misc to work on Flashcards
what is the gold standard investigation for PE?
pulmonary angiography
what is the gold standard investigation for acromegaly?
glucose tolerance test
what is the most common cause of endocarditis?
s. viridians = most common
s. aureus = most common in IVDU
s. epidermidis = prosthetic valves
what is the definition of sensitivity?
how many with the disease test positive
what is the definition of specificity?
how many without the disease test negative
what is prevalence?
number of new cases
what is incidence?
number of new cases today
what is primary prevention?
prevent disease from occuring
what is secondary prevention?
early detection of disease and stop progression
what is tertiary prevention?
reduce/treat complications
what blood results are present in acute hep B infection?
IgM
Hep antigens
what blood results are present in chronic hep B infection?
no IgM
IgG
some antigens present over 6 months
what blood results are present in resolved hep B infection?
no IgM
IgG
no antigens
what are the causes of peritonitis?
AEIOU A = appendicitis E = ectopic pregnancy I = infection O = obstruction U = ulcer
what are the symptoms of acute cholecystitis?
RUQ pain
fever
no jaundice
what are the symptoms of wernicke’s encephalopathy?
ataxia
ophthalmoplegia
confusion
what is the most likely outcome of MI?
organisation
what is becks triad?
raised JVP
hypotension + tachycardia
muffled heart sounds
what is charcot’s triad?
RUQ pain
fever
jaundice
what are the common causes of cardiac ischaemia?
coronary artery steal
coronary artery compression
coronary artery vasculitis
hypertrophic stenosis
which pathway does pain to temperature travel in?
lateral spinothalamic
what is the pathophysiology of RA?
arginine is converted to citrulline
APCs present citrulline to CDT4 helper cells which signal B cell proliferation
B cell differentiate into plasma cell and produce self antibodies which causes systemic inflammation
what is the treatment for an acute migraine?
paracetamol
NSAID
aspirin
triptan
what is the prevention for migraines?
propranolol
topiramate
amitripyline
what is the treatment for tension headaches
paracetamol
NSAID
aspirin
what is the prevention for tension headaches
amitriptyline
what is the treatment for acute cluster headaches?
sumatriptan
what is the prevention for cluster headahces?
verapamil
what is the most common cause of meningitis in babies under 3 months?
group B strep
e.coli
listeria monocytogenes
what is the most common cause of meningitis in children 3 months to 12 years old?
s. pneumoniae
n. meningitidis
h. influenzae
what is the most common cause of meningitis in teenagers?
n. meningitidis
s. pneumoniae
h. influenzae
what is the most common cause of meningitis in over 50s or immunocompromised?
listeria monocytogene
what is the staging system for lymphoma?
ann arbour
what is the scoring system for COPD?
MRC dyspnoea scale
what are different stages of MRC dyspnoea scale?
1 = not troubled by breathlessness 2 = SOB when hurrying or walking uphill 3 = walk slower as SOB, stop for breath 4 = stops for breath after 100m, stops after few mins on level walk 5 = too breathless to leave house
what is the treatment for pylonephritis?
ciprofloxacin / co-amoxiclav
fluids
catheter
analgesia
why is nitrofurantoin not used in pyelonephritis?
it stays in the lower urinary tract and does not collect above the bladder
how does oxybutynin work in treating urge incontinence?
anticholinergic
inhibits parasympathetic nervous system
decreases detrusor excitability, preventing symptoms of urgency
what are the side effects of oxybutynin?
dry eyes dry mouth dilated pupils/blurred vision tachycardia constipation dizziness confusion
what is the clinical presentation of wegener’s granulomatosis?
hearing loss
sinusitis
nose bleeds
saddle shaped nose - perforated septum
what are the blood test results for sjogren’s syndrome?
ANA
anti-Ro
anti-La
RF
describe the type of arthritis found in sjogren’s syndrome
chronic systemic inflammatory symmetric autoimmune non-erosive
what are the complications of SLE?
CVD infection anaemia of chronic disease pericarditis pleuritis interstitial lung disease lupus nephritis neuropsychiatric SLE recurrent miscarriage venous thromboembolism
what are the x-ray finding for ankylosing spondylitis?
- bamboo spine
- squaring of vertebral bodies
- subchondral sclerosis and erosions
- syndesmophytes
- ossification of ligaments, discs and joints
- fusion of facet, sacroiliac and costovertebral joints
what is the causes of joint changes in OA?
imbalance between cartilage being worn down and chondrocytes repairing it
causes structural issues in the joint
what is the appearance of the skull in Paget’s disease?
→ Cotton wool appearance - due to patches of increased and decreased density. This is due to the increase in activity of both osteoblasts and osteoclasts.
which LFT would you expect to be raised in Paget’s disease?
alkaline phosphatase (ALP)
what type of drug would you use to treat Paget’s disease?
bisphosphonates
what is the management for RA?
1st line: DMARDs - methotrexate
2nd line: 2 DMARDs (methotrexate, sulfasalazine)
3rd line: methotrexate + biologic (Anti-TNF = infliximab)
4th line: methotrexate + rituximab
what are the complications of RA?
Felty’s syndrome
anaemia of chronic disease
pulmonary fibrosis
amyloidosis
what is Felty’s syndrome?
RA
neutropenia
splenomegaly
what is dermatomyositis?
chronic inflammation of the skin and muscles
what is polymyositis?
chronic inflammation of muscles
other than polymyositis/dermatomyositis what can cause raised creatinine kinase?
rhabdomyolysis AKI MI statins strenuous exercise
what are the symptoms of polymyositis?
- muscle pain, fatigue, weakness
- occurs bilaterally
- typically affects proximal muscles
- shoulder and pelvic girdle
- develops over weeks
what are the skin symptoms for dermatomyositis?
- Gotton lesions (erythematous plaques)
- photosensitive erythematous rash on back, shoulders and neck
- purple rash on face and eyelids
- periorbital oedema
- SC calcinosis
which antibodies are present in polymyositis and dermatomyositis?
- anti-Jo-1 = poly and derm
- Anti-Mi-2 = derm
- ANA = derm
which disease presents with brittle bones?
osteomalacia
what is osteomalacia?
Osteomalacia is a disease of defective bone mineralisation, due to Vitamin D deficiency.
what is the presentation of osteomalacia?
fatigue, bone pain, bone and muscle weakness, and pathological / abnormal fractures.
what are the investigations for osteomalacia?
serum 25-hydroxyvitamin D low, serum calcium & phosphate low, serum ALP high, PTH high, z-ray may show osteopenia, DEXA may show low bone mineral density
what is the management for osteomalacia?
vitamin D supplementation (colecalciferol)
what is the treatment for gout?
1st line = NSAIDs
2nd line = colchicine
3rd line = steroids
what is seen in x-rays in pseudogout?
chondrocalcinosis - calcium deposition in joint space
what is the most likely causative organism for septic arthritis?
s.aureus
ehat is the treatment for septic arthritis?
flucloxacillin (+ rifampicin for first 2 weeks)
what are the differential diagnoses for Parkinsons?
benign essential tremor lewy body dementia drug induced parkinsonism stroke PSP MSA wilsons disease
what are the complications of Parkinson’s disease?
reduced quality of life depression treatment side effects dementia constipation
A 71 year old man complained of progressive weakness and double vision that was more pronounced in the evenings. On examination he had fatiguable weakness of upgaze and shoulder abduction. Initial tests showed that his acetylcholine receptor antibodies were positive. Which further test would you also consider?
CT chest
what are the components of CURB65?
C = confusion U = urea >7mmol/L R = resp rate >30 B = BP systolic <90 and/or diastolic <60 age >65
what is the FEV1 and FVC values for obstructive lung diseases?
FEV1/FVC < 0.7
FEV1
what is the FEV1 and FVC for restrictive lung diseases?
FEV1/FVC > 0.7
FVC and FEV1 < 80%
give 3 obstructive lung diseases
COPD
asthma
bronchiectasis
give 3 restrictive lung diseases
interstitial lung disease scoliosis sarcoidosis idiopathic pulmonary fibrosis neuromuscular disease marked obesity