochokinesis and Demetria (past-pointing)
Ataxia
Slurred Stoccato speech
Hypotonia
Intention tremor
Nystagmus
Gait abnormality (wide based)
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41
Q

What are the causes of mononeuritis multiplex?

A

WARDS PLC

Wegners (Granulmatosis with polyangitis)
AIDs/Amyloidosis
Rheumatoid
Diabetes
Sarcoidosis

Polyarteritis nodosa
Leprosy
Carcinomatosis

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42
Q

What are the causes of carpal tunnel syndrome?

A

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
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43
Q

What are the X-ray features of osteoarthritis?

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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44
Q

What are the X-ray features of RA?

A

Loss of joint space
Osteopaenia (juxta-articulate)
Soft-tissue swelling
Erosions

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45
Q

What are the features of limited cutaneous systemic sclerosis?

A

CREST syndrome

Calcinosis
Raynauds
Esophageal and gut dysmotility
Sclerodactyly
Telangiectasia
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46
Q

What are the diagnostic criteria for melanoma?

A

ABCDE

Asymmetry 
Border - irregular
Colour - non-uniform
Diameter over 7mm
Elevation, evolving
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47
Q

What are the causes of acute pancreatitis?

A

GET SMASHED

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune (PAN)
Scorpion venom
Hypertriglyceridaemia, hypothermia, hypercalcaemia
ERCP
Drugs
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48
Q

What are the symptoms of acute limb ischaemia?

A 
Pale
Pulseless
Painful
Perishingly cold
Paraesthetic
Paralysed
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49
Q

What are the features of hypocalcaemia?

A

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)

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50
Q

What are the risk factors for osteoporosis?

A

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.

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51
Q

What are the causes of upper lobe fibrosis?

A 
Berylliosis, siliocosis (pneuoconiosis)
Radiation
Extrinsic allergic alveolitis
Ankylosing spondylitis
Sarcoidosis
Tuberculosis
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52
Q

What are the causes of lower lobe fibrosis?

A

RA/SLE connective tissues disease
Asbestosis
Idiopathic
Drugs e.g. Amiodarone, nitrofuratoin, bleomycin, methotrexate

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53
Q

What are the histological features of asthma?

A

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.

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54
Q

In an SBA histoligical feature ‘red and grey hepatisation’ is indicative of what cause?

A

Pneumonia

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55
Q

Which drugs are contraindicated in Raynaud’s?

A

Beta-blockers

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56
Q

What are the features of Multiple Endocrine Neoplasia type 1?

A

3 P’s Parathyroid, Pituitary, Pancreas (e.g. Insulinoma, gastrinoma) most common presentation is Hypercalcaemia

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57
Q

What are the features of Multiple Endocrine Neoplasia type 2a?

A

Medullary Thyroid Cancer

2 P’s Parathyroid, Phaemochromocytoma

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58
Q

What are the features of Multiple Endocrine Neoplasia type 2b?

A

Medullary thyroid cancer
1 P phaeochromocytoma
Marfinoid body habitus
Neuromas

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59
Q

What are some causes of dupuytren’s contracture?

A

Manual labour
Phenytoin treatment
Alcoholic liver disease
Trauma to hand

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60
Q

Describe the salter Harris classification of physical fractures.

A

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
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61
Q

What are the causes of Dysphagia?

A

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
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62
Q

What is the most likely finding on echocardiogram in a patient with HOCM?

A

Asymmetric septal enlargement.

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63
Q

Which antibodies are associated with Autoimmune Hepatitis type 1?

A

Anti-smooth muscle

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64
Q

Which autoantibodies are most associated with Autoimmune Hepatitis type 2?

A

Anti Liver/Kidney Microsomal type I (Anti-LKM1)

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65
Q

Which autoantibodies are most associated with polymyositis?

A

Anti-Jo1

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66
Q

Which autoantibodies are most commonly associated with Primary Biliary Cirrhosis?

A

Anti-mitochondrial

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67
Q

In an SBA histology findings ‘multiple areas of cystic degeneration, fibrous stroma, numerous giant cell’ is indicative of which cause?

A

Describes Brown tumour aka osteitis fibrosa Cystic a rare but well-recognised complication of longstanding primary hyperparathyroidism.

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68
Q

In an SBA histological findings ‘basophilic intracellular vacuoles’ on muscle biopsy is indicative of what cause?

A

Inclusion body myositis

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69
Q

What are the paraneoplastic associations of Squamous cell lung carcinoma?

A

PTH

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70
Q

What are the paraneoplastic associations of small cell lung carcinoma?

A

ACTH, LEMS, SIADH

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71
Q

In an SBA ‘String of beads’ appearance on CT angiogram is indicative of what cause?

A

Fibromuscular Dysplasia

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72
Q

Which leads and coronary artery correspond to the anterolateral anatomical location?

A

I, aVL, V4-V6

Left main stem

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73
Q

Which leads and coronary artery correspond to the anteroseptal anatomical location?

A

V1-V4

Left anterior descending

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74
Q

Which leads and coronary artery correspond to the inferior anatomical location

A

II,III, aVF

Right coronary

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75
Q

Which leads and coronary artery correspond to the lateral anatomical location?

A

I, aVL +/- V5-V6

Left circumflex.

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76
Q

Which leads and coronary artery correspond to the posterior anatomical location?

A

Tall R waves in V1 + V2 + horizontal ST depression

Usually left circumflex but can be right coronary.

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77
Q

In an SBA ‘non-caseating granuloma’ on lung biopsy is indicative of which cause?

A

Sarcoidosis

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78
Q

In an SBA ‘panacinar emphysema’ on lung biopsy is indicative of which cause?

A

Alpha-1 antitrypsin deficiency.

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79
Q

What are the histological findings in Lewy body dementia?

A

Cytoplasmic aggregations of alpha-synuclein

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80
Q

What histological findings are associated with MND?

A

Cytoplasmic TDP-43 is associated with hereditary and non-heriditary motor neuron disease

Cytoplasmic SOD1 is asscoatied with hereditary forms of motor neuron disease.

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81
Q

What histological findings are associated with Alzheimer’s disease?

A

Aggregation of cytoplasmic tau protein and extra cellular beta-Amyloid plaques.

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82
Q

What are the classical features in Normal Pressure Hydrocephalus?

A

Triad of:
Gait disturbance
Urinary Incontinence
Dementia

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83
Q

What are the symptoms of lithium toxicity?

A

CARD CASH

Collapse
Anorexia
Renal failure
D+V
Coarse tremor
Ataxia (Cerebellar signs)
Sleepy/Drowsiness
Hypokalaemia
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84
Q

What are the differentials for anterior mediastinal mass?

A

5 T’s

Thymus
Teratoma
Thoracic Aortic Anuerysm
Thyroid
Terrible Lymphadenopathy
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85
Q

In an SBA ‘mozzarella and tomato’ appearance of fundoscopy is indicative of which cause?

A

CMV Retinitis

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86
Q

What are the major causes of high-output heart failure?

A

BS TAPS

Beriberi (Vitamin B1/Thiamine deficiency)
Severe chronic anaemia
Thyrotoxicosis
AV fistula and AV malformation
Paget's disease
Septicaemia
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87
Q

In an SBA ‘magenta-coloured acid-schiff positive macrophages’ is indicative of what cause?

A

Whipple’s disease

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88
Q

What are the main causes of dilated cardiomyopathy?

A

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

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89
Q

What are some causes of SIADH?

A

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.

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90
Q

What are the post-operative complications of surgery?

A

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

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91
Q

What are the causes of nephrogenic diabetes inspidus?

A

PC DIM

Post-obstructive Uropathy
CKD
Drugs e.g. Lithium Demeclocycline
Inherited e.g. AVPR2 mutation
Metabolic e.g. Hypokalaemia, hypercalcaemia
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92
Q

What are the causes of cranial diabetes insipidus?

A

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

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93
Q

What are the complications of stomas?

A

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.
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94
Q

What are the four clinical patterns of Motor neuron disease?

A

Amyotrophic lateral sclerosis
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis

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95
Q

What are the features and causes of IIIrd CN palsy?

A

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.
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96
Q

What are the features and causes of a spastic hemiparesis?

A

Features: Unilateral increased tone, reduced power, brisk reflexes, upgoing plantar.

Causes: Stroke, SOL, MS.

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97
Q

What are the features and causes of a IVth CN palsy?

A

Features: Unilateral Abducted eye inability to adduct, diplopia on look down and in (noticed on descending stairs)

Causes:
-Trauma

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98
Q

What are the features and causes of a sensory-motor peripheral neuropathy?

A

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
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99
Q

Describe the features and causes of cerebellar syndrome?

A

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
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100
Q

What are the features and causes of a motor peripheral neuropathy?

A

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
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101
Q

Describe the features and causes of lateral medullary syndrome?

A

Features: Unilateral cerebellar syndrome, reduce pain sensation, Horner’s , contralateral limb sensory loss.

Causes: Stroke, Harmorrhage

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102
Q

What are the features and causes of a spastic paraparesis?

A

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
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103
Q

What are the features and causes of a UMN 7th CN palsy?

A

Features: Unilateral facial droop with preserved facial markings, unilateral weakness, normal sensation, normal hearing.

Causes: Stroke, Haemorrhage, MS

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104
Q

What are the features and causes of Parkinsonism?

A

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
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105
Q

What are the features and causes of a VIth CN palsy?

A

Features: Unilateral adducted unable to abduct eye.

Causes: Stroke, Raised ICP, MS

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106
Q

What are the features and causes of a Vth, VIIth, VIIIth CN palsy?

A

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.

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107
Q

What are the causes of a mixed UMN and LMN lesion?

A

Fred’s Tabby Cat Seeks Mice

Friedrich's Atacia
Tabes Dorsalis
Cervical spondylosis
Subacute degeneration of the cord
MND
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108
Q

What are the features and causes of a LMN VIIth CN palsy?

A

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.
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109
Q

What are some causes of an acute single episode headache?

A
  • With Meningism e.g. meningitis, encephalitis, SAH
  • Head injury
  • Venous sinus thrombosis
  • sinusitis
  • tropical illness
  • low pressure headache
  • acute glaucoma
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110
Q

What are the causes of recurrent acute headaches?

A
  • Migraine
  • Cluster headaches
  • Trigeminal neuralgia
  • Recurrent (Mollarets) Meningtitis
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111
Q

What are some causes of chronic headache?

A
  • tension headache
  • raised ICP
  • Medication-overuse headache
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112
Q

What are some causes of seizures?

A

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
Q

What are some causes of nystagmus?

A

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
Q

What are the features and causes of bulbar palsy?

A

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
Q

What are the features and causes of pseudobulbar palsy?

A

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
Q

What are the causes of lobar collapse?

A

Bronchiogenic tumour
Mucous plug
Foreign body
Hilar lymph nodes.

117
Q

What are the Ottawa ankle rules?

A

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
Q

What are the causes of CKD?

A

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
Q

What features on fundoscopy would you expect to find in hypertensive retinopathy?

A

Hard Exudates
Cotton wool spots
Flame haemorrhages
Papilloedema

120
Q

In an SBA ‘Fibrinoid necrosis’ is a histological trademark of what cause?

A

Malignant Hypertension

121
Q

What are the causes or QT prolongation?

A
  • 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
Q

What are the Beta-blockers used in Heart failure?

A

My Cardiac Blockers

Metoprolol
Carvedilol
Bisoprolol

123
Q

In an SBA ‘HLA B27’ is indicative of what cause?

A

Seronegative Arthropathy

124
Q

In an SBA ‘HLA B51’ is indicative of what cause?

125
Q

In an SBA ‘HLA DQ2/DQ8’ are indicative of what cause?

126
Q

In an SBA ‘HLA DR4/DR8’ is indicative of what cause?

127
Q

What are the diagnostic features of SLE?

A

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
Q

Which autoantibody is associated with anti-phospholipid syndrome?

A

Anti-cardiolipin.

129
Q

What are the causes of lymphadenopathy?

A

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
Q

What are the causes of clubbing?

A

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
Q

What are the chief non-GI causes of vomiting?

A

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
Q

What are the causes of hepatomegaly?

A

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
Q

What are the causes of bilateral Hilar lymphadenopathy?

A

Sarcoidosis
Infection e.g. TB
Malignancy e.g. Lymphoma, carcinoma, mediastinal tumours
Organic dust disease e.g. Silicosis, berylliosis
Extrinsic allergic alevolitis
Histocytotosis

134
Q

What are the cause of goitre?

A

Diffuse vs nodular

Diffuse: physiological, Graves, Hashimoto’s thyroiditis, subacute dequervains thyroiditis (painful)

Nodular: multinodular goitre, adenoma, carcinoma

135
Q

What are the causes of gastritis?

A 
Alcohol
NSAIDs
H.Pylori
Hiatus hernia
Atrophic gastritis
Granulomas (sarcoid, crohns)
CMV
Zollinger-Ellison syndrome
Menetriers disease
136
Q

What are the causes of cirrhosis?

A

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
Q

Which autoantibodies are associated with Autoimmune Hepatitis type 3?

A

Soluble liver antigen (SLA) or Liver-pancreas antigen (LPA)

138
Q

What are the causes of bone pain?

A 
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
Q

What are the nerve roots supply the main muscle groups of the Upper limb?

A

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
Q

What are the nerve roots supply the main muscle groups of the lower limb?

A

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
Q

What are the red flags for back pain?

A 
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
Q

What are the causes of a right iliac fossa mass?

A 
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
Q

What are the causes of a pelvic mass?

A

Foetus
Fibroids
Bladder
Ovarian cysts

144
Q

What are the causes of ascites?

A 
Malignancy
Infection e.g. TB
CCF or pericarditis
Nephrotic syndrome
Hypothyroidism
Pancreatitis
Cirrhosis
Budd-chiari
145
Q

What are the causes of hepatosplenomegaly?

A 
Infection e.g. Hepatitis, EBV
Amyloidosis
Malignancy
Sickle-cell
Leukaemia
Leishmaniasis
Paraproteinaemia
CML
Gaucher's syndrome
Portal hypertension
146
Q

What are the causes of splenomegaly with fever?

A 
Hepatitis
EBV
Malaria
TB
CMV
HIV
Sarcoidosis
Malignancy
147
Q

What are the cause of splenomegaly with lymphadenopathy?

A

Glandular fever
Leukaemia/lymphoma
Sjrogren’s syndrome

148
Q

What are the causes of splenomegaly with purpura?

A

Septicaemia, typhoid
DIC, Amyloid
Meningococcaemia

149
Q

What are the causes of splenomegaly with arthritis?

A

Sjogren syndrome
RA, SLE
Infection e.g. Lyme
Vasculitis/ behcets

150
Q

What are the causes of splenomegaly with ascites?

A

Carcinoma
Portal hypertension
P

151
Q

What are the causes of splenomegaly with a murmur?

A

Infective endocarditis
Rheumatic fever
Hypereosiniphilia
Amyloid

152
Q

What are the causes of splenomegaly with anaemia?

A 
Sickle-cell
Thalassaemia
Leishmaniasis
Leukaemia
Pernicious anemia
153
Q

What are the causes of splenomegaly with weight loss and CNS signs?

A

Cancer/ lymphoma
TB arsenic poisoning
Paraproteinaemia

154
Q

What are the causes of rectal bleeding?

A 
Diverticulitis
Colorectal cancer
Haemorrhoids
Crohn's/UC
Perianal disease
Angiodysplasia
Ischaemic colitis
Variceal bleeds
155
Q

What is they formula for calculated plasma osmalility?

A

2(Na + K) + Ur + Glu

156
Q

What is the formula for creatinine clearance?

A

CrCL = F x (140-Age) x Weight/Creatinine

Where F = 1.04 if female and 1.23 in males

157
Q

In an SBA ‘Subtotal villous atrophy and intraepithelial lymphocytes’ is indicative of what cause?

A

Coeliac disease

158
Q

What is the management of Extended Spectrum Beta Lacatamase Bacterium?

A

Carbopenems or Colistin (Polymyxin antibiotic)

159
Q

In an SBA ‘ Ground glass hepatocytes’ is indicative of what causes?

160
Q

In an SBA ‘Smudge Cells’ are indicative of what cause?

161
Q

In an SBA ‘Atypical lymphocytes’ is indicative of what cause?

A

EBV/Glandular fever

162
Q

What is the management of patient found to be MRSA positive?

A

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
Q

What are some side-effects of common DMARDs?

A
  • 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
Q

What are the some side-effects of biological agents?

A
  • Serious infection
  • TB and hepatitis B Reactivation
  • worsening Heart failure
  • hypersensitivity
  • blood disorders
165
Q

What is triple therapy for H.pylori?

A

Omeprazole
Clarithromycin
Amoxicillin

166
Q

What is the Rutherford classification of PAD?

A

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
Q

What are the grades of hypertensive retinopathy?

A

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
Q

What are the grades of diabetic retinopathy?

A
  • 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
Q

What is the management of warfarin in the context of major bleeding?

A

Stop warfarin
Give IV Vitamin K 5mg
Prothrombin complex concentrate (if unavailable then FFP)

170
Q

What is the management of warfarin in the context of INR over 8 and minor bleeding?

A

Stop Warfarin
IV Vitamin K 1-3mg
Repeat IV if INR still too high at 24hrs
Restart warfarin when INR less than 5

171
Q

What is the management of warfarin in the context of INR over 8 and no bleeding?

A

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
Q

What is the management of warfarin in the context of INR 5-8 and minor bleeding?

A

Stop Warfarin
IV Vitamin K 1-3mg
Restart when INR less than 5

173
Q

What is the management of warfarin when INR is 5-8 and no bleeding

A

Withhold 1-2 doses of warfarin

Reduce subsequent maintenance dose.

174
Q

What are the causes of warm autoimmune haemolytic anaemia?

A 
Idiopathic
CLL
Lymphoma
SLE
RA (unique)
Drugs e.g. Methyldopa (unique)
175
Q

What are the causes of cold autoimmune haemolytic anaemia?

A 
Idiopathic
CLL
Lymphoma
EBV (unique)
Mycoplasma pneumoniae (unique)
HIV (unique)
SLE
176
Q

Which conditions are most associated with Thyroid Peroxidase antibodies?

A 
Hashimoto's Thyroiditis (90%)
Graves Disease (75%)
177
Q

Which conditions are most associated with Thyroglobulin antibodies?

A

Thyroid Cancer

Hashimoto’s Thyroiditis

178
Q

Which condition are most associated with Thyroid stimulating hormone receptor antibodies?

A

Graves’ disease.

179
Q

What are the boundaries of Hesselbach’s triangle?

A

Medial: Rectus Abdominus
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament

Hernias occurring within the triangle tend to be direct, and those outside indirect

180
Q

What is the recommended antibiotic for exacerbations of chronic bronchitis?

A

Amoxicillin or Tetracycline or Clarithromycin

181
Q

What is the recommended treatment for Uncomplicated Community Acquired Pneumonia?

A

Amoxicillin

Doxycycline or clarithomycin if pen-allergic
(add flucloxacillin is staphylococci is suspected e.g. Infleunza)

182
Q

What is the recommended treatment for Pneumonia possibly caused by atypical pathogens?

A

Clarithromycin

183
Q

What is the recommended treatment for Hospital Acquired Pneumonia?

A

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
Q

What is the recommended treatment of Lower Urinary tract infection?

A

Trimethoprim or Nitrofurantoin

Alternatively Amoxicillin or Cephalosporin

185
Q

What is the recommended treatment of Acute pyelonephritis?

A

Broad-spectrum cephalosporin e.g. Ceftazidime or Quinolone e.g. Ciprofloxacin

186
Q

What is the recommended treatment of Acute prostatis?

A

Quinolone or Trimethoprim

187
Q

What is the recommended management of Impetigo?

A

Topical Fusidic acid

Oral flucloxacillin or Erythromycin if wide spread.

188
Q

What is the recommended treatment of cellulitis?

A

Flucloxacillin

Clarithromycin of Clindamycin if pen-allergic

189
Q

What is the recommended treatment of Erysipelas?

A

Phenoxymethypenicillin

Erythromycin if pen-allergic

190
Q

What is the recommended treatment of animal or human bite?

A

Co-Amoxiclav

Doxycycline + Metronidazole if pen-allergic

191
Q

What is the recommended treatment of mastitis during breast-feeding?

A

Flucloxacillin

192
Q

What is the recommended treatment of throat infections?

A

Phenoxymethylpenicillin

Erythromycin alone if pen-allergic

193
Q

What is the recommended treatment of sinusitis?

A

Amoxicillin OR doxycycline OR erythromycin

194
Q

What is the recommended treatment of otitis media?

A

Amoxicillin

Erythromycin if pen-allergic

195
Q

What is the recommended treatment of otitis externa

A

Flucloxacillin

Erythromycin if pen-allergic

196
Q

What is the recommended treatment for a periodontal abscess?

A

Amoxicillin

197
Q

What is the recommended treatment for acute necrotising Gingivitis?

A

Metronidazole

198
Q

What is the recommended treatment of Gonorrhoea?

A

Intramuscular Ceftriaxone and Oral azithromycin

199
Q

What is the recommended treatment of Chlamydia?

A

Doxycycline or Azithromycin

200
Q

What is the recommended treatment of pelvic inflammatory disease?

A

Oral Ofloxacin + Oral Metronidazole OR IM Ceftriaxone and oral doxycycline and oral metronidazole

201
Q

What is the recommended treatment of syphilis?

A

Benzathine benzypenicilin OR doxycycline OR Erythromycin

202
Q

What is the recommended treatment of Bacterial Vaginosis?

A

Oral or Topical Metronidazole OR topical Clindamycin

203
Q

What is the recommended treatment for Clostridium Difficle?

A

First Episode: Metronidazole

Second or subsequent infection: Vancomycin

204
Q

What is the recommended treatment of campylobacter enteritis?

A

Clarithromycin

205
Q

What is the recommended treatment of salmonella?

A

Ciprofloxacin

206
Q

What is the recommended management of Shigellosis?

A

Ciprofloxacin

207
Q

What is are the characteristic side-effects of Amoxicillin?

A

Rash with infectious mononucleosis

208
Q

What are the characteristic side-effects of Co-Amoxiclav?

A

Cholestatis

209
Q

What are the characteristic side-effects of Flucloxaciilin

A

Cholestasis

210
Q

What are the characteristic side effects of erythromycin?

A

GI upset

Prolongs QT interval

211
Q

What are the characteristic side-effects of ciprofloxacin?

A

Lower seizure threshold

Tendonitis

212
Q

What are the characteristic side-effects of Metronidazole?

A

Disulfiram-like reaction following alcohol ingestion.

213
Q

What are the characteristic side-effects of doxycycline?

A

Photosensitivity

214
Q

What are the characteristic side-effects of trimethoprim?

A

Rashes including photosensitivity
Pruritus
Suppression haematopoiesis

215
Q

What are some important history questions to ask a patient with Chest pain?

A
  • 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
Q

In an SBA ‘Hill-Sachs lesion’ is indicative of what cause?

A

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
Q

What are the approximate incubation periods for common causes of Gastroenteritis?

A

1-6hrs: Staph Aureus, Bacillus Cereus
12-48hrs: Salmonella, E.coli
48-72hrs: Shigella, campylobacter
Over 7days: Giardiasis, amoebiasis

218
Q

What are some drugs that may exacerbate myasthenia gravis?

A 
Penicillamine
Quinidine, procainamide
Beta-blockers
Lithium
Phenytoin
Antibiotics e.g. Gentamicin, macrolides, quinolones, tetracyclines.
219
Q

What are some causes of post-operative pyrexia?

A

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
Q

What are the causes of a white-out lesion with the trachea pulled toward the white out?

A

Pneumonectomy
Total lung collapse e.g. Endobronchial intubation
Pulmonary hypoplasia

221
Q

What are the causes of a white-out lesion with a central trachea?

A

Consolidation
Pulmonary oedema (usually bilateral)
Mesothelioma

222
Q

What are the causes of a white out lesion with the trachea pushed away from lesion?

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass.

223
Q

What are the criteria for LTOT in COPD?

A

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
Q

What are the side-effects of isotretinoin?

A 
Teratogenicity
Low mood
Dry eyes and lips
Nose bleeds (dry nose)
Raised triglycerides
Hair thinning
225
Q

In an SBA ‘ c-myc gene transolcation’ is indicative of what cause?

A

Burkitt’s lymphoma

226
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden

227
Q

What are the monitoring requirements of Statins?

A

LFTs at baseline, 3 months and 12 months

228
Q

What are the monitoring requirements of ACE inhibitors?

A

U+E prior to treatment, after increasing dose and annually.

229
Q

What are the monitoring requirements of Amiodarone?

A

TFT LFT U+E CXR prior to treatment

TFT LFT every 6 months

230
Q

What are the monitoring requirements of Methotrexate?

A

FBC U+E and LFT before treatment, weekly until stabilised and 2-3 months there after

231
Q

What are the monitoring parameters of Azathioprine?

A

FBC, LFT before treatment

FBC weekly for first 4 weeks

FBC and LFT every 4 months

232
Q

What are the main monitoring parameters of Lithium?

A

TFT, U+E before treatment

Lithium levels weekly until stabilised then every 3 months

TFT, U+E every 6 months

233
Q

What are the main monitoring parameters for Sodium Valproate?

A

LFT FBC before treatment and LFT periodically during first 6 months

234
Q

What are the monitoring parameters of Glitazones?

A

LFT before treatment and ‘regularly’ during treatment

235
Q

Which chromosome is typically affected in Neurofibromatosis type 1?

A

Chromosome 17

236
Q

Which chromosome is typically affected in Neurofibromatosis type 2?

A

Chromosome 22

237
Q

Which chromosome is typically affected in Von-hippel lindau?

A

Chromosome 3

238
Q

Which chromosome is typically affected in tuberous sclerosis?

A

Chromosome 16

239
Q

Which chromosome is typically affected in adult polycystic kidney disease type 1?

A

Chromosome 16

240
Q

What are the main live vaccines?

A

MMR BOY V

Measles, Mumps, Rubella, BCG, Oral polio, Yellow fever, Varicella

241
Q

What is the frequency of Fluid therapy in DKA?

A 
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
Q

What are the Acute Phase Proteins?

A 
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
Q

What are the causes of Intravascular Haemolysis?

A 
Mismatched blood transfusion
G6PD deficiency
Red cell fragmentation e.g. Heart valves, TTP, DIC, HUS
Paroxysmal Nocturnal Haemoglobinuria
Cold autoimmune haemolytic anaemia
244
Q

What are the causes of Extravascular haemolysis?

A
  • Haemoglobinopathies e.g. Sickle Cell, thalassaemia
  • Hereditary spherocytosis
  • Haemolytic disease of newborn
  • Warm autoimmune haemolytic anaemia
245
Q

What is the stereotypical history of E. coli Gastroenteritis?

A

Common amongst travellers
Watery stools
Abdominal cramps and nausea

246
Q

What is the stereotypical history of Giardiasis?

A

Prolonged, non bloody diarrhoea

247
Q

What is the stereotypical history of Cholera?

A

Profuse rice-water diarrhoea
Severe dehydration resulting in weight loss
Not common amongst travellers

248
Q

What is the stereotypical history of Shigella?

A

Blood diarrhoea

Vomiting and abdominal pain

249
Q

What is the stereotypical history of Staph Aureus gastroenteritis?

A

Severe vomiting

Short incubation period

250
Q

What is the stereotypical history of Campylobacter Gastroenteritis?

A

A flu-like prodome is usually followed by crampy abdominal pains, fever, and diarrhoea which may be bloody, complications include Guillian-Barre syndrome

251
Q

What is the stereotypical history of Bacillus Cereus Gastroenteritis?

A

Two types of illness are seen

  • Vomiting within 6 hours, usually due to rice
  • Diarrhoeal illness occuring after 6 hours.
252
Q

What are the causes of a Canon A wave?

A

Complete Heart Block

Ventricular Tachycardia

253
Q

What are the main molecular biology techniques?

A

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
Q

What is the toxic metabolite of paracetamol?

A

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
Q

Describe Gell and Coombs Type 1 Hypersensitivity reaction and gives some examples.

A

Type 1 - Anaphylactic

Mechanism - Antigen reacts with IgE bound to mast cells

Examples: Anaphylaxis, Asthma, Hay fever, Eczema

256
Q

Describe Gell and Coombs type II hypersensitivity reaction and give some examples

A

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
Q

Describe Gell and Coombs Type III hypersensitivity reaction and give some examples

A

Type III - Immune complex

Mechanism - Free antigen and antibody (IgG, IgA) combine

Examples - serum sickness, SLE, Post-streptococcal glomerulonephritis, Extrinsic allergic alveolitis

258
Q

Describe Gell and Coombs Type IV hypersensitivity reaction and give some examples.

A

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
Q

Describe Gell and Coombs Type V hypersensitivity reaction and give some examples.

A

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
Q

What are Gell and Coombs classifications of hypersensitivity?

A

Type I - Anaphylatic

Type II - Cell Bound

Type III - Immune Complex

Type IV - Delayed Hypersensitivity

Type V

261
Q

Which condition is associated with HLA-A3?

A

Haemochromatosis

262
Q

Which condition is associated with HLA-B5?

A

Behcet’s Disease

263
Q

Which condition is associated with HLA-B27?

A

Ankylosing Spondylitis
Reiter’s syndrome
Acute anterior uveitis

264
Q

Which condition is associated with HLA-DQ2/DQ8?

A

Coeliac disease

265
Q

Which condition is associated with HLA-DR2?

A

Narcolepsy

Goodpasture’s syndrome

266
Q

Which condition is associated with HLA-DR3?

A

Dermatitis herpetiformis
Sjögren’s syndrome
Primary billary cirrhosis

267
Q

Which condition is associated with HLA-DR4?

268
Q

What antibodies are responsible for bullous pemphigoid?

A

Antibodies against hemidesmosomal proteins BP180 and BP230

269
Q

Which antibodies are involved in pemphigus vulgaris?

A

Antibodies against desmoglein-3 ( a Cadherin-type epithelial cell adhesion molecule)

270
Q

What is the significance of C1q, C1rs, C2, C4 deficiency?

A

Classical pathway components, deficiency predisposes to immune complex disease e.g. SLE, Henoch-Schonlein Purpura

271
Q

What is the significance of C3 defiency?

A

A complement defiency leading to recurrent bacterial infections.

272
Q

What is the significance of C5 deficiency?

A

A complement deficiency that predisposes to Leiner disease, also causes recurrent diarrhoea, wasting and seborrhoeic dermatitis.

273
Q

What is the significance of C5-9 deficiency?

A

A complement deficiency, the complement encodes the membrane attack complex (MAC) making patients particularly prone to Neisseria Meningitidis infection

274
Q

What are the main causes of Gingival Hyperplasia?

A

Drugs causes e.g. Phenytoin, Ciclosporin, Calcium Channel blockers (especially nifedipine)

Other e.g. Acute myeloid leukaemia (Myelomonocytic and monocytic types)

275
Q

What are the main Classifications of bacteria and some examples?

A

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
Q

What are the causes of Renal Papillary Necrosis?

A

Causes (POSTCARDS):

  • Pyelonephritis
  • Obstruction
  • Sickle Cell Disease
  • Tuberculosis
  • Cirrhosis
  • Analgesic abuse
  • Renal Vein Thrombosis
  • Diabetes
  • Systemic Vaculitidies
277
Q

What is a drug cause of acquired haemophilia A?

278
Q

Whats the main difference between IgG and IgM?

A

IgG is a chronic antibody that allows immunity over time

IgM is an acute phase antibody

279
Q

What type of genetic disorder is Hereditary hypophosphataemic rickets?

A

X-Linked Dominant

Medicine (30 decks)

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