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RACP 2022 Written > Things To Memorise String of Pearl + other > Flashcards

Things To Memorise String of Pearl + other Flashcards

1
Q

Causes of NAGMA?

A

U- Ureteric Fistula
S Small bowel fistula
E Extra Chloride
D Diarrhoea
C Carbonic anhydrase inhibitors
A Addison’s (type 4 - RTA hyperK)
R RTA (1&2, hypo K)
P Pancreatic fistula

NAGMA vs HAGMA?

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2
Q

Metabolic Acidosis - High Anion GAP - Causes

A

CAT MUDPILES, >12.
C - Cyanide
A Alcohols
T Toluene
M methanol metformin
U uraemia
D DKA
P Paracetamol paraldehyde
I Isoniazid Iron
L Lactate
E ethylene glycol
S Salicylates sepsis

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3
Q

Causes of Metabolic Alkalosis?

A

CLEVER PD
Contraction - dehydration
Liquroice , laxative abuse
Endocrine (Conn’s and Cushings
Vomiting
Excess alkali (antacids)
REnal (bartter’s, severe K depletion
Poster hypercapnia
Diuretics

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4
Q

Abx Protein Synthesis Inhibitors acting on ribosomes>

A

50s Subunit: Erythromycin, Clindamycin
30s: Aminoglycosides (gent), Tetracylces
Both: linezolid

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5
Q

Abx Mech Folic Acid Synthesis in cytoplams

A

sulfonamids, trimethoprim

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6
Q

ABx Mech : cell walll inhbiors - blocks synthesis/repair

A

penicillins, cephalosproins
carbapensems
vanc
fosfomycin, ioniazide

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7
Q

Abx mech Cell Membrane - loss of permeability

A

Daptomycin, polyxins

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8
Q

ABx Mech: act at DNA/RNA

A

Inhibit replication and transcription inhibiyt gyrase - quinolones,

Inhibit RNA polymerase - Rifampin

DNA Damage - metronidazole nitrofurantoin

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9
Q

Mech of Colistin Abx?

A

Binding to LPS and phospholipids in the outer cell membrane

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10
Q

Anti-epileptic Drugs: Act at sodium channel

A

Carbamazepine, Lacosamide, lamotrigine, phenytoin, topiramate, zoniamide (Act where?)

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11
Q

Anti-Epilepetic Drugs Alpha2-gamma modification mechanism at voltage gated calcium channels which drugs?

A

gabepentin, pregabalin

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12
Q

Anti-eplileptic Drugs: Which are calcium channel blockage

A

Ethosuximide, Lamotrigine, Zonisamdie

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13
Q

Anti-Epileptic Drugs: act by modulation of SV2a medicated neurotransmitter realease - at synatpic vesicle proteins

A

Levetiracetam (keppra) mechanism?

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14
Q

Anti-Epileptic Drugs: mech potassium channel activation

A

Retigabine

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15
Q

Anti- Epileptic Drugs: mech antagonism of glutamate (at NMDA or AMPA receptors) at synapse?

A

Lamotrigine (NMDA), Topiramate (AMPA)

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16
Q

ANti-Epileptic Drugs: mech potentiation of GABA activity at inhbitor neuron

A

Barbiturates, Benzodiazepines, Topiramate, Valporate

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17
Q

Drug Interaction: Valproate + lamotrigine

A

Lamotrigine metabolised by N-glucorondiation, Valporate may cause sig rise in plasma concetration by competitively inhibiting its glucoronidation&raquo_space; increased lamotrigine levels

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18
Q

Interaction Valproate + carbapenems

A

Decreased efficacay of sodium valproate - 60 to 100% decrease in valproate plasma conc

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19
Q

Carbamaz, phenytoin, phenobarb effect on lamotrigine?

A

All CYP3A4 inducers > decrease lamotrigine levels

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20
Q

Carbamaz, Phenytoin, Phenobarb interaction with OCP?

A

All decrease efficacy of OCP and of Cyclosporin > better to use Valproate inhbits CYP2C9 not CTP3A4

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21
Q

Proportion of breakthrough?

A

1/6th of 24 hour dose of regular opioids

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22
Q

Incontinence in elderly? common type and meds?

A

Common = urge - anticholinergic drugs eg oxybutyin (dementia, can increase IOP, tachycardia), Mirabegron B3 adrenergic (HTN)
Stress = duloxetine, pelvic floor, sling surg for 100% stress.

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23
Q

SE Amitriptyline - anti-cholinergic

A

dry mouth, urinary retention, blurred vision, mydriasis, constipation

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24
Q

SE - cholinestersase inhibitor aka Donepezil

A

GI symptoms (diarrhea, nausea, cramps), vivid dreams and benign bradycardai

25
Mechansim of memantine?
NMDA antagonist. can be used in combo with donepezil (cholinesterase inhibitor)
26
What kind of memory spared in vascular dementia?
Episodic memory?
26
What kind of memory spared in vascular dementia?
Episodic memory?
27
What type of dementia is ApoE4 assoicated with?
ApoE4 - late onset AD Early onset Alzheimers disease: - Presenilin 1 & 2 - B amyloid precusor gene - Down's Syndrome
28
Anti-psych/dep assoc weight loss?
Citalopram, Fluoxetine, Paroxetine
29
What hormones decrease with aging?
male testosterone, growth hormone, basal renin and aldosterone, DHEA
30
Hormones incrase with normal aging?
FSH/LH both sexes Increased insulin resistance incidence of auto-immune throiditis Bone resorption 2nd raise PTH vassopression with increase risk of hypoNA ANP in response to rise in intravascular volume leading to nocturia
31
Neurofibromatosis: Skin changes: Malignancy Assoc:
Skin changes: cafe-au-liat macules, neurofibromas, freckling Malignancy Assoc: schwannoma, gliomas, leukaemias, CNS tumours, sarcoma
32
Tuberous sclerosis (skin and cancer associations?)
Skin: angiofibromas, periungual fibromas, shagreen patches Ca: Sarcoma, rhabdomyoma, renal, angiomyolipoma
33
Gorlin syndrome Skin and Ca associations?
skin: BCCs, palmar pits, typical facies Ca: Medulloblastoma, breast, lymphoma
34
Von hippel Lindau Disease skin/cancer
Cafe-au-lait, haemangiomas cancer: Haemangioblastoma, renal phaeochromaocytoma
35
Wiskott-Aldridge Syndrome (canc/skin assoications)
skin: Eczema Ca: lymphoma, leukaemia
36
Myeloma cut offs
>60% marrow or >100 ratio
37
APTT checks which Pathway? hence which factors? What about the other one?
Checks Intrisnic pathway: prekallikren, HMWK, VIII , IX, XI, XIII, (8.9,11, 12). Extrinsic = III (TF) and VII (7) Common = I, II, IV, V, VI, X, XIII (1,2,4,5,6,10.13)
38
Role of vWF? Featues of vWF Disease. Treatment?
Major Adhesion molecule sticks platelet to exposed subendothelium. Binds FVIII, prolongs half life. In vWF Disease bleeding, prolonged APTT low levelsof vZWF and factor VIII DDAVP releases vWF and FVIII from stores Major side ffect hypoNa
39
Mechansim of Romiplostim/Eltrombopag?
Increased platelet production in marrow. SE: myalgia, joint and extremeity discomfort, insomina, thromboytoiss. fatal clots and bone marrow fibrosis.
40
Intravascular Haemolysis? and characteritic?
Mismatched transfusion g6PD TTP, DIC, HUS, red cell frag from Heart valves PNH Cold AIHD free haemoglobin is excreted in urine a haemoglobinuria. Raised plasma haemoglobin
41
Extravascular hemolysis
Haemoglobinopathies Hereditary spherocytosis Hemolytic disease of newborn Warm AHA
42
Schiztocytes what type of anaemia?
MAHA or TTP or HUS
43
microspherocytes type of anaemia?
Autoimmune hemolytic anemia
44
Macrocytosis and PMN with hypersegmented nuclei
B12 deficiency
45
Target cells?
Thalassemias and liver disease.
46
What does Cryoprecipitae contain, Used in Tx for?
5 F's, Fibrinogen, F VIII, F XIII, von willebrane factor and fibronectin Used: dysfibrogenmia, DIC, vWD
47
Which factors Heamophilia B vs Heamophilia A
A - VIII, B IX
48
Common translocations t(9;22) T(15:17) T(8:14) t(11:14)
t(9;22) - phli - 95% of CML (good), also in ALL bad factor T(15:17) aPML (fusion PML and RAR alpha genes T(8:14): Burkitts - Myc oncogene + Ig t(11:14): Mantle cell cyclin D1 and Ig.
49
HypoSpleen associations?
Sickle cell, Celiac disease, graves, SLE, amyloid. HOwell jolly bodies Siderocytes
49
HypoSpleen associations?
Sickle cell, Celiac disease, graves, SLE, amyloid. HOwell jolly bodies Siderocytes
50
Tx aplastic anaemia
blood products + prevent infection ATG and ALG (anti-thymocyge and antilymphocyt eglobulin) - can provoke serum sickness. Stem cell transplant ciclosporin
51
Conditions associated with low uptake radioacitve iodine thyroid scan?
1: patients on thyroxine 2: subacute thyroiditis 3: postpartum throiditis 4:amiodarone therapy 5: ectopic thyroid tissue
52
Factors cause low T3
High cortisol, cytokines, drugs inhbiti deiodinase (propranolol, amiodarone)
53
Factorrs cause low T4
reduce dhormone binding proteins reduced binding to proteins
54
factors cause low TSH
Glucocorticoids Dopaimine
55
Step of VIt D synthesis
1 SKIN: 7 Dehydrocholesterol > vitamind D3 cholecalciferol UV light 2 Livers: D3 hydroxylated to 25 hydroxycholecalciferol (calcidiol) 25-hydroxylase 3. Kidney Calcidiol > to 1,25-dihydroxycholecalciferol (Calcitriol) enzyme 1-aplha hydroxylase_
56
Decrease SHBG
Obesity nephrotic syndrome hypothyroid use of glucocorticiod, progestins and androgenic steriods DIabetes

RACP 2022 Written (21 decks)

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