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MBChB Y1-3 > Year 2 > Flashcards

Year 2 Flashcards

1
Q

Name the genetic condition associated with the following tumours:

Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas

A

MEN2a

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2
Q

Describe the pathophysiology of pemphigus vulgaris

A

Type II hypersensitivity - IgG4 antibodies against desmosomal proteins leads to loss of keratinocyte adhesion in the skin and mucous membranes, leading to superficial blisters, erosions, and mucosal ulcers

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3
Q

In _____________ hyperparathyroidism, caused by a autonomous parathyroid following years of renal failure, PTH will be high and calcium will be high

A

Tertiary

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4
Q

What hearing test results (using a tuning fork) would indicate sensorineural hearing loss?

A

Air conduction > bone conduction (Rinne’s)
Head in good ear (Webers)

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5
Q

Name the genetic condition associated with the following tumours:

Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas
Mucosal neuromas

A

MEN2b

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6
Q

Vertical double vision with hypertropia/hypotropia on cover test suggests a problem with which of the ocular muscles?

A

SO, SR, IR, IO

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7
Q

What is nephrotic syndrome?

A

Indicative of a non-proliferative process affecting podocytes

Clinical features:

  • Heavy proteinuria (> 3 g/day)
  • Hypoalbuminaemia
  • Non-dependent oedema, classically periorbital
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8
Q

Name the enzyme deficient in acute intermittent porphyria, and the porphyrin which will accumulate as a result

A

Porphobilinogen deaminase, porphobilinogen

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9
Q

Which condition is associated with anti-centromere antibody?

A

Limited systemic sclerosis

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10
Q

Which cranial nerve supplies all the extraocular muscles except the superior oblique and lateral rectus?

A

CN III - oculomotor

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11
Q

Where is the lesion? Name the defect

A

Lesion of optic nerve → ipsilateral monocular visual loss

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12
Q

A patient with CN _____ palsy typically presents with horizontal diplopia which is worsened when they attempt to look towards the affected side; unopposed adduction of the eye results in a convergent squint or esotropia (eye turns inwards)

A

CN VI

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13
Q

Describe the mechanism of action of SGLT2 inhibitors

A

Lower renal threshold for glucose so increase urinary glucose excretion

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14
Q

Describe the clinical presentation of a meniscal tear

A

Pain and tenderness localised to joint line (medial or lateral)

Usually twisting sports injury in younger patients

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15
Q

What is Anderson-Fabry’s disease?

A

X-linked lysosomal storage disease - inborn error of glycosphingolipid metabolism (deficiency of ⍺-galactosidase A)

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16
Q

Describe the clinical presentation of Alport’s syndrome

A

Suspect in patients with microscopic haematuria +/- hearing loss in the early years

Proteinuria seen later but confers bad prognosis

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17
Q

Injury to which nerve results in wrist drop?

A

Radial nerve

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18
Q

What hearing test results (using a tuning fork) would indicate conductive hearing loss?

A

Bone conduction > air conduction (Rinne’s)
Head in bad ear (Webers)

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19
Q

Which nerves can be damaged by a supracondylar fracture of the humerus?

A

Median, ulnar

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20
Q

What is the most common cause of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

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21
Q

How would you manage an intracapsular hip fracture in a previously low-functioning patient?

A

Hemi-arthroplasty

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22
Q

Describe the usual mechanism of injury of a PCL injury

A

Tend to occur following a direct blow to anterior tibia (e.g. dashboard, motorbike)

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23
Q

How would you manage a displaced intracapsular fracture in a previously high-functioning patient?

A

Total hip replacement

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24
Q

Cover test: uncovered eye moves up

A

Hypertropia

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25
Q

Cover test: uncovered eye moves inward

A

Exotropia

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26
Q

Describe the biopsy findings in focal segmental glomerulosclerosis

A

Light microscopy - small areas of mesangial collapse and sclerosis

Electon microscopy:

  • Primary FSGS → diffuse podocyte process fusion
  • Secondary → podocyte process fusion limited to sclerotic areas

Minimal Ig/complement deposition on IF

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27
Q

A patient with a CN ____ palsy typically presents with a ‘down and out’ appearance of the affected eye

A

CN III

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28
Q

Damage to which nerve will cause the following clinical signs:

A

Radial nerve

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29
Q

Describe the clinical presentation of Meniere’s disease

A

Attacks are comprised of a triad of severe paroxysmal vertigo, with sensorineural hearing loss and tinnitus on the affected side

Vertigo is recurrent, spontaneous, rotational vertigo with at least 2 episodes >20 mins (often lasting hours)

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30
Q

Which nerve supplies the first webspace of the foot?

A

Deep peroneal nerve

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31
Q

Describe the usual mechanism of injury of an LCL injury

A

Usually occur with varus stress and hyperextension, often occurs in combination with PCL or ACL injury

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32
Q

What is the second most common cause of nephrotic syndrome in adults?

A

Membranous nephropathy

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33
Q

Injury to which nerve will result in a winged scapula?

A

Long thoracic nerve

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34
Q

Injury to which nerve results in a positive Trendelenburg sign?

A

Superior gluteal nerve

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35
Q

Describe the pathophysiology of bullous pemphigoid

A

Type II hypersensitivity – anti-hemidesmosome antibodies (IgG) react with an antigen of the hemidesmosomes anchoring basal cells to the basement membrane

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36
Q

Describe the mechanism of action of TZDs

A

Reduce insulin resistance by interaction with PPAR-y

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37
Q

Describe the usual mechanism of injury of an ACL injury

A

Usually twisting sports injury

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38
Q

A patient with CN ____ palsy typically presents with a vertical diplopia when looking inferiorly, and the affected eye turned upward when in primary position?

A

CN IV

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39
Q

Which nerve is affected in carpal tunnel syndrome?

A

Median nerve

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40
Q

Damage to which nerve will cause the following clinical signs:

A

Median nerve

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41
Q

Describe the mechanism of sulphonylureas

A

Close ATP-sensitive K+ channels which stimulate insulin release

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42
Q

Describe the findings in a right-sided CN IV palsy

A

Right eye turns upwards

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43
Q

Where is the lesion? Name the defect

A

Lesion at parietal upper radiation → contralateral homonymous inferior quadrantanopia

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44
Q

Describe the classical clinical presentation of porphyria cutanea tarda

A

Middle-aged man, associated with liver disease

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45
Q

Describe the clinical presentation of an ACL injury

A

Audible pop followed by deep knee pain and swelling (haemarthrosis) within an hour of the injury

Pain settles but leaves rotatory instability (gives way on turning on a planted foot due to excessive internal rotation of the tibia)

Excessive anterior translation of the tibia on the anterior drawer test and Lachman test

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46
Q

Which condition is associated with anti-cardiolipin antibody and lupus anti-coagulant?

A

Anti-phospholipid syndrome

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47
Q

What type of hearing loss is demonstrated by the audiogram?

A

Sensorineural hearing loss

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48
Q

Which condition is associated with anti-Scl-70 antibody?

A

Diffuse systemic sclerosis

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49
Q

What is a vestibular migraine?

A

Episode of vertigo in someone who has a history of migraines - about 25% of migraine sufferers have spontaneous attacks of vertigo and ataxia

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50
Q

Which nerve is affected in cubital tunnel syndrome?

A

Ulnar nerve

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51
Q

Injury to which nerve results in foot drop?

A

Common peroneal nerve

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52
Q

What is the Dix-Hallpike manoeuvre?

A

Diagnostic examination for benign positional paroxysmal vertigo - positive test will invoke the symptoms and geotropic, tortional nystagmus will be present

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53
Q

Damage to which nerve will cause the following clinical signs:

A

Axillary nerve

54
Q

Describe the clinical presentation of IgA nephropathy

A

Nephritic - asymptomatic microhaematuria +/- non-nephrotic range proteinuria

Macroscopic haematuria after resp/GI infection

AKI/CKD

55
Q

Which condition is associated with anti-dsDNA, anti-Smith, anti-Ro, anti-RNP?

A

SLE

56
Q

How would you manage a subtrochanteric hip fracture?

A

IM nail

57
Q

Describe the biopsy findings in membranoproliferative glomerulonephritis

A

LM - big lobulated hypercellular glomeruli with thick membranes - tram tracks

IF - granular deposits of C3

EM - electron dense sub-endothelial deposits +/- sub-epithelial +/- mesangial

58
Q

Name the vasculitis:

cANCA, PR3 70-90%, MPO 5-10%

A

GPA

59
Q

Which cranial nerve supplies the superior oblique extraocular muscle?

A

CN IV - trochlear

60
Q

Which form of MEN is commonly associated with:

Parathyroid: hyperplasia/adenomas
Pancreas: gastrinoma, insulinoma
Pituitary: prolactinoma

A

MEN1

61
Q

Where is the lesion? Name the defect

A

Lesion at optic tract → contralateral homonymous hemianopia

62
Q

Which form of glomerulonephritis is associated with anti-phospholipase A2 antibodies?

A

Membranous nephropathy

63
Q

What type of hearing loss is demonstrated by the audiogram?

A

Conductive hearing loss

64
Q

What type of drug is liraglutide?

A

GLP-1 antagonist

65
Q

What is Meniere’s disease?

A

Idiopathic disorder causing vertigo

66
Q

What is Alport’s syndrome?

A

X-linked mutation in COL4A5 gene leads to deficient collagenous matrix deposition

67
Q

Which form of MEN is commonly associated with:

Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas
Mucosal neuromas

A

MEN2b

68
Q

Describe the biopsy findings in minimal change glomerulonephritis

A

Normal renal biopsy on LM and IF

Foot process fusion on EM

69
Q

Describe the mechanism of action of metformin

A

Biguanide, regulates gluconeogenesis and increases gut glucose metabolism via AMP kinase

70
Q

Describe the usual mechanism of injury in an MCL injury

A

Valgus stress with possible external rotation (e.g. rugby tackling from the side)

71
Q

Describe the findings in a right-sided CN III palsy

A

Right eye turns down and out

72
Q

Name the vasculitis:

pANCA, PR3 10-30%, MPO 70-90%

A

MPA

73
Q

Describe the clinical presentation of an LCL injury

A

Knee swelling with ecchymosis, pain, deformity and instability

Lateral joint line tenderness

Varus stress test - lateral joint laxity

74
Q

How would you manage a non-displaced intracapsular hip fracture in a previously high-functioning patient?

A

Compression hip screw

75
Q

Name the enzyme deficient in porphyria cutanea tarda, and the porphyrin which will accumulate as a result

A

Uroporphophyrinogen decarboxylase, uroporphyrinogen 3

76
Q

What is nephritic syndrome?

A

Indicative of a proliferative process affecting endothelial and mesangial cells

Clinical features:

  • Haematuria/active urinary sediment (RBC and granular casts, proteinuria)
  • Oliguria
  • Oedema/fluid retention
  • Hypertension
  • Acute renal failure
77
Q

In _____________ hyperparathyroidism, e.g. caused by low calcium or vitamin D, or CDK, PTH will be high and calcium will be low or normal

A

Secondary

78
Q

How does primary adrenal insufficiency lead to volume depletion and hypertension?

A

Decreased mineralocorticoids → K+ retention and Na+ loss

79
Q

Damage to which nerve will cause the following clinical signs:

A

Musculocutaneous nerve

80
Q

What is benign positional paroxysmal vertigo?

A

Vertigo caused by the presence of otoliths in the semi-circular canal instead of the utricle; most common cause of vertigo on looking up

81
Q

Which condition is associated with anti-Ro, anti-La?

A

Sjogren’s

82
Q

Which cranial nerve supplies the lateral rectus extraocular muscle?

A

CN VI - abducens

83
Q

Where is the lesion? Name the defect

A

Lesion at optic chiasm → bitemporal hemianopia

84
Q

Which condition is associated with anti-CCP?

A

Rheumatoid arthritis

85
Q

Describe the biopsy findings in IgA nephropathy

A

LM - mesangial cell proliferation and expansion, diffuse mesangial IgA deposition

IF - IgA and C3 deposits in mesangium

EM - electron dense deposits in mesangium

86
Q

Describe the clinical presentation of a PCL injury

A

Popliteal knee pain and bruising

Positive posterior drawer test

Positive sag sign

87
Q

Which nerve can be damaged during an anterior hip dislocation?

A

Obturator nerve

88
Q

What diagnosis should you consider in an infant presenting with bilious (green) vomiting?

A

Midgut volvulus caused by malrotation

89
Q

What type of drug is sitagliptin?

A

DPP4 inhibitor

90
Q

What type of drug is empagliflozin?

A

SGLT2 inhibitor

91
Q

Damage to which nerve will cause the following clinical signs:

Motor: paralysis of the hamstring muscles, weakness of hip extension

Sensory: sensation lost below the knee except for the medial side of leg and medial border of the foot (saphenous area)

A

Sciatic nerve

92
Q

Immunofluorescence of which blistering skin disorder will show chicken wire deposition of IgG within the epidermis

A

Pemphigus vulgaris

93
Q

How can nephrotic syndrome predispose to infections, renal vein thrombosis, and pulmonary emoboli?

A

Protein loss includes antibodies, complement and proteins in clotting cascade

94
Q

In _____________ hyperparathyroidism, caused by a parathyroid tumour, PTH will be high and calcium will be high

A

Primary

95
Q

Cover test: uncovered eye moves outward

A

Esotropia

96
Q

Describe the clinical presentation of an MCL injury

A

Knee swelling with ecchymosis, pain, deformity and instability

Medial joint line tenderness (over origin/insertion of MCL)

Medial joint laxity and pain on valgus stress

97
Q

Cover test: uncovered eye moves down

A

Hypertropia

98
Q

Which nerve can be damaged by a fracture of the proximal humerus, humeral shaft or proximal radius?

A

Radial

99
Q

Damage to which nerve will cause the following clinical signs:

A

Ulnar nerve

100
Q

What type of drug is pioglitazone?

A

TZD

101
Q

Describe the clinical presentation of vestibular neuritis and labyrinthitis

A

Vertigo - first attack severe, lasting days with N+V

Labyrinthitis is associated with tinnitus or hearing loss (not seen in vestibular neuritis)

May be viral symptoms

102
Q

Describe the classical clinical presentation of erythropoietic protoporphia

A

Baby crying in the sun

103
Q

Describe the findings in a right-sided CN VI palsy

A

Right eye turns inwards

104
Q

Where is the lesion? Name the defect

A

Lesion at occipital visual cortex → contralateral homonymous hemianopia (macular sparing)

105
Q

How would you manage an intertrochanteric hip fracture?

A

Dynamic hip screw

106
Q

Which form of MEN is commonly associated with:

Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas

A

MEN2a

107
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change glomerulonephritis

108
Q

Describe the mechanism of action of GLP-1 antagonists

A

Enhance the incretin effect

109
Q

Describe the biopsy findings in membranous nephropathy

A

Light microscopy - thickened basement membranes, spikes on a silver stain

IF - granular deposits of IgG and C3 along GBM

EM - electron dense sub-epithelial deposits

110
Q

Describe the clinical presentation of benign positional paroxysmal vertigo

A

Vertigo on looking up, turning in bed, bending forward, moving head too quickly etc.

Attacks last seconds

Associated with N+V

111
Q

Describe the clinical presentation of Anderson-Fabry’s disease

A

Renal failure

Cutaneous - angiokeratomas

Cardiac - cardiomyopathy, valvular disease

Neuro - stroke, acroparaesthesia

Psychiatric

112
Q

How would you manage Anderson-Fabry’s disease?

A

Enzyme supplementation - fabryzyme

Management of complications

113
Q

Damage to which nerve will cause the following clinical signs:

Motor: weakness of adduction

Sensory: paraesthesia on the medial side of the thigh

A

Obturator nerve

114
Q

Which nerve can be damaged during a fracture of the humeral neck or anterior dislocation of the humerus?

A

Axillary nerve

115
Q

Describe the management of epistaxis

A

Stepwise approach:

  1. First aid measures - pinching the fleshy anterior part of the nose, leaning forward, spitting out into a bowl, ice pack compression
  2. On arrival to secondary care: resuscitation if necessary, arrest/slow flow (e.g. ice, topical vasoconstrictor), anterior rhinoscopy/nasal endoscopy to investigate source of bleeding
  3. Direct therapy - silver nitrate cautery if there is an identifiable anterior bleeding point
  4. Indirect therapy e.g. nasal packs to compress difficult to identify bleeding points (likely posterior) or heavy bleeding points
  5. Surgery - sphenopalatine artery ligation (endoscopic)
116
Q

Immunofluorescence of which blistering skin disorder will show liner IgG and complement deposited around the basal membrane?

A

Bullous pemphigoid

117
Q

Name the genetic condition associated with the following tumours:

Parathyroid: hyperplasia/adenomas
Pancreas: gastrinoma, insulinoma
Pituitary: prolactinoma

A

MEN1

118
Q

Which cranial nerve supplies the lateral rectus muscle?

A

CN VI (abducens)

119
Q

Which cranial nerve innervates the superior oblique muscle?

A

CN IV (trochlear)

120
Q

Describe the clinical presentation of minimal change glomerulonephritis

A

Facial/generalised oedema

Heavy proteinuria - nephrotic syndrome

121
Q

Damage to which nerve will cause the following clinical signs:

Motor: loss of knee extension, weakness of hip flexion

Sensory: loss of skin over the front and medial side of the thigh and over the medial side of the leg and medial border of the foot

A

Femoral nerve

122
Q

Describe the biopsy findings in Alport’s syndrome

A

Variable thickness of the glomerular basement membrane

123
Q

What type of drug is gliclazide?

A

Sulphonylurea

124
Q

Describe the mechanism of action of DPP4 inhibitors

A

DPP4 usually deactivates GLP-1

125
Q

Which cranial nerve supplies all extraocular muscles except superior oblique and lateral rectus?

A

CN III (oculomotor)

126
Q

Where is the lesion? Name the defect

A

Lesion at temporal lower optic radiation → contralateral homonymous superior quadrantanopia

127
Q

Describe the classical clinical presentation of acute intermittent porphyria

A

Females ~30 years, acute abdomen, mood disturbance, neuro symptoms

128
Q

Horizontal double vision with esotropia/exotropia on cover test suggests a problem with which of the ocular muscles?

A

LR or MR

129
Q

Name a blistering skin disorder which is Nikolsky sign positive

A

Pemphigus vulgaris

130
Q

A normal Rinne’s test would be ________

A

Air conduction is greater than bone conduction (also seen in sensorineural hearing loss)

131
Q

Name the vasculitis:

pANCA, PR3 <2%, MPA 10-30%

A

EPGA

132
Q

Name the enzyme deficient in erythropoietic protoporphia, and the porphyrin which will accumulate as a result

A

Ferrochelase, protoporphyrin IX

MBChB Y1-3 (3 decks)

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