tx Flashcards
1
Q
sle - renal
A
- steroids
- mycophenalate
- cyclophosmide
2
Q
PMR -
A
steroid cannot betaken anymore
TOCLIZUMAB
3
Q
SLE internal organ
A
prednisilone / cyclophosmaide
4
Q
SLE - antibodies
A
- BELIMUMAB
5
Q
graves disease eye
A
steroids
tociluzimab rituximab
radiotherapy
6
Q
Good pasture mx
A
- plasma exchange
- IV immunoglobulin
- methyprednislone and cyclophospmide
7
Q
guillan barr syndrome Tx
A
IV immunogloblins first
8
Q
Myasthenia gravis Tx
A
- long acting acetylcholine inhibtors - pyridostigmine
- prednisilone
- azathioprine , cyclosporin , mycophenolate motefil
9
Q
MYASTHENIA CRISIS
A
PLASMAPHORESIS
OR
INTRAVENOUS IMMUNOGLOBULINS
10
Q
renal cancer
A
- mycophenolate motefil
11
Q
multiple myeloma
A
- thalidomine / bortezomib
12
Q
ankylosing spondylitis
A
NSAIDS
ANTI - TNF = etanercept / adalimumab
methotrexate/ sulfasalaizne
13
Q
psoriatic arthirits
A
NSAIDS
methotrexate
anti - tif - infliximab / adlaimumab and etanercept
ustekinumab/secukinumab
apremilast - PDE4 inhibtor
14
Q
Pulmonary fibrosis
A
pirfenidone
nintedanib
15
Q
pemphigus vulgaris
A
prednisilone
azathioprine / cyclophosphomide
rituximab
16
Q
adhesive capsulitis
A
NSAIDS
PHYSIO
ORAL / INTRARTIULAR STEROIDS
17
Q
low esr found in ?
A
POLYCETHMIA - JAK 2
18
Q
polycethmia rubra vera treatmnet
A
aspirin - prevent thromembolic events
venesection - first choice
hydroxyurea
19
Q
recative arthritis tx
A
analgesia= NSAIDS
intrarticular steroids
sulfasalazine and mthotrexate if persistant
20
Q
osteoarthritis
A
topical nsaids - first line - esp if hands and knees
oral NSAID
(do not recommend paracetamol or opiods )
intrarticular sterodids
if not = joint replacemnet
21
Q
rheumatoid arthritis tx
A
flares - steroids - short course
maintenance = methotrextate / sufasalaizne / leflunomide / hydroxycholorquine
INAQEUATE REPSONSE TO TWO DMARD INCLUDING METHOTREXATE = TNF A INHIBTORS = adalimumab
rituximab
22
Q
carpal tunnel syndrome
A
intrarticula steroids
brace
or surgery
23
Q
yersinia
A
- quinilones / tetracylie / macrolides / /co-trimoxazole
24
Q
animal bites resistant to amox
A
metrondazole and doxycylin
25
liver abscess
metronidazole + ciprofloxacin +amoxi
amox allergy = metro+ clinda
26
AUTOIMMUNE HEPATITIS
STEROIDS AND AZATHIOPRINE
27
Stills disease features
ana and rf negative
arthralgia
lymphadenopathy
rash - salmon pink
elevated serum ferritin
pyrexia
28
Stills disease Tx
= NSAIDS
steroids - does not mprove prognosis but improoves symptoms
methotrexate / anakinara - against IL1 /anti-TNF
29
CLL can cause
CAN CAUSE warm AUTOIMMUN HEMOLYTIC ANEMIA = need prednisilone if not responding rituximab
30
CLL- FCR not responding
(fludrabine , cyclophosphamide , rituximab)
if not working - irutinib / ALEMTUZIMAB (anti-cd52)
31
HUS tx
fluid replacemnt / blood transfusion / dialysis
plasma exchange and eculuzimab - for non diarrheal
32
PNH
Management
* blood product replacement- pancytopneia
* anticoagulation - thrombotic
* eculizumab, a monoclonal antibody directed against terminal protein C5,
33
sideroblastic anemia features
high ferrtin
iron sat
high iron
basophilic stippling
prussian blue or perls
34
sideroblastic anemia cause ?
myelodysplsi
alcohol
lead
ant-TB
Congenital cause: delta-aminolevulinate synthase-2 deficiency
35
pyoderma gangrenosum Tx
oral steroids
ciclosporin / infliximab
surgery to do with IBS delayed till this is managed
36
psoriasis exacerbation
* alcohol
* drugs: beta blockers,
* lithium,
* antimalarials (chloroquine and hydroxychloroquine), NSAIDs
* ACE inhibitors,
* infliximab
* withdrawal of systemic steroids
37
mycophenlate side effects
tremor / hypertonia / somnolence
38
evolocumab / ezetemibe
educed cholestrol
ezetimibe - reduces cholesterol from small intestine
39
disseminated gonoccoal infection = spread to knee
iv ceftriaxone
39
diabetic foot ulcer
co - amoxiclav
40
pneumocystic jirovecii prophylaxis =
trimethoprim sulfmethoxazole
41
SBP - Tx
iv pip/taz iv cefoaxim
42
cystine stones Tx
penicillamine
43
HLA-B58 related to ?
steven johnson syndrome
or drug rcausing eosinophilia and systemic symtoms
44
HLAB52= related to
TAKYASU ARTERITIS
ULCERATIVE COLITIS
45
allopurinol side effects with
azathioprine (as azathioprine is converted to 6 mercapturine = xanthine oxidase responsible to oxidate this
theophyline - as allopurinol is a CYP enzyme inhibtor
cyclophosmide = allopuirnol reduces its renal clearance
46
WASP
recurrent bacterial chest infection
eczema
thrombocytopenia
low IgM
47
heerfordt syndrome
parotid enlargemnet and fever - seocndary to sarcoidosis
48
what is thin basemnet mebrane disease -
perisiant micosopic heamturea
AD - disorder of collagen 4 / family history of microspic heamturea without kidney failure
normotension and creatinin levels
49
which abx causes agranulocytosis ?
trimethoprim
50
what is cetuximab
- epidermalgrowth factor inhibtor
51
what iswhat is nivolumab
programmed cell death inhibitor
used as chemotherapy
for T cells to alert other cells of cancerous cell
52
insulinoma tx
rapid weight gain
diplopia
hypoglycaemia
CT pancreas
surgery
diazoxide / somatostatin
53
BRUCELLOSIS TX and feature in clinical lab
WBC normal
Dry cough, fever , multiple joint pain
doxy + Rifampicin
erythromycin
54
shigella tx
none
unless immunocomprmised then ciprofloxacin
55
what has absent cornea reflex ?
vestibular shwanoma - tinitus and vertigo and abesnt corneal reflex
56
campylobacter
macrolides
then fluroquinilones
57
convex st segment elevation ?
burgada - v-v3 followed by t wave inversion
58
concave st elevation
pericarditis
59
what do we give in gas gangrene - clostridium perfingens
clindamycin and metronidazole
60
posterior cerebellar artery stroke feature
contralateral homonymous hemianopia - with macula sparing
visual agnosia
61
weber syndrome
branches of posterior after supplying midbrain
- ipsilateral cn3 palsy
-contralateral weakness of upper and lower extremity
62
anterior inferior cerebellar artery
same s wallenberg - put ipsilateral facial paralysis and deafness
63
drug for dermatitis herpetiformis
dapsone
64
diverticulosis feature and tx
LLQ
FEVER - RAISED WBC
MORE IN COPD AND INCREASED AGE
CAN HAVE DIARRHEA MIXED WITH BLOOD
RESPOND WELL TO iv fluids and IV co-amoxiclav
65
dominant temporal lobe affected ?
receptive aphasia
dyslexia
impaired VERBAL MEMORY
WORD AGNOSIA
INABILITY TO INTERPRET WORDS SAID
66
non dominant temporal lobe affected ?
impaired musical skills
impaired non verbal memory
67
lichen planus tx
potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or azahioprin , ciclosporin
68
TX of whipple disease ?
2 weeks of IV therapy is must
1) ceftriaxoe or penicillin
co trimoxazole nd tetracyclines are alternatives
69
function of tociluzimab ?
IL6- INHIBTOR
USED IN RHEUAMTOID NOT CONTROLLED BY DMARDS AND ANT-TNF
PMR
AND ALSO TEMPORAL ARTERITIS
70
nephrogenic DI - failing to respond to solute or protein reduction is given?
hydrochlorothiazide
71
Oculogyric crisis tx
benztropine or procyclidine
72
Oculogyric crisis causes
restlessness, agitation
involuntary upward deviation of the eyes
Causes
antipsychotics
metoclopramide
postencephalitic Parkinson's disease
73
membranous nidiopathic membranous nephropathy TX ?
idiopathic/ chronic - rituximab
rapidly progressive - steroids and cyclophosphamide
74
polyarteritis nods usually seen in ?
hep B
mononeuritis multiplex, sensorimotor polyneuropathy
LIVIDO RETICULARIS
75
ANA and p-ANCA stands for ?
ANA - anti-nuclear
ANCA - anti neutrophil
76
raloxifene- decrease the risk of
breast cancer
increase VTE risk
77
STRONIUM RANELATE - CONTRAINDICATED IN
IN SIGNIFICANT HEART DISEASE
78
Klinefelter's syndrome dx?
elevated gonaditropin levels but low testosterone
xxy
79
difference between viral labrynthitis and vestibular neuritis
both have recent viral infection
viral labrynthitis - sudden onset vertigo
hearing loss may happen
vestibular neuritis - recurrent vertigo lasting days and and hours
NO HEARING LOSS
80
hyperparathyroidism
Indications for surgery
serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
81
TTP tx ?
abx worsen
plasma exchange
steroids/ immunosuppressants (rituximab)
vincristine
82
dermatomyositis not controlled by prednisolone ?
azathioprine
if co existing lung disease - cyclosporin and cyclophosmaide
83
Dx of guillan barre syndrome
LP - ISOLATED ELEVATED PROTEIN, normal white cell count
Nerve conduction studies - decreased velocity due to demyelination
84
Cause of which immunoglobulin deficiency makes blood transfusion reaction
IgA (most common immunoglobulin deficiency)
85
How is brugada syndrome different from HOCM AND long QT syndrome
Vfib occurs at night unlike HCOM and long qt syndrome which occurs more during the day and related to exercise
Resistant to anti arrythmia - ICD needed
AJMALINE and flecainide used to see the ECG changes
86
Difference between different dyslipidemia
Familial heterozygous hyperlipidemia
Total cholesterol rise mainly LDL
TG stay stable
Cardiovascular disease - same in homozygous however cardiovascular disease states at teenage years
Familial combined- increase in total cholesterol and triglycerides
87
Common cause of third nerve palsy
Posterior communicating artery aneurysm
Cavernous sinus thrombosis - usually 6th nerve palsy before and associated with sinusitis
88
Chest drain insertion location
5th intercostal space mid axillary line
Tension - The preferred insertion site is the 2nd intercostal space in the mid-clavicular line in the affected hemithorax.
89
Abx given in tetanus alongside tetanus immunoglobulin
Metronidazole
90
VOMITING LEADS TO
HYPOCHLORAEMIC acidosis
91
Difference between Becker and duchenne dystrophy
progressive proximal muscle weakness
Gower's sign: child uses arms to stand up
Calf pseudohypotrophy
Duchenne - occurs from 5 years early
Becker from 10 years AND NO INTELLECTUAL IMPAIRMENT
92
Which juice is a potent inhibitor of CYP3A4
Grapefruit
93
Causes of drug induced lupus and investigations
Anti ANA positive
Anti-DS DNA NEGATIVE
Anti-histone POSITIVE
Anti-ro - POSITIVE
Anti- smith POSITIVE
Hydralazine
Isoniazid
Phenytoin
Procainamide
94
prophylaxis of CMV
valganciclovir
95
what antipsychotic is used in Parkinson when presented with schizophrenia ?
quetiapine / clozapine
96
TX for sagittal sinus thrombosis ?
enoxaparin
97
barrett oesophagus tx ?
metaplasia -endoscopy every 3-5 years
low grade dysplasia - endoscopy radio frequency ablation
98
SAAG > 11g/L
indicates ?
(indicates portal hypertension)
= cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
Cardiac
right heart failure
constrictive pericarditis
Other causes
Budd-Chiari syndrome
portal vein thrombosis
veno-occlusive disease
myxoedema
99
SAAG <11g/L
indicates ?
Hypoalbuminaemia
nephrotic syndrome
severe malnutrition (e.g. Kwashiorkor)
Malignancy
peritoneal carcinomatosis
Infections
tuberculous peritonitis
Other causes
pancreatitis
bowel obstruction
biliary ascites
postoperative lymphatic leak
serositis in connective tissue diseases
100
Pleural effusion: causes
Transudate (< 30g/L protein)
Transudate (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs' syndrome
101
what can transform into AML ?
primary polycethmia
102
tx for resistant eczema to - topical steroids and tacrolimus ?
ciclosporin / azathioprine / mycophenolste
103
pytriasis resistant to ketaconazole ?
oral itraconazole
104
Tx for erythrodermic psoriasis ?
ciclosporin
105
