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Medicine Year 1 > Week 142 Inflammatory B. Disease > Flashcards

Week 142 Inflammatory B. Disease Flashcards

0
Q

ASA’s have minimal use in ____

A

Chron’s disease

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1
Q

Aminosalicylates are first line treatment for___

A

Ulcerative collitis

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2
Q

Aminosalicylates prevent ____

A

Colonic Cancer

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3
Q

Mechanism of action of ASAs is ______ _________ by inhibiting synthesis of inflammatory the mediators ______, T________ and P________ Factors.

A

Prostaglandins

OTHERS - see ppt

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4
Q

Sulfasalazine is a type of ______. It’s side effects are ________.

A

ASA.

5-ASA bond of drug is cleaved, activating the drug. Lots of side effects, however. Leucopenia, rash, male infertility, ORANGE discolouration of body secretions.

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5
Q

Mesalazine is a _____. It is absorbed in the ____ and has very few ______.

A

ASA.
Current first line choice, that is well tolerated, and rapidly and completely absorbed in the upper jejenum.
Oral and rectal administration.

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6
Q

Name Two Mesalazine formulations.

A

Asacol
Pentasa
(mezavant) (third)

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7
Q

With mesalazine, you must prescribe ________ .

A

Brand names.

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8
Q

What is the aim of corticosteroid use?

A

Induce remission. NO role in maintenance therapy.

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9
Q

What is the action of corticosteroids?

A

Anti-inflammatory action sim. to glucocorticoids produced naturally.
Inactivates pro inflammatory transcription factors.

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10
Q

What happens with long term corticosteroid use?

A

ADVERSE EFFECTS
Buffalo hump
Cushing syndrome

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11
Q

What do you aim to protect with calcium and bisphosphonates when giving corticosteroid treatment?

A

BONES.

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12
Q

What is prenisolone?

A

Corticosteroid.

Closely mimics endemic cortisone.

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13
Q

Why is it important to taper doese of corticosteroids?

A

Prevent addisonian crisis.

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14
Q

Name 3 oral corticosteroids.

A

Prednisolone
Budesonide
Beclametasone

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15
Q

Name an IV corticosteroid.

A

Hydrocortisone.

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16
Q

When are Thiopurines recommended?

A

UNLICENSED.
When 5-ASA are ineffective/not tolerated. If steroid dependent. If severe or frequent relapse. If require 2 or more corticosteroid in 12 mth period. If requires more than 50mg sterod (?check that value!)

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17
Q

What is azathioprine?

A

A thiopurine.
Avoid in pregnancy (cytotoxic)
50-150mg bd.
Some mild side effects, but also bone marrow suppression, luekopenia, and hepatotoxicity.

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18
Q

What is TPMP? What does it do?

A

Thiopurine methyltransferase.

Metabolises Azathioprine and 6-MP.

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19
Q

Risks with TPMT ?

A

Higher risk of bone marrow suppression in patients with TMPT insufficiency.

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20
Q

Ciclosporin is a ____ used for management of active severe _____. Induces remission in ____ and has NO therapeutic effect in ______.

A

Calcineurin inhibitor
Ulcerative collitis
50-80%

Chron’s.

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21
Q

Ciclosporin is a rescue therapy after ___ days of failed ____ therapy.

A

7 days

IV steroid therapy

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22
Q

Target blood level for Ciclosporin?

A

150-250 mcg/L

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23
Q

Ciclosporing interacts with ________.

A

PVC giving sets (max 6 hours).

For continuous infucsion, use non-pvc giving sets or change every 6 hours.

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24
Q

Adverse effects of ciclosporin?

A

hypertension
infection
renal impairment, increased risk of seizure with iv if:
-hypocholesterolaemia
-Hypomagnesaemia ALSO ////: Gum hypertrophy and hirsuitism.

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25
Q

Which drugs should you be aware of if taking ciclosporin?

A

Macrolide antibiotics - clarithromycin, erythromycin.
These inhibit metabolism of the active drug (cyclosporin), so monitor bloods to ensure levels do not as metabolism is induced.

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26
Q

What action does methotrexate have?

A

Anti inflammatory.

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27
Q

Methotrexate is used for treatment of ______. NOT _____.

A

Chrons, NOT Ulcerative collitis.

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28
Q

What do you give once weekly (5mg) to prevent or reduce side effects from methotrexate?

A

Folic acid.

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29
Q

Always prescribe methotrexate as a _____ dose.

A

Weekly.

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30
Q

Which drugs are used in biological therapy for UC and CD?

A

Infliximab
Adalimumab

These are monoclonal antibodies that target TNF-alpha, an inflammatory mediator.

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31
Q

Method of action of infliximab?

A

Chimeric anti inflammatory action.

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32
Q

If ciclosporin is contraindicated or inappropriate in ulcerative collitis, what can you use?

A

Infliximab.

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33
Q

What is Adalimumab?

A

humanised monoclonal antibody
Licenced for UC and Chrons. NICE only recommends CD.
Targets TNF-Alpha cells.

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34
Q

Benefit of adalimumab over infliximab?

A

Subcut injections –> easier to give.

35
Q

Monoclonal antibody therapies can activate latent _____ infection.

A

Tb (Tuberculosis)

36
Q

If Mesalazine and steroid therapy hasn’t worked you can use ____

A

Either ciclosporin or infliximab.

37
Q

Drugs for maintenance of remission os UC?

A

5-asa (mezalasine)

One other?

38
Q

Treatment of active chrons?

A

Corticosteroids

If doesnt work, use azathiopine, methotrextrate or monoclonal antibodies.

39
Q

Maintenance of remission in Chron’s?

A

Azathiopine
Methotrexate
One other? See ppt.

40
Q

what is the fundamental difference between surgery for UC and chron’s?

A

Chron’s - operate for complications

UC - operate to cure

41
Q

The most common indication for urgent surgery in UC is _______.

A

Failed medical treatment.

42
Q

_______ is single factor in reducing mortality in urgent UC.

43
Q

A subtotal colectomy leaves ______ behind.

A

Sigmoid colon.

44
Q

Further surgery from UC includes_____

A

Ileo–anal pouch

Completion proctectomy

45
Q

Indications for elective surgery for UC?

A 
Chronic
Steroid dependence
Recurrent acute symptoms
Extra GI manifestations
Retardation of growth
46
Q

Which operation has a high rate of morbidity?

A

Ileo-anal pouch

47
Q

The best surgery for UC is _______ in terms of morbidity.

A

Proctocolectomy and permanent ileostomy.

48
Q

The best lifestyle factor to reduce Chron’s is _____

A

QUIT SMOKING

49
Q

complications of Chron’s disease (operable)?

A 
Stenosis
Fistulae
Abscess
Bleeding
Perforation
50
Q

Isolated small bowel disease most frequently in ____

A

terminal ileum

51
Q

37% of patients with chron’s will have ________.

A

Peri anal disease.

52
Q

In perianal chron’s….________

A

Drain sepsis, maintain function. Nothing more!

53
Q

For short term Chron’s, you can use the antibiotic _______ for beneficial effect. NOT long term solution.

A

Metronidazole.

54
Q

Which is the loci mutation is the “trigger point” for allowing bacteria into the mucosa in IBD’s?

A

NOD2/CARD15 –> activates nuclear factor kappa B (NF-kB)

55
Q

Describe tenesmus.

A

The feeling that you need to evacuate bowels constantly.

56
Q

Pertinent question to ask RE IBD suspected?

A

Does it interrupt you at NIGHT?

57
Q

Ulcers in the mouth would indicate _______.

A

Chron’s disease.

58
Q

VILLOUS ATROPHY AND CRYPT HYPERPLASIA IS FOUND IN _____

A

COELIAC DISEASE

59
Q

A POSITIVE UREASE TEST INDICATES WHAT?

A

H. PYLORI INFECTION

60
Q

CRYPT ABSCESSES AND MUCOSAL INFLAMMATION INDICATE WHAT?

A

ULCERATIVE COLLITIS.

61
Q

EXCESSIVE WIND, SUDDEN OR UNEXPLAINED WEIGHT LOSS, D AND V AND STOMACH CRAMPS INDICATE WHAT?

A

COELIAC DISEASE

62
Q

BLOOD IN STOOL, ABDOMINAL PAIN AND UNEXPLAINED WEIGHT LOSS MEANS WHAT?

A

COLORECTAL CANCER.

63
Q

THICK MUCUS IN BODY SECRETIONS MEANS WHAT?

A

CYSTIC FIBROSIS

64
Q

FAITGUE, LETHARGY, DYSPNOEA, FAINTNESS…INDICATE POTENTIALLY WHAT?

A

PERNICIOUS ANAEMIA (ALSO LACK OF B12)

65
Q

WATERY (SOMETIMES BLOODY DIARRHOEA, ABDO CRAMPS, FEVER, MUCUS IN THE STOOL, NAUSEA AND DEHYDRATION MEANS WHAT?

A

PSEUDOMEMBRANOUS COLITIS

66
Q

IF IT LOOKS LIKE CHRONS DISEASE BUT IT’S NOT CHRONS DISEASE, IT’S…?

A

TUBERCULOSIS OF TERMINAL ILEUM

67
Q

INFLAMMATORY INFILTRATE WITH NON CASEATING GRANULOMAS MEANS WHAT?

68
Q

PAPILLAE ARE FOUND ON THE ______

69
Q

WHICH PART OF THE SMALL INTESTINE IS DISTINGUISHABLE BY IT’S FINGER SHAPED INTESTINAL VILLLI?

70
Q

STAPH. AUREUS RELEASES WHICH TOXIN?

A

EXFOLIATIVE TOXIN

71
Q

WHICH TOXIN AFFECTS cAMP LEVELS IN THE GUT?

A

CHOLERA TOXIN

72
Q

WHICH TOXIN ACTS AT NEUROMUSCULAR JUNCTIONS CAUSING FLACCID PARALYSIS?

73
Q

WHICH TOXIN CAUSES SCARLET FEVER?

A

ERYTHROGENIC TOXIN

74
Q

BORDATELLA PERTUSSIS CAUSES WHAT?

A

WHOPPING COUGH

75
Q

COMMON SKIN INFECTION CAUSED BY THE POX VIRUS THAT OCCURS MOST OFTEN IN CHILDREN, WHERE SMALL ROUND PEARLY-WHITE LUMPS APPEAR IN CLUSTERS ON THE BODY?

A

MOLLUSCUM CONTAGIOSUM

76
Q

WHICH VIRUS USUALLY PRESENTS WITH ERYTHEMA INFECTIOSUM?

A

PARVOVIRUS

77
Q

WIDELY VACCINATES BUT CAUSES A FINE PINK RASH AND CAN CAUSE DEVELOPMENTAL DEFORMITIES IF ENCOUNTERED INTRAUTERINE.

78
Q

FEVER, SORE THROAT, FATIGUE AND BACK/NECK/LIMB PAIN/STIFFNESS IS LIKELY WHICH VIRUS?

A

POLIOVIRUS

79
Q

WHAT ARE THE SYMPTOMS OF ROSEOLA VIRUS?

A

HIGH FEVER LASTING 3-5 DAYS, ROSY PINK RASH ON TORSO AND NECK . GENERALLY NOT SEVERE.

80
Q

VARICELLA VOSTER VIRUS CAUSES WHAT? WHAT RE ITS SYMPTOMS?

A

CHICKENPOX

FEVER, RASH (SPOTS APPEAR IN CROPS) CAN BE VERY ITCHY.

81
Q

WHICH VACCINE IS AVAILABLE IN THE USA BUT NOT IN THE UK?

A

VARICELLA - CHICKENPOX.

82
Q

KOPLIKS SPOTS ARE FOUND IN _____

83
Q

WHICH AREAS OF THE GI TRACT CONTAIN M CELLS?

A

PEYERS PATCHES

84
Q

THE ORIGIN OF ALL LYMPHOCYTES IS IN THE ____ ______.

A

BONE MARROW.

85
Q

GIARDIA PARASITES RESIDE WHERE?

86
Q

BACTERIAL FERMENTATION OF COMPLEX CARBOHYDRATES IS DONE WHERE?

A

THE CAECUM

Medicine Year 1 (39 decks)

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