Thursday [27/4/23]

Question 1

SE of steroids

Answer 1

Glucocorticoid side-effects
endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
Cushing’s syndrome: moon face, buffalo hump, striae
musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head
immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
psychiatric: insomnia, mania, depression, psychosis
gastrointestinal: peptic ulceration, acute pancreatitis
ophthalmic: glaucoma, cataracts
dermatological: acne
suppression of growth in children
intracranial hypertension
neutrophilia

Mineralocorticoid side-effects
fluid retention
hypertension

Question 2

isotretinoin adverse effects

Answer 2

teratogenicity - females MUST be taking contraception
low mood
dry eyes and lips
raised triglycerides
hair thinning
nose bleeds

Question 3

SLE kidney Cx

Answer 3

class I: normal kidney
class II: mesangial glomerulonephritis
class III: focal (and segmental) proliferative glomerulonephritis
class IV: diffuse proliferative glomerulonephritis
class V: diffuse membranous glomerulonephritis
class VI: sclerosing glomerulonephritis

Question 4

Which part of the immune cells do immunoglobulins bind to? [1]

Answer 4

Immune cells bind to the crystallising region (Fc) of immunoglobulins

Question 5

what is associated with glacuoma? [2]

Answer 5

Acute angle closure glaucoma is associated with hypermetropia, where as primary open-angle glaucoma is associated with myopia

Question 6

Tx for gonorrhoea? ]1[

Answer 6

IM ceftriaxone

Question 7

features of organophsophate poisoning

Answer 7

Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation

Question 8

SE of quinolones

Answer 8

Quinolones are a group of antibiotics which work by inhibiting DNA synthesis and are bactericidal in nature. Examples include:
ciprofloxacin
levofloxacin

Mechanism of action
inhibit topoisomerase II (DNA gyrase) and topoisomerase IV

Mechanism of resistance
mutations to DNA gyrase, efflux pumps which reduce intracellular quinolone concentration

Adverse effects
lower seizure threshold in patients with epilepsy
tendon damage (including rupture) - the risk is increased in patients also taking steroids
cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children
lengthens QT interval

Contraindications
Quinolones should generally be avoided in women who are pregnant or breastfeeding
avoid in G6PD