Study Group Rapid Fire Flashcards
1
Q
When should you consider withdrawing antiepileptic medication?
*counsel patients they may never be seizure free
A
At 2-4 years with seizure free
Slow titration over 2-3 months, 6 months for BZDs
2
Q
There is a patient on two antiepileptics. How would you approach weaning?
A
Taper one at a time (never together)
3
Q
Which anti epileptic has the longest half life?
A
Brabituates (followed by BZD)
4
Q
What is the pathogenesis behind epilepsy?
A
Large numbers of neurons with prolonged depolarisation (repetitive firing)
5
Q
Describe the difference between a focal and generalised seizure
A
- focal - one hemisphere
- generalised - both
6
Q
What is the seizure type associated with aura?
A
Usually focal
7
Q
True or false - incontinence is specific for seizures
A
False
- urinary incontinence occurs, not specific, more common with syncope
- faecal incontinence very rare
8
Q
List 4 causes of provoked seizures
A
- acute precipitant
- metabolic
- trauma
*consider AED if risk of having ongoing seizures
9
Q
A 12 year old, with normal development is noted to be starting for a few seconds in class. What is the best treatment?
A
10
Q
A 16 year old girl is noted to have mycolonic jerks around 5am. She has a fake ID and drinks alcohol on the weekend and because she is studying, gets poor sleep during the weeknights. What Ix findings do you expect and what is the treatment?
A
Juvinelle myoclonic epilepsy
- 3 Hz spike/pokyspike discharges
- valproate (1st), lamotrigine, zonisamide
- usually life long treatment
11
Q
A 80 year old man has recurrent encephalitis. He describes an aura where he can see the future and has automatic lip movements. What would you expect on his MRI?
A
Mesial temporal lobe epilepsy with hippocampal sclerosis
- hippocampal atrophy and T2 signal increase
12
Q
Why do we tend to treat epilepsy after the second seizure?
A
- risk of 70% of further seizures after a 2nd one
13
Q
List two AEDs that should be avoided in the elderly
A
- carbemazepine
- lamotrigine
14
Q
Why should sodium valproate be avoided in children?
A
Can cause liver toxicity in children with mitochondrial disorders
15
Q
When would you refer a patient for surgery if they had epilepsy?
A
- trial of 2 AEDs unsuccessfully
16
Q
What drug is lowered with contraception
A
Lamotrigine (all other drugs lead to clearance of hormonal contraception)
17
Q
What is the best tolerated AEDs in pregnancy?
A
- lamotrigene
- carbemazipine
18
Q
What is the seizure that tends to occur at night?
A
19
Q
In terms of post ictal psychosis, when does it occur in epilepsy?
A
Occurs 12-72 hours AFTER a seizure
20
Q
Match the drug to its mechanism of action
1. Carbemazipine
2. Leviciteram
3. Phenytoin
4. Sodium valproate
A. Inhibits presynaptic Ca channels reducing neurotransmitter release, neuromodulator
B. Sodium channel blocker, known as for having reduced metabolism as you decrease the dose
C. PIP3 reduction, blocks sodium channel that leads to increases GABA
D. Sodium channel blockade
A
1 - D
2 - A
3 - B
4 - C
*GABA inhibitory
21
Q
What class of AEDs are usually associated with neurotoxicity?
A
Sodium channel blockers
22
Q
How does clonazepam work?
A
GABA agonist, potential its effect
23
Q
What is the only AED that is an inhibitor?
A
Sodium valproate
All others are inducers
24
Q
What is the only AED that is an inhibitor?
A
Sodium valproate
All others are inducers
25
List the first line medication for 1) focal and 2) generalised epilepsy?
- carbemazipine - focal
- sodium Val - generalised
26
What electrolyte abnormalities differentiate between adrenal insufficiency and crisis?
Crisis would also have hypoglycaemia and hypercalcaemia
Severe abdominal pain, hypotension
27
What is the cause of pernicious anaemia and the time onset?
- 2-5 years
- antibodies against interlace factor
- associated with autoimmune conditions
- jaundice, glossitis!, early sign of peripheral neuropathy
28
Describe the common characteristics of restless legs syndrome
1. sensation starts after rest
2. Movement provides relief
3. Symptoms characteristically worse at night - difficulty falling and staying asleep
*not all patients with PMLS have RLS
*to do with low iron in the brain, not necessarily low serum iron
29
For the following list the common vector
- scarlet like fever
- rats -
- malaria, yellow fever, dengue
- typhus, Lyme disease, Q fever
- yersinia pestis; fleas
- rats - none
- mosquitoes
- ticks can be a host for many things
30
List 3 cutaneous manifestations of SLE
31
What are the mechanisms associated with hypercalcaemia of malignancy? (Where there is osteoclastic bone resorption and release of calcium from bone)
- osteolytic mets with local realise of cytokines including osteoclast activating factors (e.g. MM)
- tumour secretion of PTHrP
- tumour production of calcitriol 1,25 dihydroxy vitamin D which leads to increased bone reabsorption and intestinal calcium absorption (associated with lymphomas)
32
List and describe the different forms of vitamin D
33
Explain the MOA in 1st Gen vs 2nd Gen antipsychotics
- 1st gen - dopamine antagonists
- 2nd gen - serotonin-dopamine antagonists
34
What antipsychotic can cause rash and photosensitivity
Chlorpromazine (1st gen antipsychotic)
35
Which antipsychotic is associated with conduction abnormalities
1st gen, haloperidol
36
Which generation of antipsychotics is NMS more associated with?
1st gen
37
What is the major side effect of 2nd gen antipsychotics?
- metabolic side effects
- olanzapine is probably the worse
38
What are the most common side effects associated with quetiapine
- somnolence
- orthostatic hypotension
- dizziness
39
Which antipsychotic is most known to cause apathetic, headache and agitation ?
Aripiprazole
40
Apart from sodium valproate, what drug should be avoided in pregnancy for treating bipolar disorder?
- sodium Val causes intellectual impairment and fetal abnormalities
- carbemazipine - fetal abnormalities
- halloparidol - no major abnormalities, maybe EPSE in baby
- lithium - caution, need fetal cardiac monitoring due to risk of heart defect but BEST mood stabiliser for bipolar
41
List the six subtypes of autoimmune myositis
- dermomyositis
- polymyositis
- anti-synthatese syndrome
- immune mediated necrotising myopathy
- Inclusion body
- overlap
42
What is the subtype of myositis associated with a high risk of cancer?
Dermatomyositis
43
What two antibodies are associated with myositis associated cancer?
TIF1-gamma
Anti NXP2
44
What are the cardinal features of anti synthetase syndrome?
- myositis
- ILD
- mechanics hands
- Raynauds
- inflammatory polyarthritis
- oesophageal dysmotility
45
What is the specific feature of statin associated IMMUNE mediated necrotising myositis
- anti-HMGCR
- will have an elevated CK
46
What condition is associated with distal upper limb and proximal lower limb weakness?
Inclusion body myositis
47
A 80 year would home has a negative myositis screen but has severe dyspnoea on excertion for several years. What is the likely type of myositis?
- MDA5+
- a form of dermatomyositis
- associated with rapidly progressing ILD and high mortality
- get alopecia, cutaneous involvement
48
What is the antibody associated with anti-synthetatse syndrome?
Jo1
49
What is the cardinal natural history of inflammatory myopathies?
Progressive, painless muscle weakness
50
What is lymphangitis carcinamatosis?
Tumour spread through the lung lymphatics
- usually CXR normal, may get kerly B lines
- CT will show irregular and nodular thickening
51
What is proctitis and what are the pathogens that may cause it?
- inflammation of the anal canal and distal rectum
- chlamidiya, gonorreha, HSV, shyphilis, Mpox
52
How do you treat proctitis?
- valaciclovir for HSV premtively
- ceftriaxone + doxycycline for chlamidiya and gonorreha
53
What is the triad of Lofgrens syndrome?
- erythema nodosum
- bilateral hilar lymphadenopathy
- fever
- arthritis
*specific ACUTE sarcoid presentation
54
What is the PLAB2 gene associated with?
breast
55
Name the species associated with salt water and undercooked seafood
Vibrio species, especially v.Vinicius
56
What is a well known organism associated with freshwater?
Aeromonas
57
Leptospirosis has a spectrum of infections. What is a key physical examination finding of this?
- conjunctivitis without purulent discharge known as conjunctival hyperaemia
- can be association with freshwater swimming amongst other things
58
Leptospirosis has a spectrum of infections. What is a key physical examination finding of this?
- conjunctivitis without purulent discharge known as conjunctival hyperaemia
- can be association with freshwater swimming amongst other things
59
List the anatomical locations that may lead to aortic regurgitation
- aortic valve leaflets
- aortic root
- annulus
- ascending aorta
60
List the anatomical locations that may lead to aortic regurgitation
- aortic valve leaflets
- aortic root
- annulus
- ascending aorta
61
List some broad causes of AR
- IE
- rheumatological causes
- iatrogenic
- medication
- bicuspid valve
- turner syndrome*
62
What is the class I recommendation for surgical valve replacement in AR?
- LVEF <50%
*both LVEDV>6.5 and LVEF>50% becomes a class IIb recommendation
63
What differs in the clinical presentation between a carotid artery dissection and ischaemic stroke
Dissection - often associated with neck pain
64
What condition is dermatitis hermatoformis associated with?
Coeliac disease
65
What is the formula for NNT
1/ARR
66
What is the Insulin sensitivity factor?
This is the power of a unit of insulin in the body (how much one unit will drop the BSL)
67
Explain why Azathioprine and allopurinol should not be prescribed together
68
Why is feboxustat less preferred than allopurinol?
Both XO inhibitors, but feboxustat associated with CVD adverse effects
69
What other class of drugs, apart from XO inhibitors can be used in gout?
Uricosoric drugs - promote renal clearance of uric acid
- includes probenecid, benzbromarone
70
What is the mechanism of action of colchisine?
Anti-inflammatory
Interferes with inflamasome complex associated with activation of 1L-1beta
71
Noonan syndrome is a multi-system genetic disorder caused by genetic mutations. It causes congenital heart disease. What is the most common CHD defect?
Pulmonary stenosis
72
What is a key feature of POTS and what are the parameters
- HR rise >30 when going from sitting to standing
- no blood pressure drop associated
- one of the most prevalent symptoms is brain fog
73
If a patient has a bicuspid aortic valve with aortic root dilation, what would be the diameter to intervene?
55cm
74
What is the HLA gene associated with SJS and carbemazepine?
HLA 1502
02, letter C
75
What type of bacteria is yersinia monocytogenes?
Gram positive rod
76
What is the inheritance pattern of CAH?
Autosomal recessive
77
There are two types of CAH. Describe 3 differences between each
78
There are two types of CAH. Describe 3 differences between each
79
What is the most common cause of atypical genitalia in 46, XX newborns?
21 hydroxylase deficiency
80
What is the classical test used to confirm a diagnosis of classical CAH?
17-OH progesterone
81
What is the treatment of CAH?
82
What is the treatment of CAH?
83
If you have a testicular adrenal rest tumour associated with CAH, how often should you screen?
At least 1-2 years when asymptomatic
84
Which CAH type is at risk of TART?
- patients with the classical type - males
- mainstay of treatment is glucocorticoids, surgery is not going to restore testosterone and sperm production
85
The common peroneal nerve wraps around the knee and is therefore very susceptible to compression/injury. What does the lesion look like?
Motor
- foot drop (difficulty in dorsiflexion) [deep]
- difficulty in eversion [superficial]
Sensory
- impaired sensation in the forum of the foot + wedge spaces between digits 1 & 2 and lateral shin
ANKLE REFLEXES INTACT
86
What are the common causes of sciatic nerve neuropathy?
- trauma - from dislocation, fracture, replacement
87
What are the clinical features of a sciatic nerve palsy
NORMAL hip movements - flex, ext, abb, add
Knee ext - normal
Motor
- impaired knee flexion
- no ankle jerk
Sensory
- entire fibular territory
88
What are the clinical features of L5 radiculopathy?
Everything!
- Motor - reduced dorsiflexion, foot eversion, foot inversion, toe extension
- no ankle jerk
89
Review the causes and differences between AIN and ATN
ATN - affects tubules that are supplied by end arteries; prone to hypoperfusion and toxins
AIN - usually drug induced, affect the intertistium
90
What are the causes of pemphigus vulgaris?
- autoimmune disease - painful blisters and erosions, mostly in the mouth
- drug induced
91
What are important triggers of pemphigus vulgaris and what is the associated staining pattern?
- intercellular spaces
- drug induced - ACE/ARBs, cephlasporins
- can be trigger by lymphoma, infection, trauma
92
What is the linear staining pattern associated with bullous pemphagoid and what are the key drugs that may cause it?
- linear IgG basement membrane deposits
- PD-1 inhibitors - pembrolizumab, nivolumab
- DPP-4 inhibitors - “gliptins”
93
What vaccines should be checked with a specialist in an individual with an egg allergy?
- yellow fever
- Q fever
*’MMR, influenza can be given - small trace of egg protein
94
What is hereditary angiooedema and what is the inheritance pattern?
- autosomal dominant
- lack of C1 or dysfunctional C1 inhibitor protein
95
Describe bradykinin mediated angiooedema
- includes hereditary, acquired and ACE angiooedema.
- NOT associated with itching, urticaria does not occur
- slow progress - hours
- associated with abdominal pain
- low response to epinephrine, antihistamines and steroids
96
Describe histamine mediated angiooedema
- associated with urticaria and puritis
- various triggers
- IgE mediated
- rapid in onsent and responsive to antihistamines, steroids, adrenaline
- abdominal pain less likely
97
How is bradykinin mediated angiooedema treated?
- C1 inhibitor
98
What length of the intestine maximally is removed for short gut syndrome?
200cm
99
What patients should get antibiotic prophylaxis if undergoing dental or oral procedure and have a risk of IE?
- prosthetic valve
- cardiac valve repair
- previous IE
- unrepaired congenital heart disease
- if valve disease without devices could consider?
100
Explain why transdermal oestrogen is the preferred option compared to oral oestrogen?
Oral oestrogen increases active protein C resistance, increasing risk of a clot (protein C is a natural anticoagulant)
Transdermal oestrogen bypasses this
101
True or false
Transdermal oestrogen can be used in women who have migraines and smoke
True - transdermal option is minimising the risk of a clot
102
What is the difference between micronised and medroxy progesterone?
- micronised - natural progesterone
- medroxy - synthetic progestin with slight androgens mix and glucocorticoid activity
103
What is the empirical reason micronised progesterone is preferred compared to medroxy progesterone?
- thought to be safer with regards to risks associated with breast cancer
*tricky as breast cancer risk also associated with exposure duration
104
What is cataplexy?
Sudden muscle weakness that occurs when a person is awake
105
What is the role of orexin and where is it found?
- found in the hypothalamus
- neuropeptide - regulates sleep-wake cycle
106
What is the key difference between type 1 and 2 narcolepsy?
Cataplexy - bilateral muscle weakness while conscious
107
Why would you still give a rabies vaccine even if it has been weeks?
Long latency period - about 45 days
108
What major condition is syphilis associated with?
HIV
109
What is the time frame for late onset syphilis?
2 years
110
When is the usual onset of secondary syphilis?
2-8 weeks after chancre
111
What makes early and late syphilis different?
Early - still infectious
Late - non infectious sexually
112
What makes early and late syphilis different?
Early - still infectious
Late - non infectious sexually
113
What are the organ systems late syphilis affects?
114
What channel does gabapentin and Pregabalin work on?
Alpha-2 calcium channel ligand
115
What is the suggested first line treatment for restless legs syndrome?
- in the chronic setting - Pregabalin and gabapentin
- not for dopamine agonists in the chronic phase due to risk of augmentation and therefore impulse control disorders
116
Explain why barbiturates are more dangerous than benzos?
- both are GABA agonists
- barbiturates open GABA channels, causing chloride ions to move more freely
- Benzos are allosteric enzymes, meaning they make it easier for GABA to open, but the overal level of sedation doesn’t change
117
What cancer are patients with a PALB2 mutation most at risk of developing?
Brest
118
Why can’t daptomycin be used to treat pneumococcal pneumonia?
Inhibited by pulmonary surfactant
119
What is the difference between an alpha thal carrier and trait?
- 1 defective gene - silent carrier
- 2 defective genes - trait
120
With respect to cancer, which types of immunosupressed patients should receive treatment for hepatitis B?
Applies if HBsAg neg and anti-HBc positive
- depends on the type of cancer
- Higher risk cancer therapy (blood and marrow transplantation (BMT), B-cell depleting/B-cell active/anti-CD20 monoclonal antibodies, acute leukaemia and high grade lymphoma therapy) should receive antiviral prophylaxis.
- Lower risk cancer therapy (therapy which is not classified as higher risk) do not require antiviral prophylaxis.
121
122
What is the importance of the HBeAg?
- hep B viral protein
- measure of active viral replication
123
What is the approach to managing patients with chronic hepatitis B infection?
Assess the phase of infection
124
In a general sense, what are the phases of chronic Hep B?
- immune tolerance - don’t treat
- immune clearance - treat
- immune control
- immune escape
125
When should you treat chronic Hep B
- in the immune clearance and escape phase - ALT is abnormal
- there is NO antibodies against HbeAg
- HBV DNA only low with immune control
*in the immune tolerance and control
Phrases, antibodies are produced gained Hbe
126
What cells does CLL/SLL affect?
Monoclonal B cells
- mature cells that are immature immunologically!
127
CLL progression is a 2 step process. What is responsible for this?
- genetic/cytogenic causes - step 1
- CD5+ B cells keep getting activated by mutations that leads to mutated B cells
128
What is the most common physical abnormality associated with CLL?
Lymphadenopathy
129
What is the most common physical abnormality associated with CLL?
Lymphadenopathy
130
What is the most common extra articulate organ affected by CLL?
Skin - associated with lukemia Curtis
131
What is the pathognomic features on a blood film associated with CLL?
Smudge cells
132
What is found on immunophenotypic analysis of a blood smear for CLL?
B cell antigens - CD 19, 20, 21, 23, 24
CD 5 - T cell antigen
*CD 19, 23, 5 most common
133
When should treatment be started for CLL?
- in symptomatic patients
134
What are the two mutations associated with HIGH risk in CLL?
- 17p
- TP53
135
What genes are high risk in CLL?
- TP53
- 17p
136
What is richters phenomenon in the context of CLL?
Transformation to high grade lymphoma - 90% to DLBCL, 10% to Hodgkins
137
Venetoclax is used for refractory CLL. How does it work?
BCL-2 inhibitor
Brisk apoptosis
Dose escalation for TLS
138
What is differentiation syndrome and how is it treated?
Associated with AML - emergency
Consequence of ATRA and ATO for APML
Treat with steroids!
139
What is the most common cause of hyperviscosity syndrome?
WM
140
What type of Ig causes hyperviscosity syndrome and how is it treated?
- associated with IgM
- require IVIG, fluid, chemo for the underlying condition
141
What is the type of cancer leukostasis is commonly affected by?
- AML
- abnormal clumping of white blood cells, can lead to impaired flow
- common in brain and lungs
142
What is achalasia?
Smooth muscle disorder
Impaired relaxation of the distal oesophageal sphincter - bird beak on monometry
*no known cause
143
Why is endoscopy indicated for Ix of achalasia?
To exclude pre malignant and malignant lesions involving the oesophagus
144
What is the main symptoms of bile salt malabsorption?
- chronic diarrhoea
- bile acids are absorbed in the terminal ileum - hence why a complication of chrons disease
145
What is the key allergen associated with thunderstorm asthma?
Rye grass
146
Why does protein C decrease when warfarin prescribe?
It is a natural anticoagulant that inhibits factors including VII, IX, X
147
What is the lifetime risk of progression to MM with solitary bone vs solitary extrameduallary plasmacytoma?
- solitary bone - approx 50%
- extraemedullary - <10%
148
What is the role of carbergoline and how is it used?
Dopamine agonist; used for the treatment of high prolactin secretion*
149
What is the role of somatostatin and therefore what is the clinical significance of a somatostatin analogue?
- inhibits growth hormone - can be used in acromegaly
- NETs
- insulinoma
150
What is the type of amyloid associated with autoimmune disorders?
- AL
- acute phase reactant - causes an increase in IL-6
- associated with conditions such as IBD and RA
151
What is the pathogenesis is amyloid?
Misfolded beta sheet proteins
152
What is the pathogenesis is amyloid?
Misfolded beta sheet proteins
153
What is the pattern of staining for amyloid?
Apple-green bifringent staining
154
What is the treatment for TTR amyloid?
Tafamidis - TTR stabiliser
155
What is rulizole and when is it used?
- used in ALS and other MND disorders
- TTX sensitive Na channel blocker
- delays onset of ventilator dependence
156
How is syphilis investigated?
1 do a NAAT - check if organism present
2. Do a treponemal (TPPA) to see if trep reactive OR non-trep (if antibodies)
*antibodies last for life even if treated
*disease activity reduces with treatment
157
Outline the treatment of syphilis for patients with early, late and neurological involvement respectively
158
What is the test used to look at microscopic sediment?
Centrifuging a urine sample
159
Describe the role of trikafta in treating cystic fibrosis
160
What is the difference clinically when there is glycogen storage disease vs. aberrant fatty metabolism?
- glycogen storage - fatigue and exercise intolerance after short periods of moderate exercise
- fatty acid impaired metabolism - fatigue after prolonged exercise
161
What is the main risk of Tac and cyclosporine?
- nephrotoxicity
162
How does MMF work and what are the major side effects?
- MMF involved in purine synthesis
- associated with cytopenia - onset 2-6 months; associated with valganciclovir use +\- bactrim for prophylaxis
163
Why does the MMF/TAC combination have less rejection than CYC/MMF?
MMF levels are lowered by CYC but not TAC
164
What are the main benefits of MTOR inhibitors?
- less cancer risk - esp SCC/BCC
- less CMV infection
165
What is a key side effect of MTOR inhibitors?
wound complications - limited universal de novo use
166
Why are younger living donors at higher risk when it comes to transplants with respect to EKSD?
- May develop risks later in life and have one kidney* (for younger donors)
167
What is the role of TPO?
Thyroid peroxidase (TPO) is an enzyme made by the thyroid gland. The thyroid uses iodine, with the help of TPO, to make the hormones triiodothyronine (T3) and thyroxine (T4). These both help control metabolism and growth.
168
Τhуrοtοхiсоѕis –Gуոеϲοmаѕtiа associated with a mild elevation of serum еѕtrаԁiоl and a normal LΗ is a common laboratory finding and does not indicate a tumor that secretes hCG or еstrаԁiοl. Gуոеϲomаѕtia due to thyroid hormone is almost always clinically evident with symptoms and signs of thуrοtοхiϲоѕiѕ. However, thуrοtοхiϲοѕis is associated with a usual pattern of high-normal or elevated serum FSH and ԼΗ, high or high-normal serum total tеѕtοѕtеrοոe, high serum ЅНBG, and low or low-normal free serum tеѕtοѕterοոe (algorithm 1)[16,17]. This pattern is due to increased (thyroxine-induced) aromatization of tеѕtοѕterоne to еѕtrаԁiol; increased еstrаdiоl increases serum SHBG and lowers free tеѕtοѕtеroոе.
169
What is the role of SHBG?
carrier protein for testosterone, oestradiol and DHT in the bloodstream
170
What can high T4 and T3 cause in relation to SHBG
causes testosterone to aromatise to estradoil --> increases SHBG --> decreased testosterone
171
What is the finding of hyperthyroid vs. germ cell tumour with regards to SHBG, testosterone and LH/FSH
hyperthyroid
- increased SHBG
- normal testosterone
- clinical signs of thyrotoxicosis
- high-normal LH, FSH, bHCG
Germ cell tumour
- an increase in hCG is going to point you in that direction
172
Explain how you would figure out if a case of prolactinoma if you noted a patient had gynaecomastia?
- low-normal LH
- low T
- check prolactin --> may be an adenoma*
173
What condition is thymomas associated with?
Myasthenia gravis
174
Describe the key features of pericarditis
Substernal or left precordial pleuritic chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back) is the characteristic pain of pericarditis. The pain is usually relieved by sitting up or bending forward, and worsened by lying down (both recumbent and supine positions) or by inspiration (taking a breath in
175
What is the key valvular finding and associated cardiac disease associated with Noonan syndrome?
- pulmonary stenosis
- HCM (20%)
- short stature - associated with growth hormone deficiency
176
Explain/draw out the findings associated with
1. monocular loss
2. bitemporal heminopia
3. L) upper quadrantinopa
4. L) lower quadrantantopia
5. L) homonous heminopia
1. optic nerve
2. optic chaism
3. R) temporal lobe
4. R) parietal lobe
5. R) optic tract*
*left hemisphere has an upper and lower bank for occipital lobe
177
What would be a feature associated with occipital lobe lesions?
macular sparing usually
178
Thyroid cancer can be divided into two main sub-types. What are these?
1. Follicular
1a differentiated - papillary, follicular
*papillary most common
1b undifferentiated - anaplasitc
2. parafollicular or C-cells - medullary
179
What is the most common type of thyroid cancer?
Papillary
180
Where does medullary cancer arise from?
parafollicular or C cells (own subtype)
181
What is the most common presentation associated with medullary cancer?
- solitary nodule
- better detected with FNA
- usually should expect a rise in calcitonin and CEA
- check for mutations in RET
182
What is the key mutations associated with medullary thyroid cancer?
RET
183
What is the mutation associated with MEN2A and 2B?
RET
184
For each MEN1, MEN2A and MEN2B, list the key cancers associated
MEN2B not associated with parathyroid
gastrinoma - MEN1
185
What are the two main types of BPPV and what is the most common?
- posterior canal (most common)
> use Dix Hallpike to illicit and then Epley to treat
- horizontal
186
Describe the nystagmus associated with BPPV with a RIGHT posterior canal BPPV
- torsional up beat nystagmus towards the RIGHT side (torsional is the key feature)
187
What is geotropic nystagmus associated with?
Geotropic nystagmus is typically caused by free-floating particles in the endolymph of the affected semicircular canal, which is consistent with the canalithiasis theory of BPPV
188
What are two common causes of hypervolemia in peritoneal dialysis?
chronic hyperglycaemia
hypoalbuminaemia
*both will drive fluid into the intravascular space
189
What is the major risk factor for ultrafiltration failure in peritoneal dialysis?
- repeated episodes of peritonitis
*also >2 years duration, expisre to high dialysate glucose, diabetes, beta blockers
190
Why should sodium phosphate be avoided in bowel preparation for patients receiving dialysis?
these preparations can raise serum levels of phosphate or magnesium and provoke further loss of residual kidney function
191
What choice of bowel prep should be given to patients with hepatic, renal or cardiac impairment?
polyethylene glycol
192
What is the mechanism of orbitopathy in Graves disease?
immune activation of fibroblasts*
193
Describe the key differences between left and right side colon cancer
Some general principles
- R) side - worse prognosis - BRAF (RIGHT side) mutation so EGFR doesnt work
- If MSI-H tumours, use immune checkpoint inhibitors
194
What would help to differentiate between Lynch syndrome vs. sporadic macrosatellite cancers?
BRAF V600E mutation: Present in 69-78% of sporadic MSI CRCs with MLH1 methylation, but rarely in Lynch syndrome CRCs5
.
MLH1 promoter methylation: Common in sporadic MSI CRCs, but not in Lynch syndrome45.
195
What is the clinical relevance of Lambert Eaton syndrome?
strong association with SCLC
196
What is the gram stain of listeria monocytogenes and what is the clinical relevance?
gram +ve bacilis
- can be seen in elderly patients with meningitis
- add benpen to the treatment regime*
197
What is the key difference between Lambert Eaton syndrome and Myasthenia Gravis?
- Lambert Eaton = pre-synaptic, commonly V/Q channels
- Myasthenia - post-synaptic - antibodies against Ach receptor
198
In the male productive system, explain the difference between the roles of FSH and LH
- LH -> leydig cells -> testosterone
- FSH -> sertolli cells -> speramtogenesis
199
What is the expected histology of BPH?
ΒРH is a histologic diagnosis defined as an increase in the total number of stromal and glandular epithelial cells within the transition zone of the prostate gland. This hyperplasia causes formation of large, discrete prostatic nodules.
200
Explain why alpha 1 adrenergic receptors are useful in treating BPH?
block smooth muscle contraction (tamsulosin)
*selective preferred over non-selective
*PDE5 inhibitors, antimuscarinics are possible alternatives
201
Why should non-selective alpha blockers not be used in BPH?
concern for a blood pressure lowering effect
202
What is the treatment of choice if a patient has LUTS symptoms and BPH?
We use phosphodiesterase 5 (PDE-5) inhibitors as monotherapy in patients with erectile dysfunction and LUTS from BPΗ.
203
How does dutaseride work?
This is a 5 alpha reductase inhibitor
*used if prostate volume >30g as it prevents the simulation of the prostate
5-ARIs are most known for preventing conversion of testosterone, the major androgen sex hormone, to the more potent androgen dihydrotestosterone (DHT), in certain androgen-associated disorders.
204
What is mycosis fungoides associated with?
Cutaneous T cell lymphoma - about 88% of causes
205
How is cutaneous T cell lymphoma treated?
Extracorporal photophoresis
206
What would you expect on the histology for neutrophilic dermatoses?
neutrophilic infiltrates in the absence of any infection
207
Neuro sweet syndrome is a consequence of many disorders, most commonly AML. How do you treat it?
High dose steroids; treat the underlying condition
208
List four causes of bullae
209
What are causes of atrophic plaques in the setting of systemic disease?
*look out for the button hole sign, where the skin puckers in
210
Explain the utility of NT pro BNP and BNP
- BNP - undifferentiated heart failure, favours in a HF diagnosis
- Sacubitril-valsartan inhibits the degradation of ΒΝΡ but not ΝΤ-рrοBΝP. Therefore would expect a build up of BNP
211
In coagulaiton testing, what is the impact of warfarin?
Effects the levels of protein C and S as they are dependent on Vitamin K (may get a false positive)*
