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RACP 2022 Topics > Study Group Rapid Fire > Flashcards

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

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2
Q

There is a patient on two antiepileptics. How would you approach weaning?

A

Taper one at a time (never together)

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3
Q

Which anti epileptic has the longest half life?

A

Brabituates (followed by BZD)

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4
Q

What is the pathogenesis behind epilepsy?

A

Large numbers of neurons with prolonged depolarisation (repetitive firing)

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5
Q

Describe the difference between a focal and generalised seizure

A
  • focal - one hemisphere
  • generalised - both
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6
Q

What is the seizure type associated with aura?

A

Usually focal

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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

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8
Q

List 4 causes of provoked seizures

A
  • acute precipitant
  • metabolic
  • trauma
    *consider AED if risk of having ongoing seizures
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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
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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

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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

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12
Q

Why do we tend to treat epilepsy after the second seizure?

A
  • risk of 70% of further seizures after a 2nd one
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13
Q

List two AEDs that should be avoided in the elderly

A
  • carbemazepine
  • lamotrigine
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14
Q

Why should sodium valproate be avoided in children?

A

Can cause liver toxicity in children with mitochondrial disorders

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15
Q

When would you refer a patient for surgery if they had epilepsy?

A
  • trial of 2 AEDs unsuccessfully
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16
Q

What drug is lowered with contraception

A

Lamotrigine (all other drugs lead to clearance of hormonal contraception)

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17
Q

What is the best tolerated AEDs in pregnancy?

A
  • lamotrigene
  • carbemazipine
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18
Q

What is the seizure that tends to occur at night?

A
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19
Q

In terms of post ictal psychosis, when does it occur in epilepsy?

A

Occurs 12-72 hours AFTER a seizure

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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

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21
Q

What class of AEDs are usually associated with neurotoxicity?

A

Sodium channel blockers

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22
Q

How does clonazepam work?

A

GABA agonist, potential its effect

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23
Q

What is the only AED that is an inhibitor?

A

Sodium valproate
All others are inducers

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24
Q

What is the only AED that is an inhibitor?

A

Sodium valproate
All others are inducers

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25
Q

List the first line medication for 1) focal and 2) generalised epilepsy?

A
  • carbemazipine - focal
  • sodium Val - generalised
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26
Q

What electrolyte abnormalities differentiate between adrenal insufficiency and crisis?

A

Crisis would also have hypoglycaemia and hypercalcaemia
Severe abdominal pain, hypotension

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27
Q

What is the cause of pernicious anaemia and the time onset?

A
  • 2-5 years
  • antibodies against interlace factor
  • associated with autoimmune conditions
  • jaundice, glossitis!, early sign of peripheral neuropathy
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28
Q

Describe the common characteristics of restless legs syndrome

A
  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
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29
Q

For the following list the common vector
- scarlet like fever
- rats -
- malaria, yellow fever, dengue
- typhus, Lyme disease, Q fever

A
  • yersinia pestis; fleas
  • rats - none
  • mosquitoes
  • ticks can be a host for many things
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30
Q

List 3 cutaneous manifestations of SLE

A
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31
Q

What are the mechanisms associated with hypercalcaemia of malignancy? (Where there is osteoclastic bone resorption and release of calcium from bone)

A
  • 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)
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32
Q

List and describe the different forms of vitamin D

A
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33
Q

Explain the MOA in 1st Gen vs 2nd Gen antipsychotics

A
  • 1st gen - dopamine antagonists
  • 2nd gen - serotonin-dopamine antagonists
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34
Q

What antipsychotic can cause rash and photosensitivity

A

Chlorpromazine (1st gen antipsychotic)

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35
Q

Which antipsychotic is associated with conduction abnormalities

A

1st gen, haloperidol

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36
Q

Which generation of antipsychotics is NMS more associated with?

A

1st gen

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37
Q

What is the major side effect of 2nd gen antipsychotics?

A
  • metabolic side effects
  • olanzapine is probably the worse
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38
Q

What are the most common side effects associated with quetiapine

A
  • somnolence
  • orthostatic hypotension
  • dizziness
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39
Q

Which antipsychotic is most known to cause apathetic, headache and agitation ?

A

Aripiprazole

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40
Q

Apart from sodium valproate, what drug should be avoided in pregnancy for treating bipolar disorder?

A
  • 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
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41
Q

List the six subtypes of autoimmune myositis

A
  • dermomyositis
  • polymyositis
  • anti-synthatese syndrome
  • immune mediated necrotising myopathy
  • Inclusion body
  • overlap
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42
Q

What is the subtype of myositis associated with a high risk of cancer?

A

Dermatomyositis

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43
Q

What two antibodies are associated with myositis associated cancer?

A

TIF1-gamma
Anti NXP2

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44
Q

What are the cardinal features of anti synthetase syndrome?

A
  • myositis
  • ILD
  • mechanics hands
  • Raynauds
  • inflammatory polyarthritis
  • oesophageal dysmotility
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45
Q

What is the specific feature of statin associated IMMUNE mediated necrotising myositis

A
  • anti-HMGCR
  • will have an elevated CK
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46
Q

What condition is associated with distal upper limb and proximal lower limb weakness?

A

Inclusion body myositis

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47
Q

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?

A
  • MDA5+
  • a form of dermatomyositis
  • associated with rapidly progressing ILD and high mortality
  • get alopecia, cutaneous involvement
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48
Q

What is the antibody associated with anti-synthetatse syndrome?

A

Jo1

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49
Q

What is the cardinal natural history of inflammatory myopathies?

A

Progressive, painless muscle weakness

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50
Q

What is lymphangitis carcinamatosis?

A

Tumour spread through the lung lymphatics
- usually CXR normal, may get kerly B lines
- CT will show irregular and nodular thickening

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51
Q

What is proctitis and what are the pathogens that may cause it?

A
  • inflammation of the anal canal and distal rectum
  • chlamidiya, gonorreha, HSV, shyphilis, Mpox
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52
Q

How do you treat proctitis?

A
  • valaciclovir for HSV premtively
  • ceftriaxone + doxycycline for chlamidiya and gonorreha
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53
Q

What is the triad of Lofgrens syndrome?

A
  • erythema nodosum
  • bilateral hilar lymphadenopathy
  • fever
  • arthritis
    *specific ACUTE sarcoid presentation
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54
Q

What is the PLAB2 gene associated with?

A

breast

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55
Q

Name the species associated with salt water and undercooked seafood

A

Vibrio species, especially v.Vinicius

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56
Q

What is a well known organism associated with freshwater?

A

Aeromonas

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57
Q

Leptospirosis has a spectrum of infections. What is a key physical examination finding of this?

A
  • conjunctivitis without purulent discharge known as conjunctival hyperaemia
  • can be association with freshwater swimming amongst other things
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58
Q

Leptospirosis has a spectrum of infections. What is a key physical examination finding of this?

A
  • conjunctivitis without purulent discharge known as conjunctival hyperaemia
  • can be association with freshwater swimming amongst other things
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59
Q

List the anatomical locations that may lead to aortic regurgitation

A
  • aortic valve leaflets
  • aortic root
  • annulus
  • ascending aorta
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60
Q

List the anatomical locations that may lead to aortic regurgitation

A
  • aortic valve leaflets
  • aortic root
  • annulus
  • ascending aorta
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61
Q

List some broad causes of AR

A
  • IE
  • rheumatological causes
  • iatrogenic
  • medication
  • bicuspid valve
  • turner syndrome*
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62
Q

What is the class I recommendation for surgical valve replacement in AR?

A
  • LVEF <50%
    *both LVEDV>6.5 and LVEF>50% becomes a class IIb recommendation
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63
Q

What differs in the clinical presentation between a carotid artery dissection and ischaemic stroke

A

Dissection - often associated with neck pain

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64
Q

What condition is dermatitis hermatoformis associated with?

A

Coeliac disease

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65
Q

What is the formula for NNT

A

1/ARR

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66
Q

What is the Insulin sensitivity factor?

A

This is the power of a unit of insulin in the body (how much one unit will drop the BSL)

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67
Q

Explain why Azathioprine and allopurinol should not be prescribed together

A
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68
Q

Why is feboxustat less preferred than allopurinol?

A

Both XO inhibitors, but feboxustat associated with CVD adverse effects

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69
Q

What other class of drugs, apart from XO inhibitors can be used in gout?

A

Uricosoric drugs - promote renal clearance of uric acid
- includes probenecid, benzbromarone

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70
Q

What is the mechanism of action of colchisine?

A

Anti-inflammatory
Interferes with inflamasome complex associated with activation of 1L-1beta

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71
Q

Noonan syndrome is a multi-system genetic disorder caused by genetic mutations. It causes congenital heart disease. What is the most common CHD defect?

A

Pulmonary stenosis

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72
Q

What is a key feature of POTS and what are the parameters

A
  • HR rise >30 when going from sitting to standing
  • no blood pressure drop associated
  • one of the most prevalent symptoms is brain fog
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73
Q

If a patient has a bicuspid aortic valve with aortic root dilation, what would be the diameter to intervene?

A

55cm

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74
Q

What is the HLA gene associated with SJS and carbemazepine?

A

HLA 1502
02, letter C

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75
Q

What type of bacteria is yersinia monocytogenes?

A

Gram positive rod

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76
Q

What is the inheritance pattern of CAH?

A

Autosomal recessive

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77
Q

There are two types of CAH. Describe 3 differences between each

A
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78
Q

There are two types of CAH. Describe 3 differences between each

A
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79
Q

What is the most common cause of atypical genitalia in 46, XX newborns?

A

21 hydroxylase deficiency

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80
Q

What is the classical test used to confirm a diagnosis of classical CAH?

A

17-OH progesterone

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81
Q

What is the treatment of CAH?

A
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82
Q

What is the treatment of CAH?

A
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83
Q

If you have a testicular adrenal rest tumour associated with CAH, how often should you screen?

A

At least 1-2 years when asymptomatic

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84
Q

Which CAH type is at risk of TART?

A
  • patients with the classical type - males
  • mainstay of treatment is glucocorticoids, surgery is not going to restore testosterone and sperm production
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85
Q

The common peroneal nerve wraps around the knee and is therefore very susceptible to compression/injury. What does the lesion look like?

A

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
Q

What are the common causes of sciatic nerve neuropathy?

A
  • trauma - from dislocation, fracture, replacement
87
Q

What are the clinical features of a sciatic nerve palsy

A

NORMAL hip movements - flex, ext, abb, add
Knee ext - normal

Motor
- impaired knee flexion
- no ankle jerk

Sensory
- entire fibular territory

88
Q

What are the clinical features of L5 radiculopathy?

A

Everything!
- Motor - reduced dorsiflexion, foot eversion, foot inversion, toe extension
- no ankle jerk

89
Q

Review the causes and differences between AIN and ATN

A

ATN - affects tubules that are supplied by end arteries; prone to hypoperfusion and toxins
AIN - usually drug induced, affect the intertistium

90
Q

What are the causes of pemphigus vulgaris?

A
  • autoimmune disease - painful blisters and erosions, mostly in the mouth
  • drug induced
91
Q

What are important triggers of pemphigus vulgaris and what is the associated staining pattern?

A
  • intercellular spaces
  • drug induced - ACE/ARBs, cephlasporins
  • can be trigger by lymphoma, infection, trauma
92
Q

What is the linear staining pattern associated with bullous pemphagoid and what are the key drugs that may cause it?

A
  • linear IgG basement membrane deposits
  • PD-1 inhibitors - pembrolizumab, nivolumab
  • DPP-4 inhibitors - “gliptins”
93
Q

What vaccines should be checked with a specialist in an individual with an egg allergy?

A
  • yellow fever
  • Q fever
    *’MMR, influenza can be given - small trace of egg protein
94
Q

What is hereditary angiooedema and what is the inheritance pattern?

A
  • autosomal dominant
  • lack of C1 or dysfunctional C1 inhibitor protein
95
Q

Describe bradykinin mediated angiooedema

A
  • 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
Q

Describe histamine mediated angiooedema

A
  • associated with urticaria and puritis
  • various triggers
  • IgE mediated
  • rapid in onsent and responsive to antihistamines, steroids, adrenaline
  • abdominal pain less likely
97
Q

How is bradykinin mediated angiooedema treated?

A
  • C1 inhibitor
98
Q

What length of the intestine maximally is removed for short gut syndrome?

A

200cm

99
Q

What patients should get antibiotic prophylaxis if undergoing dental or oral procedure and have a risk of IE?

A
  • prosthetic valve
  • cardiac valve repair
  • previous IE
  • unrepaired congenital heart disease
  • if valve disease without devices could consider?
100
Q

Explain why transdermal oestrogen is the preferred option compared to oral oestrogen?

A

Oral oestrogen increases active protein C resistance, increasing risk of a clot (protein C is a natural anticoagulant)
Transdermal oestrogen bypasses this

101
Q

True or false
Transdermal oestrogen can be used in women who have migraines and smoke

A

True - transdermal option is minimising the risk of a clot

102
Q

What is the difference between micronised and medroxy progesterone?

A
  • micronised - natural progesterone
  • medroxy - synthetic progestin with slight androgens mix and glucocorticoid activity
103
Q

What is the empirical reason micronised progesterone is preferred compared to medroxy progesterone?

A
  • thought to be safer with regards to risks associated with breast cancer
    *tricky as breast cancer risk also associated with exposure duration
104
Q

What is cataplexy?

A

Sudden muscle weakness that occurs when a person is awake

105
Q

What is the role of orexin and where is it found?

A
  • found in the hypothalamus
  • neuropeptide - regulates sleep-wake cycle
106
Q

What is the key difference between type 1 and 2 narcolepsy?

A

Cataplexy - bilateral muscle weakness while conscious

107
Q

Why would you still give a rabies vaccine even if it has been weeks?

A

Long latency period - about 45 days

108
Q

What major condition is syphilis associated with?

A

HIV

109
Q

What is the time frame for late onset syphilis?

A

2 years

110
Q

When is the usual onset of secondary syphilis?

A

2-8 weeks after chancre

111
Q

What makes early and late syphilis different?

A

Early - still infectious
Late - non infectious sexually

112
Q

What makes early and late syphilis different?

A

Early - still infectious
Late - non infectious sexually

113
Q

What are the organ systems late syphilis affects?

A
114
Q

What channel does gabapentin and Pregabalin work on?

A

Alpha-2 calcium channel ligand

115
Q

What is the suggested first line treatment for restless legs syndrome?

A
  • 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
Q

Explain why barbiturates are more dangerous than benzos?

A
  • 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
Q

What cancer are patients with a PALB2 mutation most at risk of developing?

A

Brest

118
Q

Why can’t daptomycin be used to treat pneumococcal pneumonia?

A

Inhibited by pulmonary surfactant

119
Q

What is the difference between an alpha thal carrier and trait?

A
  • 1 defective gene - silent carrier
  • 2 defective genes - trait
120
Q

With respect to cancer, which types of immunosupressed patients should receive treatment for hepatitis B?

A

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
Q
A
122
Q

What is the importance of the HBeAg?

A
  • hep B viral protein
  • measure of active viral replication
123
Q

What is the approach to managing patients with chronic hepatitis B infection?

A

Assess the phase of infection

124
Q

In a general sense, what are the phases of chronic Hep B?

A
  • immune tolerance - don’t treat
  • immune clearance - treat
  • immune control
  • immune escape
125
Q

When should you treat chronic Hep B

A
  • 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
Q

What cells does CLL/SLL affect?

A

Monoclonal B cells
- mature cells that are immature immunologically!

127
Q

CLL progression is a 2 step process. What is responsible for this?

A
  • genetic/cytogenic causes - step 1
  • CD5+ B cells keep getting activated by mutations that leads to mutated B cells
128
Q

What is the most common physical abnormality associated with CLL?

A

Lymphadenopathy

129
Q

What is the most common physical abnormality associated with CLL?

A

Lymphadenopathy

130
Q

What is the most common extra articulate organ affected by CLL?

A

Skin - associated with lukemia Curtis

131
Q

What is the pathognomic features on a blood film associated with CLL?

A

Smudge cells

132
Q

What is found on immunophenotypic analysis of a blood smear for CLL?

A

B cell antigens - CD 19, 20, 21, 23, 24
CD 5 - T cell antigen
*CD 19, 23, 5 most common

133
Q

When should treatment be started for CLL?

A
  • in symptomatic patients
134
Q

What are the two mutations associated with HIGH risk in CLL?

A
  • 17p
  • TP53
135
Q

What genes are high risk in CLL?

A
  • TP53
  • 17p
136
Q

What is richters phenomenon in the context of CLL?

A

Transformation to high grade lymphoma - 90% to DLBCL, 10% to Hodgkins

137
Q

Venetoclax is used for refractory CLL. How does it work?

A

BCL-2 inhibitor
Brisk apoptosis
Dose escalation for TLS

138
Q

What is differentiation syndrome and how is it treated?

A

Associated with AML - emergency
Consequence of ATRA and ATO for APML
Treat with steroids!

139
Q

What is the most common cause of hyperviscosity syndrome?

A

WM

140
Q

What type of Ig causes hyperviscosity syndrome and how is it treated?

A
  • associated with IgM
  • require IVIG, fluid, chemo for the underlying condition
141
Q

What is the type of cancer leukostasis is commonly affected by?

A
  • AML
  • abnormal clumping of white blood cells, can lead to impaired flow
  • common in brain and lungs
142
Q

What is achalasia?

A

Smooth muscle disorder
Impaired relaxation of the distal oesophageal sphincter - bird beak on monometry
*no known cause

143
Q

Why is endoscopy indicated for Ix of achalasia?

A

To exclude pre malignant and malignant lesions involving the oesophagus

144
Q

What is the main symptoms of bile salt malabsorption?

A
  • chronic diarrhoea
  • bile acids are absorbed in the terminal ileum - hence why a complication of chrons disease
145
Q

What is the key allergen associated with thunderstorm asthma?

A

Rye grass

146
Q

Why does protein C decrease when warfarin prescribe?

A

It is a natural anticoagulant that inhibits factors including VII, IX, X

147
Q

What is the lifetime risk of progression to MM with solitary bone vs solitary extrameduallary plasmacytoma?

A
  • solitary bone - approx 50%
  • extraemedullary - <10%
148
Q

What is the role of carbergoline and how is it used?

A

Dopamine agonist; used for the treatment of high prolactin secretion*

149
Q

What is the role of somatostatin and therefore what is the clinical significance of a somatostatin analogue?

A
  • inhibits growth hormone - can be used in acromegaly
  • NETs
  • insulinoma
150
Q

What is the type of amyloid associated with autoimmune disorders?

A
  • AL
  • acute phase reactant - causes an increase in IL-6
  • associated with conditions such as IBD and RA
151
Q

What is the pathogenesis is amyloid?

A

Misfolded beta sheet proteins

152
Q

What is the pathogenesis is amyloid?

A

Misfolded beta sheet proteins

153
Q

What is the pattern of staining for amyloid?

A

Apple-green bifringent staining

154
Q

What is the treatment for TTR amyloid?

A

Tafamidis - TTR stabiliser

155
Q

What is rulizole and when is it used?

A
  • used in ALS and other MND disorders
  • TTX sensitive Na channel blocker
  • delays onset of ventilator dependence
156
Q

How is syphilis investigated?

A

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
Q

Outline the treatment of syphilis for patients with early, late and neurological involvement respectively

A
158
Q

What is the test used to look at microscopic sediment?

A

Centrifuging a urine sample

159
Q

Describe the role of trikafta in treating cystic fibrosis

A
160
Q

What is the difference clinically when there is glycogen storage disease vs. aberrant fatty metabolism?

A
  • glycogen storage - fatigue and exercise intolerance after short periods of moderate exercise
  • fatty acid impaired metabolism - fatigue after prolonged exercise
161
Q

What is the main risk of Tac and cyclosporine?

A
  • nephrotoxicity
162
Q

How does MMF work and what are the major side effects?

A
  • MMF involved in purine synthesis
  • associated with cytopenia - onset 2-6 months; associated with valganciclovir use +- bactrim for prophylaxis
163
Q

Why does the MMF/TAC combination have less rejection than CYC/MMF?

A

MMF levels are lowered by CYC but not TAC

164
Q

What are the main benefits of MTOR inhibitors?

A
  • less cancer risk - esp SCC/BCC
  • less CMV infection
165
Q

What is a key side effect of MTOR inhibitors?

A

wound complications - limited universal de novo use

166
Q

Why are younger living donors at higher risk when it comes to transplants with respect to EKSD?

A
  • May develop risks later in life and have one kidney* (for younger donors)
167
Q

What is the role of TPO?

A

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
Q

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.

A
169
Q

What is the role of SHBG?

A

carrier protein for testosterone, oestradiol and DHT in the bloodstream

170
Q

What can high T4 and T3 cause in relation to SHBG

A

causes testosterone to aromatise to estradoil –> increases SHBG –> decreased testosterone

171
Q

What is the finding of hyperthyroid vs. germ cell tumour with regards to SHBG, testosterone and LH/FSH

A

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
Q

Explain how you would figure out if a case of prolactinoma if you noted a patient had gynaecomastia?

A
  • low-normal LH
  • low T
  • check prolactin –> may be an adenoma*
173
Q

What condition is thymomas associated with?

A

Myasthenia gravis

174
Q

Describe the key features of pericarditis

A

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
Q

What is the key valvular finding and associated cardiac disease associated with Noonan syndrome?

A
  • pulmonary stenosis
  • HCM (20%)
  • short stature - associated with growth hormone deficiency
176
Q

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

A
  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
Q

What would be a feature associated with occipital lobe lesions?

A

macular sparing usually

178
Q

Thyroid cancer can be divided into two main sub-types. What are these?

A
  1. Follicular
    1a differentiated - papillary, follicular
    *papillary most common
    1b undifferentiated - anaplasitc
  2. parafollicular or C-cells - medullary
179
Q

What is the most common type of thyroid cancer?

A

Papillary

180
Q

Where does medullary cancer arise from?

A

parafollicular or C cells (own subtype)

181
Q

What is the most common presentation associated with medullary cancer?

A
  • solitary nodule
  • better detected with FNA
  • usually should expect a rise in calcitonin and CEA
  • check for mutations in RET
182
Q

What is the key mutations associated with medullary thyroid cancer?

A

RET

183
Q

What is the mutation associated with MEN2A and 2B?

A

RET

184
Q

For each MEN1, MEN2A and MEN2B, list the key cancers associated

A

MEN2B not associated with parathyroid
gastrinoma - MEN1

185
Q

What are the two main types of BPPV and what is the most common?

A
  • posterior canal (most common)
    > use Dix Hallpike to illicit and then Epley to treat
  • horizontal
186
Q

Describe the nystagmus associated with BPPV with a RIGHT posterior canal BPPV

A
  • torsional up beat nystagmus towards the RIGHT side (torsional is the key feature)
187
Q

What is geotropic nystagmus associated with?

A

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
Q

What are two common causes of hypervolemia in peritoneal dialysis?

A

chronic hyperglycaemia
hypoalbuminaemia
*both will drive fluid into the intravascular space

189
Q

What is the major risk factor for ultrafiltration failure in peritoneal dialysis?

A
  • repeated episodes of peritonitis
    *also >2 years duration, expisre to high dialysate glucose, diabetes, beta blockers
190
Q

Why should sodium phosphate be avoided in bowel preparation for patients receiving dialysis?

A

these preparations can raise serum levels of phosphate or magnesium and provoke further loss of residual kidney function

191
Q

What choice of bowel prep should be given to patients with hepatic, renal or cardiac impairment?

A

polyethylene glycol

192
Q

What is the mechanism of orbitopathy in Graves disease?

A

immune activation of fibroblasts*

193
Q

Describe the key differences between left and right side colon cancer

A

Some general principles
- R) side - worse prognosis - BRAF (RIGHT side) mutation so EGFR doesnt work
- If MSI-H tumours, use immune checkpoint inhibitors

194
Q

What would help to differentiate between Lynch syndrome vs. sporadic macrosatellite cancers?

A

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
Q

What is the clinical relevance of Lambert Eaton syndrome?

A

strong association with SCLC

196
Q

What is the gram stain of listeria monocytogenes and what is the clinical relevance?

A

gram +ve bacilis
- can be seen in elderly patients with meningitis
- add benpen to the treatment regime*

197
Q

What is the key difference between Lambert Eaton syndrome and Myasthenia Gravis?

A
  • Lambert Eaton = pre-synaptic, commonly V/Q channels
  • Myasthenia - post-synaptic - antibodies against Ach receptor
198
Q

In the male productive system, explain the difference between the roles of FSH and LH

A
  • LH -> leydig cells -> testosterone
  • FSH -> sertolli cells -> speramtogenesis
199
Q

What is the expected histology of BPH?

A

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
Q

Explain why alpha 1 adrenergic receptors are useful in treating BPH?

A

block smooth muscle contraction (tamsulosin)
*selective preferred over non-selective
*PDE5 inhibitors, antimuscarinics are possible alternatives

201
Q

Why should non-selective alpha blockers not be used in BPH?

A

concern for a blood pressure lowering effect

202
Q

What is the treatment of choice if a patient has LUTS symptoms and BPH?

A

We use phosphodiesterase 5 (PDE-5) inhibitors as monotherapy in patients with erectile dysfunction and LUTS from BPΗ.

203
Q

How does dutaseride work?

A

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
Q

What is mycosis fungoides associated with?

A

Cutaneous T cell lymphoma - about 88% of causes

205
Q

How is cutaneous T cell lymphoma treated?

A

Extracorporal photophoresis

206
Q

What would you expect on the histology for neutrophilic dermatoses?

A

neutrophilic infiltrates in the absence of any infection

207
Q

Neuro sweet syndrome is a consequence of many disorders, most commonly AML. How do you treat it?

A

High dose steroids; treat the underlying condition

208
Q

List four causes of bullae

A
209
Q

What are causes of atrophic plaques in the setting of systemic disease?

A

*look out for the button hole sign, where the skin puckers in

210
Q

Explain the utility of NT pro BNP and BNP

A
  • 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
Q

In coagulaiton testing, what is the impact of warfarin?

A

Effects the levels of protein C and S as they are dependent on Vitamin K (may get a false positive)*

RACP 2022 Topics (1 decks)

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