VIA III Flashcards
What bacteria is associated with mesenteric adenitis?
yeseria
Criteria for Bariatric surgery?
BMI 35+ with comorbidity or
BMI 40+
What is the acute management of Cluster headache?
And long term?
100% o2 for 15min
and sumatriptan in the long term
What is a short synacthen test?
Stimulation test for deficiency of ACTH - Addison’s disease
Hyponatraemic + hyperkalaemic with weight loss, tiredness and nausea?
Addison’s disease
What is Addison’s disease?
Primary Adrenal insufficiency - decreased Cortisol and decreased Aldosterone
What is Conn’s syndrome?
Primary Hypothyroidism. Increased Aldosterone levels - leading to normal/low Na, increased fluid. The body loses hydrogen and hence the pH goes up.
Acute exacerbation of Gout caused by..?
90% caused by decreased renal clearance. Other causes include:
GORD + Constant heartburn and regurgitation and dysphasia. On gastroscopy you would see….
Barrett’s oesophagus
30 yo female + Unilateral blurring and acute pain + central scotoma + Right swollen disc
Optic Neuritis (MS)
Treatment of spontanenous Bacterial peritonitis?
Antibiotics - re-tap in 24 hours and neutrophil should have decreased by 50%.
You know its spontaneous bacterial peritonitis because the tap has neutrophils
If the tap didn’t have neutrophils therapeutic paracentesis would be first line.
What to avoid in Ventricular tachycardia?
Adenosine. Adenosine is given in SVT.
45yo man when to Africa two weeks ago - presenting fever, headache and maculopapular rash
HIV infection
How do you treat PCP ( Pneumocystis jirovecii)?
oral Co-trimoxazole
HIV is a DNA Virus?
T or F?
F - It is a retroviridae - works through reverse RNA transcriptase
Mixed upper motor neuron disease and lower motor neuron disease in the upper and lower limb
Motor neuron disease
Lower motor neuron signs in Upper limbs + Upper motor neuron signs in lower limb
Cervical cord compression
Signs of progressive bulbar palsy?
tongue fasiculations + difficulty swallowing and chewing
35 yo woman, two months post partum, 4 week history of joint pain, skin rash and fever. ESR: 40. Diagnosis?
SLE
RA wouldn’t have a rash.
Differentiating between discoid rash in SLE vs Eczema?
SLE would have other symptoms too
What is the genes affected by Coeliac?
HLA DQ2 and HLA DQ8
What do you see on histology with Coeliac?
The tiny, finger-like projections which line the bowel (villi) become inflamed and flattened
Investigations for Coeliac?
anti-tTG, genetics screening, Anti-endomysial antibodies (IgA)
When do you transfuse bloods in anaemia?
Transfuse blood when iron is less than 70.
Woman young, fat with increased intracranial pressure (damage to retina and optic disc swelling)?
Idiopathic (Benign) Intracranial hypertension
Why does oral analgesics not work in people that have migraine’s whilst having it?
There is gastric stasis and hence orally it is not helpfull.
Triggers for Migraine?
CHOCOLATE
Chocolate
H
OCP
How to manage migraine?
PREVENTATIVE (avoid triggers) + paracetamol, metachlopramide + aspirin
Migraine diary
triptans (intranasal)??
How to differentiate between IgA (can be triggered after sickness) and Post-Streptococcal gN?
IgA is rapid - 24 hrs.
Post Streptococcus occurs 2 weeks after illness.
Abdominal pain + Purpura + GN symptoms
HSP
Severe complication of MDMA and Serrotonin syndrome?
Fever
Treatment of neuroepeleptical malignant syndrome?
Benzotropine
How to treat alcohol withdrawal tremor?
Diazapem
Cannabis intoxication?
Dry mouth, increased appetite, conjunctival injection, tachycardia
Pupillary constriction with which drug?
Opiod intoxication
Signs of neuroepeleptical malignant syndrome?
HARM
Serotonin syndrome? (3)
CAN:
CNS
Autonomic system (temperature),
Neuromuscular excitation`
In acidic environment (Stomach) what sort of substance is more easily able to be absorbed?
An acidic substance - because it has to be non-ionised to be absorbed.
Episodic impairment of consciousness?
Fluctuating mental state in old people
Chronic sub-dural haematoma
Crescent shaped haemorrhage
Subdural haematoma
Lemon shaped haemorrhage?
Epidural haematoma
Drugs causing infiltrative lung disease? (BAM)
Bleomycin
Amiodarone
Methotrexate
Ground glass appearance/ Honeycomb appearance on CT?
Infiltrative lung disease (pulmonary fibrossi)
Young man , 47, with osteoporosis (causing vertebral collapse).. how would you investigate?
Testosterone concentration?
ddx for testosterone deficiency?
- ## Genetic syndorme (Kleinfelter’s)-
Difference between primary and secondary polycthaemia?
Primary - renal cell carcinoma producing EPo
Secondary causes - due to a chronic disease
How do you check someone’s blood group
INDirect coombs test for cross matching to pick up on the antibodies!
When do you need FFP?
When coagulopathy problem?
How do you manage an asthamtic patient who quickly gets softer breath sounds?
immediate intubation!
Most frequent cause of blood stained nipple discharge?
Duct Papilloma
What is Paget disease?
DCIS of the nipple
Indian filed fashion of the breast
Invasive lobular breast cancer
Dengue fever presents with _______
back pain and myalgia and arthralgia
Mx of Malaria?
Chloroquinone
CA-125 is a marker for _____
Ovarian Cancer
CA-19-9 is tumour marker for __________
Pancreatic cancer
Organophosphate cause inhibition of ________
Acetylcholinesterase
Normal pressure hydrocephalus can occur be either idiopathic or secondary. Secondary is due to?
The secondary type of NPH can be due to a subarachnoid hemorrhage, head trauma, tumor, infection in the central nervous system, or a complication of cranial surgery.[1]
Most common cause of polyhydramnios?
Idiopathic polyhydramnios
or Gestational. So look at RF.
Severe oligohydramnios and no foetal bladder found
Renal Agenesis
How do you manage post menopausal bleeding due to and uterus procidentia?
Vaginal hysterectomy and repair
What is the gynaecologist preparing for by inserting ureteric stents before a hysterectomy?
Clamp and ligate uterine arteries
What additional steps have to be taken to remove the ovaries compared to a simple TAH
To ligate the infundibulopelvic ligaments
Complications in surgery after a women has had C-sections
Sharp dissection of he anterior lead (broad ligament) before reflecting onto the bladder
Bout of constipation, dehydration and serum potassium is low
Bartter syndrome
Progressively unstable walking. His mother mentions he always suffered from ear infections than his brother.
Ataxic telengectasia
Blood vessels in the ear makes hm more prone
Floppy baby with absent tendon reflexes and hypotonia + fasciculation’s of his tongue
SMA
Inverted champagne bottle legs - progressive distal muscular wasting
Charcot Marie tooth disease
Broad wrists and ankles with a large forehead. Which Vitamin is he deficient in?
Vitamin D -
Bones unable to form properly
Baby is admitted with potential sepsis. Massive hepatomegaly with no jaundice
Glycogen Storage disease
Check ACE-i after ______ starting it
1 weeks
Which anti-psychotic causes Bradykinesia?
Haloperidol
Sclerotic lesion with a sunburst appearance on the fever
Osteosarcoma
Ewing sarcoma affects the shaft of the bone and is associated with onion sign
Most commonly associated with long in-situ (non-invasive) phase
Mesothelioma
What statistical test to compare two discrete values (two drugs)?
Chi-Square test
What statistical test to compare to continuous values?
Linear regression
Discrete X variable and continuous Y variable ….
T-Test
Where should you listen for breath sounds from the right middle lobe?
Posteriorly, 5 cm below the mid clavicular line
What is the only increased marker in Paget’s disease?
ALP
What antibiotics do you use for Acute prostatitis?
Quinolone
How do you treat Syphillis?
Singular IM injection of Benzathine penicillin
How do you treat gingivitis (acute necrotising ulcerative)
Metronidazole
5 Xray signs for Acute Pulmonary oedema?
ABCDE
Alveolar oedema (Bat wing appearance) B Kerley lines Cardiomegaly Dilated upper lobe vessels Effusions (Pleural)
How do you manage APO?
LMNOP
Lasix Morphine +/- Metoclopromide Nitrogen Oxygen Positive pressure/Position
Fluid retention in heart failure is a combination of 2 things..
- Reduced GFR
2. Activation of RAAS and sympathetic system
A patient is symptomatic with CHF only on moderate extertion - what NYHA category does he fall in?
NYHA Class II
NYHA - Class I - Asymptomatic
NYHA Class III - Symptomatic with minimal extertion
NYHA Class IV - Symptomatic at rest
Nephrotic syndrome related to Hep B?
Membranous
Anit-Smith antibodies seen in _______-
Lupus nephritis
Pleuritic Chest pain + Pyrexia after a previous MI
Dressler’s syndrome
Haemolytic Uraemic syndrome is Gastro caused by which bug?
E. Coli
Three common ECG changes seen with Hypokalaemia:
U waves
Flattened T waves
And ST depression
and prolonged PR interval!
Alport has all of the following except:
CKD, Presentation in childhood, Loss of smell, Microscopic haematuria, Lenticonus
Loss of smell! It presents with sensorineural hearing loss
You should cease Ace-I in a CKD patient if the eGFR is less than ____% or Rise of creatinine more than ____%
eGFR is less than 25% or Rise of creatinine more than 30%
Which of the following is false for Haemolytic Uraemic syndrome?
- Presence of Fragmented red blood cells
- Raised Serum Haptoglobin
- Decreased Platelets
You get DECREASED Haptoglobin.
All with anaemia and and AKI
Three common drugs that cause P450 inducers and affect contraception use:
Carbamazepine (whilst use and 4 weeks after), Phenytoin (whilst and 4 weeks after) and Rifampicin (whilst and 8 weeks after)
The optimum sub-bandage pressure for healing venous ulcers has been shown to be ___ mm Hg at the ankle graduating to____mm Hg at the knee
The optimum sub-bandage pressure for healing venous ulcers has been shown to be 40 mm Hg at the ankle graduating to 17mm Hg at the knee
Which asthma medication is competitive selective phosphodiesterase inhibitor?
Aminophylline
Which tumour excretes large levels of Serotonin?
And what symptoms does this lead to?
Carcinoid
Flushing, Diarrhea, Wheezing, Abdominal cramping
Dysgraphia, Dyscalculi, Finger Agnosia + Left right orientation syndrome. Stroke affecting
Pareital Lobe
What medication helps with Raynauds and Htn?
CCB - Dihydropyridine: amolodipine/Nifedipine
Common causes of decreased middle ear mobility?
Middle ear fluid (OME). Other causes are increased stiffness of the eardrum (from scarring), tympanosclerosis (the formation of dense connective tissue around the auditory ossicles), cholesteatoma, or middle ear tumor
Amitriptylline can cause ______
Bowel obstruction
Which ulcer is painful - Syphillis or HSV?
HSV
Sexually active male - Rash on palms and soles. What is it?
Syphillis
Hypersegmented neutrophils:
B12 def
How do you manage Vulval warts?
Imiquimod or Podophyllotoxin
Which part of the nephron absorbs glucose?
PCT
Carbimazole acts to reduce T3/T4 production by inhibiting _______
iodination
Dendritic cells act to …..
initiate primary immune response
Natural Killer cells induce apoptosis of infected cells which is triggered by the absence of ______ on target cells
MHC I
CD3 cells?
T Cells
CD4 Cells?
Helper T cells
CD8 Cells?
Killer T Cells
CD19/CD20 Cells?
B Cells
BCL - 2 oncogene on Chromosome 14/18
Follicular lymphoma
Myc activation on chromosome 18?
Burkitt’s lymphoma
Clopidogrel acts to block ______ receptors on ____
Blocks ADP receptors on platelets
Hypocellular bone marrow with increased fat spaces?
Aplastic anaemia
Heinz Bodies?
G6PD
Basophilic stippling
Thalassaemia
Schistocytes
haemolysis
X-linked haemarthrosis, prolonged APTT
Haemophilia A
Heavy periods, bleeding after dental work , mildly prolonged APTT
vWillebrands factor
Rouleax stacks?
Multiple Myeloma
Reed-Sternberg cells
Hodgkin
Burr cells
Uraemia
What is the Cisterna Chyli?
It is the most inferior part of the thoracic duct
The thoracic duct travels behind the aorta and drains into the ___________.
left subclavian vein
The recurrent laryngeal nerves are a branch from _______
vagus nerve
The ______ nerve goes below the aortic arch
Left recurrent laryngeal
Which lobe is Broca’s located in ?
Frontal!
Where is Wernicke’s lobe located?
Located in the posterior section of the superior temporal gyrus
We get triglyceride breakdown and fatty acid export in ____
DM-1
The sympathetic neurons provide a motor output in nerves ____
T1-L2
The recurrent larygneal nerve is associated with which artery?
Inferior thyroid artery
For dental surgery you need an ________ nerve block and ____ nerve
inferior alveolar nerve block and linguinal nerve block
Three sites where kidney stones get stuck?
- Ureteric junction of pelvic (Pelvic ureteric junction)
- Where ureter crosses over the pelvic vessels (bifurcation)
- Where the ureter enter the bladder (VUJ)
The common iliac artery forms at about nerve root (__) and bifurcates infront of the ________ into the internal and external branches.
Nerve root - L4. And bifurcates infront of the pelvic brim into the internal and external branches.
Whilst sleeping __________ helps maintain glucose levels.
Gluconeogenesis whilst sleeping. Adipose tissue when at rest
Muscle Glycogenolysis can occur during the flight or fight response but requires which enzymes?
Glucose-6-Phosphate. This is release by myocytes when under stress
Chylomicrons transport lipids from _____ to ____, ___ and ____. They transport mainly Triglycerides
Transport lipids absorbed from the intestine to adipose, cardiac, and skeletal muscle tissue, where their triglyceride components are hydrolyzed by the activity of the lipoprotein lipase, allowing the released free fatty acids to be absorbed by the tissues
LDL’s transport cholestrol from the liver to _______, which attracts ___ and leads to _____
Liver to artery walls - which attracts macrophages and leads to artherosclerosis
Efficient phagocytosis requires ______ by complement or bacteria
Oponisation
Osler’s nodes occur on the palms or fingertips? Pain/painless?
Generally fingertips and are generally tender
Sally has been taught that if she pee’s in her pants then she will get a smacking. And if she doesnt pee in her pants she gets a Lolly. What sort of conditioning is this?
Operant conditioning
Right before Mary Peed her pants She saw a pink dog. Now whenever she sees a pink dog she pees her pants!
Classical conditioning
Ankle swelling (oedema) occurs due to ________
increased Venous pressure
Treatment for H. Pylori?
Omeprazole, Clarithromycin and Amoxiciliin
Fear is sensed by which part of the brain?
The amygdala
Do pupils dilate or constrict in flight or fight response?
They Dilate!
Difference between disinfecting and sterilising?
Disinfectant removes the most viable microorganism. Sterilisation removes ALL of them!
Gram positive bacteria have a thick/thin peptidoglycan wall? And hence on gram stain are purple/pink?
THICK WALL and hence PURPLE.
Spinal cord ends at what level?
L1-L2
Tongue Deviates to stronger or weaker side?
Towards weaker side
Heparin works on ______
Anti-thrombin III - makes it more active.
Eversion of foot is done by _______ nerve
Superficial perineal nerve
Dorsiflexion specifically is done by
Deep perineal nerve
Ascending limb has low or high permeability to water? (Nephron)
Low
Hcl and intrinsic factor is produced by which stomach cells?
Pareital cells!
Chief cells of the stomach produce:
Pepsinogen!
Azygous veins drains into _____
SVC
What artery is ligated in nose bleeds?
Anterior ethmoidal artery
Alcohol increases/decreases NADh/NAD+ ratio?
Increases
Bisphosphonates inhibit the activity of _____
osteoclasts
