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summary of specialties Flashcards

1
Q

ACR values and when to refer

A

3 or more is significant
if 3-70, repeat test

refer:
- ACR 70 or more
- ACR 30 or more with persistent haematuria and no UTI
- ACR 3-29 with persistent haematuria and risk factors e.g. declining eGFR, CVD

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2
Q

how many times should you measure eGFR?

A

once:
- eGFR > 60
- eGFR 45-59 and ACR < 30

twice:
- eGFR 45-59 and ACR > 30
- eGFR 15-29 and ACR < 30

three:
- eGFR 15-29 and ACR > 30
four: - eGFR < 15

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3
Q

managing proteinuria in CKD

A
  • ACEi if ACR > 30 and HTN
  • ACEi if ACR > 70 regardless of BP
  • SGLT2i
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4
Q

ECG territories

A

V1-V4: anteroseptal, LAD
II, III, aVF: inferior, R coronary
V1-V6, I, aVL: anterolateral, prox LAD
I, aVL: lateral, left cx
V1-V3: posterior, L cx, RCA

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5
Q

nephrotic/nephritic syndrome microscopy findings

A

focal segmental glomerulosclerosis:
effacement of foot processes

goodpastures:
IgG deposits on BM

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6
Q

flash pulmonary oedema can be a sign of what renal disease?

A

renal vascular disease

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7
Q

causes of diffuse proliferative glomerulonephritis

A

post strep
SLE

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8
Q

causes of metabolic acidosis

A

normal anion gap:
GI bicarb loss
RTA
acetazolamide, ammonium chloride
addison’s

raised anion gap:
lactate (shock, sepsis, hypoxia, metformin)
ketones (DKA, alcohol)
urate (renal failure)
acid poisoning (salicylates, methanol)

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9
Q

management of thyroid storm

A

IV propranolol
methimazole/propylthiouracil
Lugol’s iodine
IV dexamethasone/hydrocortisone to block conversion of T4 to T3

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10
Q

diagnosing acromegaly

A

serum IGF-1 levels
> if raised, OGTTt

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11
Q

types of renal tubular acidosis

A

1 (distal):
- inability to secrete H+
- hypokalaemia, nephrocalcinosis
- RA, CLE, sjogrens, toxicity

2 (prox):
- reduced bicarb reabsorption in PCT
- hypokalaemia, osteomalacia
- fanconi, wilsons, carbonic anhydrase inhib

3 (mixed):
- carbonic anhydrase deficiency, hypokalaemia
- rare

4 (hyperkalaemic):
- reduced aldosterone, reduced PCT ammonia excretion
- hypoaldosteronism, diabetes

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12
Q

Gitelman’s vs Bartter’s

A

Gitelman’s: like taking thiazide, DCT
- hypoK, , hypoMg, metab alkalosis

Barrter’s: defective NaK2Cl in ascending loop
- hypoK, polyuria and polydipsia

both normotensive

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13
Q

Multiple Endocrine Neoplasia

A

1: 3Ps
parathyroid, pituitary, pancreas
adrenal and thyroid
MEN1 gene

2a: 2Ps
parathyroid, phaeochromocytoma
medullary thyroid ca
RET oncogone

MEN 2b: 1P
phaeochromocytoma
marfinoid, neuromas, medullary thyroid
RET oncogene

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14
Q

drug induced lupus vs SLE and causes of drug induced lupus

A

renal and nervous system involvement rare in drug induced

procainamide
hydralazine
isoniazid, minocycline, phenytoin

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15
Q

managing steroid induced osteporosis

A

offer bone protection if > 65y or fragility #
DEXA if < 65y

T between 0 and -1.5: repeat DEXA in 1-3y
T < - 1.5: offer bone protection

alendronate, calcium + vit D

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16
Q

causes of erythema multiforme

A

HSV, Orf
idiopathic
mycoplasma, strep
penicillin, sulfonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapine
SLE, sarcoid, malignancy

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17
Q

causes of acanthosis nigricans

A

T2DM
GI cancer
obesity
PCOS
acromegaly
cushings
hypothyroid
prader willi
familial
COCP, nicotinic acid

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18
Q

drugs affect4ed by acetylator status

A

Sulfasalazine
Hydralazine
Isoniazid
Procainamide
Dapsone

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19
Q

gaucher’s disease features

A

defective glucocerebrosidase
most common lipid storage disorder
hepatosplenomegaly, aseptic necrosis of femur

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20
Q

tay sachs features

A

defective hexosaminidase A
accumulation of GM2 ganglioside within lysosomes
developmental delay, cherry red spot on macula
normal sized liver and spleen

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21
Q

niemann pick features

A

defective sphingomyelinase
hepatosplenomegaly, cherry red spot on macula

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22
Q

krabbes disease features

A

defective galactocerebrosidase
peripheral neuropathy, optic atrophy, globoid cells

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23
Q

metachromic leukodystrophy features

A

arylsulfatase A defective
demyelination of CNS and PNS

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24
Q

fabry disease features

A

peripheral neuropathy (burning sensation)
angiokeratomas, lens opacities
proteinuria
x linked recessive

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25
Q

types of hypersensitivity reaction

A

1: anaphylactic
2: cell bound
3: immune complex free antigens combine (SLE, post strep GN, serum sickness, extrinsic allergic alveolitis)
4: delayed (TB, graft b host, contact dermatitis, scabies, chronic phase extrinsic allergic alveolitis, MS, GBS)
5: antibodies binding to cell surface receptor (graves, MG)

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26
Q

which chromosome codes for HLA antigens?

A

chromo 6

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27
Q

neurofibromatosis vs tuberous sclerosis

A

NF- axillary freckles, phaeochromocytomas, iris hamartomas (lisch nodules), acoustic neuromas (NF2)

TS- ash leaf spots, shagreen patches, subungual fibromata, adenoma sebaceum, epilepsy and developmental problems, retinal hamartomas, renal angiomyolipomata

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28
Q

anterior cerebral artery stroke

A

contralateral hemiparesis and sensory loss
lower extremity > upper

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29
Q

middle cerebral artery stroke

A

contralateral hemiparesis and sensory loss
upper extremity > lower
contralateral homonymous hemianopia
aphasia

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30
Q

posterior cerebral artery stroke

A

contralateral homonymous hemianopia
macular sparing
visual agnosia

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31
Q

webers syndrome

A

stroke from branches of posterior cerebral artery supplying midbrain
ipsi CNIII palsy
contralateral upper and lower weakness

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32
Q

posterior inferior cerebellar artery stroke

A

lateral medullary/wallenberg syndrome
ipsi facial pain and temp loss
contra limb/torso pain and temp loss
ataxia, nystagmus

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33
Q

anterior inferior cerebellar artery stroke

A

lateral pontine syndrome
similar to PICA stroke but also ipsi facial paralysis and deafness

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34
Q

lacunar stroke presentation

A

isolated hemiparesis or hemisensory loss or hemiparesis with limb ataxia

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35
Q

normal fasting glucose

A

6 or less
6-7: pre diabetes
7 or more: diabetes

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36
Q

diagnostic thresholds for gestational diabetes

A

fasting glucose 5.6 or more
2h glucose 7.8 or more

target fasting glucose: 5.3

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37
Q

Pseudohypoparathyroidism and how to diagnose

A

PTH target cell insensitivity
High PTH and PO4, low Ca

DX: PTH infusion and measure urinary po4 and cAMP

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38
Q

Causes of SIADH

A

Sulfonylureas
SSRI, TCA
Carbamazepine
Vincristine
Cyclophosphamide
PEEP, porphyrias
TB, pneumonia
CVA, SAH, subdural haemorrhages, meningitis
SCLC, pancreas, prostate ca

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39
Q

MODY inheritance

A

Autosomal dominant

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40
Q

congenital adrenal hyperplasia

A

autosomal recessive
low cortisol, high ACTH
21 hydroxylase deficiency 90%
11 beta hydroxylase deficiency 10%
rarely 17 hydroxylase deficiency
confirm dx with ACTH stimulation test

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41
Q

features of parietal lesions

A

sensory inattention
apraxias
inferior homonymous quadratanopia
gerstmanns (alexia, acalculia, right left disorientation, finger agnosia)

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42
Q

temporal lesion features

A

wernickes aphasia
superior homo quadratanopia
auditory agnosia
prospagnosia (difficulty recognising faces)

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43
Q

features of frontal lobe lesions

A

Broca’s aphasia
disinhibition
perseveration
anosmia
inability to generate a list

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44
Q

wernicke and korsakoff syndrome are a result of damage to what areas of brain?

A

medial thalamus and mamillary bodies of hypothalamus

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45
Q

hemiballism is a result of damage to what area of brain?

A

subthalamic nucleus of basal ganlia

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46
Q

huntington chorea is result of damage to what part of brain?

A

striatum (caudate nucleus) of basal ganglia

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47
Q

waterhouse friderichsen syndrome

A

adrenal insufficiency secondary to adrenal haemorrhage
may occur in meningococcal meningitis

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48
Q

osteoporosis risk factors

A

RA
hyperthyroid
hypogonadism (turners, testosterone def)
GH def
hyperparathyroid
DM
multiple myeloma, lymphoma
IBD, liver disease
CKD
osteogenesis imperfecta, homocystinuria

SSRIs, antiepileptics
PPIs
glitazones
long term heparin
aromatase inhib

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49
Q

DEXA values

A

T score:
> -1.0 normal
-1.0 to - 2.5 osteopenia
< -2.5 osteoporosis

Z score is adjusted for age, gender, ethnicity

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50
Q

polyarteritis nodosa

A

fever, malaise, arthralgia
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure
pANCA in 20% of cases
hep B in 30%

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51
Q

ANCA targets

A

cANCA serine proteinase 3 PR3
pANCA myeloperoxidase MPO

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52
Q

what drugs may exacerbate myaesthenia gravis?

A

penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoin
gent, macrolides, quinolones, tetracyclines

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52
Q

extradural vs subdural haematoma

A

extradural: lucid period, usual major injury, middle meningeal artery

subdural: fluctuating consciousness, usually minor injury, bridging veins

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53
Q

Miller Fisher syndrome

A

guillain barre variant
ophthalmoplegia, areflexia and ataxia
descending rather than ascending
anti GQ1b in 90%

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54
Q

guillain barre antibodies

A

anti GM1

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55
Q

site of lesion causing bitemporal hemianopia

A

upper quadrant defect: pituitary
lower quadrant defect: craniopharnygioma

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56
Q

demyelinating vs axonal peripheral neuropathies

A

axonal:
alcohol, DM, vasculitis, HSMN type 2, B12 def (may also be demyelinating)

demyelinating:
GBS, HSMN type 1, paraprotein neuropathy, amiodarone, chronic inflam demyelinating polyneuropathy

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57
Q

phenytoin side effects

A

fever, rash, hepatitis, dupuytrens, aplastic anaemia, drug induced lupus
dizziness, diplopia, nystagmus, slurred speech, ataxia
gingival hyperplasia, hirsuitism, coarsening of facial features
megaloblastic anaemia
peripheral neuropathy
enhanced vit D metabolism, osteomalacia
dyskinesia, lymphadenopathy
cleft palate and congenital heart disease

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58
Q

management of restless legs

A

dopamine agonists (ropinirole, pramipexole)
benzos
gabapentin

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59
Q

homocystinuria

A

autosomal recessive
deficiency of cystathionine beta synthase
fine, fair hair, marfinoid, osteoporosis, kyphosis
LDs, seizures, inferonasal dislocation of lens, myopia
arterial/venous VTE, malar flush, livedo reticularis
tx with vit B6 pyridoxine

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60
Q

HLA DRB1 is associated with what?

A

HLA DR4

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61
Q

examples of G protein coupled receptors

A

generally slow transmission, metabolic processes

Gs (stimulates adenylate cyclase to increase cAMP): beta1, beta2, H2, D1, V2, ACTH, LH, FSH, PTH, PGs

Gi (inhibits adenylate cyclase to decrease cAMP): M2, alpha2, D2, GABAB

Gq (activates phospholipase C): alpha1, H1, V1, M1, M3

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62
Q

examples of guanylate cyclase receptors

A

ANP, BNP

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63
Q

examples of tyrosine kinase receptors

A

insulin, IGF, EGF
PRL, immunomodulators, GH, GCSF, EPO, TPO

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64
Q

examples of ligand gated ion channel receptors

A

generally fast responses
nicotinic acetylcholine, GABAA, GABAC, glutamate

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65
Q

cushing’s reflex

A

HTN, bradycardia, wide pulse pressure
result of increased ICP

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66
Q

B2 (riboflavin deficiency)

A

angular cheilitis

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67
Q

B3 (niacin) deficiency

A

pellagra
dermatitis, diarrhoea, dementia

may occur in carcinoid syndrome

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68
Q

nerves running through foramen ovale, foramen rotundum

A

ovale: mandibular nerve
rotundum: maxillary nerve

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69
Q

cytokines and their sources

A

IL-1 macrophages (acute, fever)
IL-2 Th1 (
IL-3 activated Th
IL-4 Th2
IL-5 Th2 (eosinophils)
IL-6 macrophages, Th2
IL-8 macrophages (neutrophil chemotaxis)
IL-10 Th2 (inhibits Th1 cytokines)
IL-12 dendritic cells, macrophages, B cells (activates NK)
TNFa macrophages (fever, neutrophil chemotaxis)
IFNgamma Th1 (activates macrophages)

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70
Q

layers of epidermis

A

stratum corneum: flat scaley cells filled with keratin
stratum lucidum: clear layer present in thick skin only
stratum granulosum: cells form link with neighbours
stratum spinosum: squamous cells synthesise keratin, thickest layer
stratum germinativum: basement membrane, columnar, gives rise to keratinocytes and contains melanocytes

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71
Q

RAAS and where the hormones are secreted from

A

adrenal cortex GFR ACD
zona Glomerulosa: Aldosterone, mineralocorticoids
zona Fasciculata: Cortisol, glucocorticoids
zona Reticularis: androgrens, DHEA

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72
Q

lysosome vs peroxisome vs proteosome

A

lysosome: breaks down large molecules e.g. proteins, polysaccharides
peroxisome: breaks down v long chain FAs and amino acids
proteosome: degrades protein that has been tagged with ubiquitin

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73
Q

nucleolus vs ribosome vs nucleus

A

nucleus: DNA maintenance, RNA transcription, RNA splicing
ribosome: RNA translation > proteins
nucleolus: ribosome production

74
Q

T helper 1 vs T helper 2 cells

A

Th1: cell mediated response and type IV hypersensitivity, secrete IFN gamma, IL2, IL3

Th2: antibody (humoral) immunity e.g. IgE in asthma, secrete IL4, IL5, IL6, IL10, IL13

75
Q

how to calculate number needed to treat

A

NNT= 1/ absolute risk reduction

76
Q

how to calculate standard error of the mean

A

standard deviation/sq root of n

77
Q

causes of drug induced thrombocytopenia

A

quinine
abciximab
furosemide
penicillins, sulfonamides, rifampicin
carbamazepine, valproate
NSAIDs, heparin
linezolid

78
Q

diphtheria features and management

A

grey membrane on tonsils
bulky cervical lymphadenopathy
heart block
neuritis

mx: antitoxin + IM penicillin

79
Q

mumps meningitis

A

low CSF glucose

80
Q

lyme disease management

A

doxy (amox if c/i e.g. pregnant)
ceftriaxone if disseminated

81
Q

what ophthalmological conditions are associated with charles bonnet syndrome?

A

mostly ARMD
glaucoma, cataracts

82
Q

tamiflu vs relenza

A

tamiflu- oral, neuraminidase inhibitor and prevents new viral particles being released
relenza- inhaled, neuraminidase inhibitor, c/i in asthmatics

83
Q

what drugs can cause toxic epidermal necrolysis?

A

phenytoin, carbamazepine
sulfonamides
allopurinol
penicillins
NSAIDs

84
Q

What does Antithrombin III do?

A

Inhibits thrombin, factor X, factor IX
Mediates effects of heparin

85
Q

gram negative and gram positive cocci

A

G neg: neisseria, moxarella
G pos: staph, strep

86
Q

gram positive bacilli (rods)

A

ABCDL
Actinomyces
Bacillus antracis
Clostridium
Diphtheria
Listeria

87
Q

aminoglycoside mechanism

A

binds to 30s > misreads mRNA

88
Q

tetracycline mechanism

A

binds to 30s > blocks binding of tRNA

89
Q

chloramphenicol mechanism

A

binds to 50S > inhibits peptidyl transferase

90
Q

mechanism of macrolides

A

binds to 50S > inhibits translocation

91
Q

calculating variance

A

square of standard deviation

92
Q

what organs are in direct or indirect contact with kidneys?

A

right kidney:
direct- right suprarenal gland, duodenum, colon
indirect- liver, distal small intestine

left kidney:
direct- left suprarenal, pancreas, colon
indirect- stomach, spleen, distal small intestine

93
Q

what drugs can be cleared with haemodialysis?

A

BLAST
Barbiturates
Lithium
Alcohol
Salicylates
Theophylline

94
Q

causes of autoimmune haemolytic anaemia

A

warm: SLE, lymphoma, CLL, methyldopa
cold: lymphoma, mycoplasma, EBV

95
Q

causes of haemolysis: intravascular vs extravascular

A

intravascular:
mismatched transfusion
G6PD def
heart valves, TTP, DIC, HUS
paroxysmal nocturnal haemoglobinuria
cold AIHA

extravascular:
sickle, thalassaemia
hereditary spherocytosis
haemolytic newborn
warm AIHA

96
Q

rasburicase mechanism

A

converts uric acid to allantoin
for tumour lysis

97
Q

diagnosing paroxysmal nocturnal haemolysis

A

flow cytometry- low levels of CD59, CD55
mx: anticoag, eculizumab, stem cell

98
Q

leukaemioid reaction

A

caused by severe infection, haemolysis, haemorrhage or metastatic cancer with marrow infiltration
> immature cells pushed out into circulation

high ALP
toxic granulation (dohle bodies) in white cells
left shift of neutrophils

99
Q

causes of rapidly progressive GN

A

goodpastures, ANCA vasculitis

100
Q

IgA nephropathy

A

Bergers/mesangioproliferative
haematuria after URTI

101
Q

diffuse proliferative GN

A

post strep
SLE

102
Q

membranoproliferative

A

type1: cryoglobulinaemia, hepC
type 2: partial lipodystrophy

103
Q

focal segmental glomerulosclerosis

A

HIV, heroin, idiopathic

104
Q

CLL treatment

A

FCR
fludarabine + cyclophosphamide + rituximab

105
Q

apremilast

A

PDE4 inhibitor
(reduces hydrolysis of cAMP)
used for psoriatic arthropathy

106
Q

DRESS

A

triad: extensive skin rash, high fever, organ involvement
eosinophils
reaction to medications 2-8 weeks after starting drug

107
Q

management of pyoderma granulosum

A

PO prednisolone

108
Q

brugada inheritance

A

auto dominant

109
Q

criteria for starting statin in T1DM

A

over 40y or
diabetes > 10y or
established nephropathy or
other CVD risk factors

110
Q

which chemo agents are cardiotoxic?

A

anthracyclines- doxorubicin, epirubicin

111
Q

treating ovale or vivax malaria

A

chloroquine then primaquine to destroy liver hypnozoites

112
Q

acute intermittent porphyria vs porphyria cutanea tarda

A

AIP: defective porphobilinogen deaminase
PCT: defective uroporphyrinogen decarboxylase
photosensitive blistering rash on face and dorsal hands, hypertrichosis, hyperpigmentation

113
Q

management of multifocal atrial tachycardia

A

correct hypoxia and electrolytes
rate limiting CCB

114
Q

location of G protein coupled receptors

A

span cell membrane

115
Q

pyrazinamide mechanism and side effects

A

inhibits fatty acid synthase

hyperuricaemia, gout
arthralgia, myalgia
hepatitis

116
Q

ethambutol mechanism

A

inhibits arabinosyl transferase so prevents polymerisation of arabinose into arabinan

117
Q

mechanism of thiazide diuretics

A

block NaCl symptorter
> inhibit Na reabsorption at beginning of DCT
increased delivery of sodium to distal DCT

118
Q

conditions associated w/ pseudogout

A

haemochromatosis
acromegaly
wilsons
hyperPTH
low Mg, low PO4

119
Q

breakthrough morphine dose

A

1/6th total daily dose

120
Q

increasing opioid dose

A

30-50%

121
Q

drugs for metastatic bone pain

A

opioids
bisphosphonates
RTX
denosumab

122
Q

codeine to morphine

A

divide by 10

123
Q

tramadol to morphine

A

divide by 10

124
Q

morphine to oxycodone

A

divide by 1.5 to 2

125
Q

PO morphine to SC diamorphine

A

divide by 3

126
Q

12 microgram patch of fentanyl is equivalent to how much PO morphine?

A

30mg

127
Q

10micrograms transdermal buprenorphine is equivalent to how much PO morphine?

A

24mg

128
Q

pulsus paradoxus

A

> 10mmHg fall in SBP during inspiration
faint or absent pulse on inspiration

seen in severe asthma and cardiac tamponade

129
Q

collapsing pulse

A

aortic regurgitation
PDA
hyperkinetic states (anaemia, thyrotoxicosis, fever, exercise, pregnancy)

130
Q

pulsus alternans

A

regular alternation of force
seen in severe LVF

131
Q

non pulsatile JVP

A

SVC obstruction

132
Q

parts of JVP waveform

A

A- atrial contraction (large in TS, PS, pHTN; absent in AF)
cannon A- complete HB, VT, V ectopics, nodal rhythm, single chamber pacing

C- tricuspid closure
V- passive filling against closed tricuspid. (giant in TR)
X descent- fall in atrial pressure during ventricular systole
Y descent- opening of tricuspid valve

133
Q

when is metformin indicated in T1DM?

A

BMI > 25

134
Q

dipyridamole mechanism

A

non specific phosphodiesterase inhibitor
decreases cellular uptake of adenosine

135
Q

ticagrelor mechanism

A

directly blocks P2Y12 platelet activator

136
Q

clopidogrel mechanism

A

prodrug
metabolites inhibit ADP binding to P2Y12 receptor
> stops activation of GPIIb/IIIa

137
Q

actions of vitamin D

A

increases renal reabsorption of PO4
increases renal reabsorption and gut absorption of calcium
increases osteoclast activity

138
Q

asthma ladder

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA + LTRA
  5. SABA +/- LTRA, switch ICS/LABA for ICS/LABA MART
  6. SABA +/- LRTA + medium dose ICS/LABA MART or SABA +/- LRTA + medium dose ICS + LABA
  7. SABA + LRTA + high dose ICS or SABA + LRTA and trial theophylline or refer to resp
139
Q

which part of nephron is impermeable to water?

A

ascending limb of Henle

140
Q

which drugs cause hypoglycaemia?

A

sulfonylureas (gliclazide)

141
Q

which diabetes drugs can cause weight gain?

A

sulfonylureas (gliclazide), glitazones/thiazolidinediones

142
Q

COPD ladder

A
  1. SABA or SAMA
  2. LABA + ICS if steroid responsive/asthma features
    LABA + LAMA if no asthmatic features
  3. LABA + LAMA + ICS
143
Q

inducing remission in UC

A

mild/mod: rectal aminosalicylate > add PO aminosalicylate > add corticosteroid

extensive disease: rectal aminosalicylate + PO aminosalicylate > PO aminosalicylate + PO steroid

severe colitis: IV steroids or ciclosporin

144
Q

maintaining remission in UC

A

mild/mod: topical aminosalicylate
mild/mod extensive or left sided: PO aminosalicylate
severe or 2 exacerbations last year: PO azathioprine or mercaptopurine

145
Q

inducing and maintaining remission in crohn’s

A

glucocorticoids
5 ASA drugs second line
azathioprine/mercaptopurine/MTX add ons
infliximab
metronidazole for isolated perianal disease

maintaining: azathioprine/mercaptopurine 1st line, MTX second line

146
Q

rapidly progressive glomerulonephritis

A

AKA crescenteric
causes: Goodpastures, ANCA vasculitis

147
Q

mixed nephrotic/nephritic presentation

A

diffuse proliferative/post strep
membranoproliferative/mesangiocapillary

148
Q

membranoproliferative glomerulonephritis

A

AKA mesangiocapillary
presents as mixed nephrotic/nephritic
1: cryoglobulinaemia, hep C
2: partial lipodystrophy

149
Q

nephrotic syndromes

A

min change (Hodgkins, NSAIDs)
membranous GN (infections, rheum drugs, malignancy)
focal segmental (HIV, heroin)

150
Q

glucose and protein in CSF in meningitis

A

protein:
high in bacterial/TB and fungal
normal/high in viral

glucose:
< 1/2 plasma in bacterial/TB
60-80% plasma in viral. lower in HSV and mumps

151
Q

sick euthyroid

A

everything is low (TSH, T3, T4)
sometimes TSH is normal

152
Q

amiodarone induced thyrotoxicosis

A

type 1: goitre present, excess iodine. mx w/ carbimazole or percholate

type 2: destructive. no goitre. mx w/ steroids

stop amiodarone in both types

153
Q

subacute/de Quervains thyroiditis

A

phases:
1- hyperT, painful goitre, ESR raised
2: euthyroid
3: hypothyroid
4: normal

globally reduced uptake of iodine 131

154
Q

papillary thyroid ca features and mx

A

most common type
often young females, good prognosis
papillary projections and pale empty nuclei, seldom encapsulated
lymph node mets mostly; haem mets rare
mx: total thyroidectomy then radioiodine to kill residual cells. annual thyroglobulin levels to detect recurrence

155
Q

follicular thyroid ca features and mx

A

solitary thyroid nodule
second most common thyroid malignancy
mx: total thyroidectomy then radioiodine to kill residual cells and annual thyroglobulin levels to detect recurrence

156
Q

medullary thyroid ca

A

parafollicular C cells, secrete calcitonin
derived from neural crest tissue
nodal disease associated w/ poor prognosis

157
Q

secondary hyperparathyroidism

A

PTH hyperplasia as a result of low calcium (usually CKD)
PTH high, Ca low or normal, PO4 high, vit D low

158
Q

tertiary hyperparathyroidism

A

ongoing hyperplasia of PTH after correction of underlying renal disorder
PTH high, ca normal/high, PO4 normal/low, ALP high

159
Q

acromegaly management

A

surgery first line
somatostatin analogue (ocreotide)
GHr antagonist (pregvisomant)
dopamine agonist (bromocriptine)

160
Q

addisons investigations

A

ACTH stimulation test
hyperK, hypoNa, metabolic acidosis

161
Q

cushing’s investigations

A

dexa suppression test
24h urinary cortisol x2
hypoK metabolic alkalosis

162
Q

hyperaldosteronism investigations

A

hypoK, metabolic alkalosis, HTN
plasma aldosterone/renin ratio
> CT abdomen and adrenal vein sampling

163
Q

drugs that can exacerbate MG

A

penicillamine
procainamide, quinidine
beta blockers
aminoglycosides, macrolides, quinolones, tetracylines
phenytoin
lithium

164
Q

target BP

A

< 80: 140/90
> 80: 150/90

165
Q

ciclosporin and tacrolimus mechanism

A

inhibit calcineurin in T cells
> decrease IL2

166
Q

mycophenolate mofetil mechanism

A

inhibits inosine monophosphate dehydrogenase

167
Q

dermatitis herpetiformis biopsy

A

IgA deposits

168
Q

cutanea larva migrans mx

A

thiabendazole

169
Q

PRV may progress into what?

A

AML or myelofibrosis

170
Q

tetanus management

A

immunoglobulin + metronidazole IV

171
Q

leprosy management

A

rifampicin + dapsone + clofazimine
12 months

172
Q

sarcoidosis indications for steroids

A

CXR stage 2/3 disease and symptomatic
hypercalcaemia
eye/heart/neuro involvement

173
Q

sarcoidosis CXR stages

A

0: normal
1: b/l hilar lymphadenopathy
2: BHL + interstitial infiltrates
3: diffuse interstitial infiltrates only
4: diffuse fibrosis

174
Q

TB management

A

active TB:
2 months RIPE then 4 months R+I

latent TB:
3 months RIP or 6 months IP

175
Q

features of MS

A

mid-late diastolic murmur
loud S1
low volume pulse
opening snap if leaflets are still mobile
longer murmur if more severe
AF from left atrial enlargement

176
Q

which cells mediate organ rejection?

A

hyperacute: B cells
acute and chronic: cytotoxic and helper T cells

177
Q

causes of aortic regurgitation

A

rheumatic fever
calcific valve disease
rheumatoid, SLE, marfans, EDS, AS
bicuspid valve
infective endocarditis
syphilis
HTN
aortic dissection
> early diastolic murmur, collapsing pulse, wife pulse pressure, head bobbing and nail pulsation

178
Q

reversible vs irreversible features of haemochromatosis

A

reversible:
cardiomyopathy, skin pigmentation

irreversible:
liver cirrhosis, DM, hypogonadotrophic hypogonadism, arthropathy

179
Q

causes of diabetes insipidus

A

nephrogenic:
ADH receptor or aquaporin 2 channel defects
hypercalcaemia
hypokalaemia
lithium
demeclocycline
tubulointerstitial disease (obstruction, sickle cell, pyelonephritis)

cranial:
head injury, pituitary surgery, craniopharyngiomas
histiocytosis X, sarcoidosis
DIDMOAD
haemochromatosis

180
Q

scleritis vs episcleritis

A

scleritis painful; episcleritis not painful

181
Q

features of congenital rubella

A

sensorineural deafness
cataracts

182
Q

causes of membranous GN

A

hep B, malaria, syphilis
malignancy
gold, penicillamine
SLE, RA, AI thyroiditis

183
Q

drugs to avoid in HOCM

A

nitrates
ACEi
inotropes

summary (2 decks)

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