Things I keep forgetting Flashcards
Features of Gitelman’s
Low potassium
Metabolic alkalosis
Hypomagnesemia
Hypercalcaemia
Hypocalciuria
AR disorder
Mutation of SLC12A3 gene - encodes thiazide sensitive sodium chloride cotransporter n DCT
Features of Bartter’s
Hypochloraemic alkalosis
Normotensive
Hypokalaemia
Hypocalcaemia
Elevated urinary Ca excretion
Elevated urine prostaglandin E
NKCC2, ROMK, CIC-Kb mutation
Features of Gordon’s
Hypertensive
Hyperkalaemia
Low renin and aldosterone
Hypocalcaemia
Opposite effect of thiazide
WNK1 and 4 mutation
Features of Liddle’s
Salt-sensitive hypertension
High rate or renal sodium uptake
Hypokalaemia
Low renin and aldosterone
Mutation of Na channels –> increased number
Features of Fabry disease
X-linked recessive
FABRYC
Foamy urine
a-galactosidase A deficiency/Angiokeratomas
Burning pain in peripheries
Really sweaty/dry
YX genotype (Males)
Cardio-cerebrovascular disease/ceramide trihexoside accumulation
Features of Gaucher disease
AR inherited disease
Deficiency of B-glucocerebrosidase
Hepatosplenomegaly
Pancytopenia
Avascular necrosis of femur
Bone crises
Macrophage inclusions - resembles crumpled tissue paper
Features of McArdle disease
Generalised muscle weakness
Second wind phenomenon - symptoms of muscle fatigue disappear after period of activity
Rhabdomyolysis and myoglobinuria occurring after demanding physical exercise
Wolfram syndrome features
Childhood onset insulin dependent diabetes
Progressive optic atrophy
Diabetes insipidus
Sensorineural hearing loss
The emergence of a pandemic strain of influenza is best explained by which of the following mechanisms?
Antigenic shift in H and N proteins of influenza A.
Adverse effects of methotrexate
Abnormal LFTs
Liver cirrhosis
Pneumonitis
Pulmonary fibrosis
Mouth ulcers
Alopecia
Adverse effects of tocilizumab
Hypertension
Myelosuppression
Dyslipidaemia
GI perforation
Infection
Abnormal LFTs
Adverse effects of TNF inhibitors
Injection site reactions
Drug induced lupus
Demyelinating syndrome
Malignancy
Infection
Reactivated TB
Exacerbation of cardiac failure
Adverse effects of tofacitinib
Abnormal liver function tests
Myelosuppression
Dyslipidaemia
Reactivated TB
Herpes zoster
VTE
Adverse effects of hydroxychloroquine
Photosensitivity
Haemolytic anaeia
Blue-grey skin discolouration
Corneal deposits
Retinal toxicity
Adverse effects of prednisone
Adrenal suppression
Diabetes
Hypertension
Osteoporosis
Psychosis
Mania
Delirium
Depression
Insomnia
Adverse effects of sulfasalazine
Rash
Haemolytic anaemia
Abnormal LFTs
Nausea
Headache
Oligospermia
Adverse effects of leflunomide
Alopecia
Diarrhoea
GIT upset
Hypertension
Pneumonitis
Peripheral neuropathy
Hepatotoxicity
Features of PAN
Constitutional symptoms
MSK symptoms
Rash
Subcutaneous nodules
Renal involvement
Epididymo-orchitis
Features of Takayasu
Stenotic, occlusive or aneurysmal vessels
Diseases of large and medium sized arteries, with predilection for aorta and branches
Criteria for Takayasu
3 or more criteria
- Age of 40 years or younger at disease onset
- Claudication of extremities
- Decreased pulsation of one or both brachial arteries
- Difference of at least 10mmHg in SBP between arms
- Bruit over one or both subclavian arteries or abdominal aorta
- Arteriographic narrowing or occlusion of entire aorta, primary branches, or large arteries in upper or lower extremities not due to other causes
Anti-Scl-70 association
Diffuse cutaneous involvement
ILD
Anti-RNA polymerase III association
Scleroderma renal crisis
Gastric antral vascular ectasia
Anti-PM/Scl
Limited cutaneous involvement
Polymyositis
Dermatomyositis
Better survival rates
Anti Mi-2
Specific antibodies for IIM
Predict classic dermatomyositis with good response to treatment
Anti SRP
Specific antibodies for IIM
Predict severe, treatment resistant disease
Causes of secondary AVN
- Systemic corticosteroid use
- Organ transplant recipients
- Trauma
- Alcohol abuse
- SLE, other connective‐tissue diseases
- Sickle cell disease
- Haemophilia A or B
- Osteoporosis medications (i.e. bisphosphonates, denosumab)
- Bone disorders (slipped capital femoral epiphysis, congenital dysplasia of the hip)
- Radiation therapy
- Malignancy (marrow infiltration, malignant fibrous histiocytoma)
- Pregnancy
- Psoriasis
- Inflammatory bowel disease.
Conditions associated with CPPD
Hyperparathyroidism
Hypothyroidism
Haemochromatosis
Hypomagnesemia and hypophosphatasia
Familial hypocalciuric hypercalcaemia.
Muscle biopsy results of IIM
Perifascicular, perimysial or perivascular B cell infiltrates + CD4+ T helper cells
Antibodies associated with increased risk of malignancy
Anti-TIF-1
Anti-NXP-2
Anticholinergic side effects
Dry mouth
Drowsiness
Blurred vision
Urinary retention
Constipation
Tachycardia
Medications with intended anticholinergic effect
Oxybutynin
Loperamide
Bronchodilators - ipratropium, theophylline, tiotropium
Antiparkinsonian medications - beperiden, amantadine, benztropine
Atropine
Medications with UNintended anticholinergic effect
Antipsychotics (olanzapine, periciazine, chlorpromazine, haloperidol, quetiapine)
Anxiolytic (diazepam, alprazolam)
Anticonvulsants (carbamazepine)
Antidepressants (amitriptyline, bupropion, fluvoxamine, paroxetine, venlafaxine)
Antihistamines
Analgesics
Eye drops
Characteristics of azithromycin
Binds to 50S ribosomal subunit
Inhibits bacterial quorum-sending, reduces biofilm and mucous production, and has immunomodulatory effects
Long half life
Large volume of distribution
Minimal interaction with warfarin
Rarely causes QT prolongation
Can be used in pregnancy
What are biosimilars?
Biological medication that emulates bio-originator or innovative biologic
Clopidogrel metabolism
Prodrug converted to its active metabolite by CYP450 enzymes + CYP2C10 is significant contributor
Active compound then irreversibly binds adenosine diphosphate P2Y12 receptor to decrease platelet aggregation
MOA of ticagrelor and prasugrel
P2Y12 inhibitors
Ticagrelor - active compound with an active metabolite
Prasugrel - inactive compound requiring activation by CYP3A4 and CYP2B6
MOA of memantine
NMDA antagonist and dopamine agonist
Medications that could induce Addisonian crisis
CYP3A4 inducers
- Carbamazepine
- Dexamethasone
- Griseofulvin
- Nevirapine
- Phenytoin
- Rifampin
- St John’s Wort
Common drugs that act by competitive enzyme inhibiition
6-mercaptopurine –> adenylsuccinate synthetase
5-fluorouracil –> thymidylate synthetase
Acyclovir –> DNA polymerase
Allopurinol –> Xanthine oxidase
Alpha methyldopa –> dopa decarboxylase
Celecoxib –> cyclo-oxygenase-2
Methotrexate –> dihydrofolate reductase
Perindopril –> Angiotensin converting enzyme
Rosuvastatin –> HMG-CoA reductase
Features of ethylene glycol poisoning
High anion gap severe metabolic acidosis
Typical oxalate crystals
Renal impairment (due to tubular blockage by oxalate crystals)
Common causes of high anion gap metabolic acidosis
GOLD MARK
Glycols
Oxoproline
L-lactate
D-lactate
Methanol
Aspirin
Renal failure
Ketones
Medications associated with gynaecomastia
Meds with antiandrogenic properties
- Spironolactone
- Alkylating agents
- Bicalutamide
- Flutamide
- Ketoconazole
- Marijuana
- Metronidazole
- Meds with oestrogenic properties
- GnRH agonists
- Oestrogens or oestrogen agonists
- Anabolic steroids
- Diazepam
Medications that induce hyperprolactinaemia
- Haloperidol
- Metoclopramide
Medications with unclear mechanism
- Amiodarone
- Ca channel blockers
- ACE inhibitors
- Finasteride
- Antidepressants
- Minoxidil
Extrarenal manifestations of PCKD
Multiple benign hepatic cysts
Cysts in pancreas, spleen, ovary and testicles
Cerebral berry aneurysms
Cardiovascular - arterial hypertension, MV prolapse, LVH
Colon diverticula, abdominal or inguinal hernias
EIM that parallels course of IBD
Peripheral arthropathy
Erythema nodosum
Sweet’s syndrome
Oral aphthous ulcers
Episcleritis
EIM that has separate course of IBD
Axial arthropathy
Peripheral arthropathy
EIM that may or may not parallel disease activity of IBD
Pyoderma gangrenosum
Uveitis
PSC
High risk groups of HCC
Patients with cirrhosis, Child Pugh class A and B
Patients with cirrhosis, Child Pugh C, if awaiting liver transplant
Non-cirrhotic patients with HBV and following characteristics:
- Active hepatitis
- Family history of HCC
- Africans and African Americans
- Asian males > 40 years
- Asian females > 50 years
Right heart catherisation findings for post-capillary pulmonary HTN
mPAP > 20
PCWP > 15
PVR variable
BOTH ARE HIGH
Suggestive of LVEF
Right heart catherisation findings for pre-capillary pulmonary HTN
mPAP > 20
PCWP < 15
First line management for idiopathic PAH
Ca channel blockers
High risk features of thyroid nodules
Solid hypoechoic nodule or solid hypoechoic component with at least one of following:
- Irregular margins
- Taller-than-wide shape
- Microcalcifications
- Rim calcifications with extruding tissue
- Extrathyroidal extension
Low risk features of thyroid nodule
Isoechoic or hyperechoic solid nodule
Cystic nodule with eccentric solid component
Very low risk features of thyroid nodule
Partially cystic nodule
Spongiform nodule
Benign features of thyroid nodule
Cystic nodules (anechoic) without solid component
Indications for FNAC of thyroid nodules
- Solid hypoechoic nodules >/ 1cm with/without additional sonographic signs of thyroid cancer
- Consider for solid hypoechoic nodules < 1cm if any of following are present:
–> extrathyroidal growth
–> cervical lymphadenopathy
–> symptoms suggestive of distant metastases
–> pt preference for FNAC over observation - partly cystic, isoechoic and hyperechoic nodules >/ 1.5cm
- consider in spongiform or partly cystic nodule >/ 2cm
Bethesda system for thyroid cytopathology
I - nondiagnostic or unsatisfactory
II - benign
III - atypia or follicular lesion of undetermined significance
IV - follicular neoplasm or suspicious for follicular neoplasm
V - suspicious for malignancy
VI - malignant
Major criteria for modified Dukes criteria
- Positive blood culture
- Typical microorganisms from two separate blood cultures
- Microorganisms consistent with infective endocarditis from persistently positive blood cultures
- Single positive BC for coxiella burnetti or phase I IgG antibody titer > 1:800
- Positive echo
- Vegetation, abscess, or new partial dehiscence of prosthetic valve
- New valvular regurgitation
Minor criteria for modified Duke’s crtieria
- Presence of predisposing cardiac condition of IV drug use
- Temperature > 38
- Vascular phenomena
- Immunologic phenomena
- Positive blood cultures that don’t meet major criteria or serologic evidence of active infection
Mechanism of actions of polyenes
E.g. amphotericin B
Binds to cell membrane ergosterol
Forms artificial pores permitting potassium efflux and cell death
Mechanism of action of pyrimidine analogues
E.g. 5-fluorocytosine
Binds to fungal cytosine permease, which imports it into the cell, and is converted to fluorouracil and impairs nucleic acid synthesis
Mechanism of action of azoles
Inhibits C14-a-sterol demethylase
Leads to accumulation of sterol precursors and reduction of ergosterol
Mechanism of echinocandins
e.g. capsofungin, anidulafungin
Inhibits fungal cell wall polysaccharide B-1,3 glucan synthesis
