Things I Did Not Know

Question 1

Hep B Serology, cause?
- HbsAg and HBcAb positive
- HBeAg and HBV DNA negative
- HBeAb is positive
- asymptomatic

Answer 1

Inactive hepatitis B surface antigen (HBsAg) carrier state.

Question 2

Hep B Sero cause?
HBeAg positive
HBsAg positive
HBV DNA positive
LFTs persisently elevated
HBeAg negative/positive

Answer 2

Chronic Hep B HBe Ag + or negative chronic

Question 3

Hep B Sero cause
HBsAg negative
HBsAb positive
normal LFTs
very low levels of HBV DNA <10,000 coples/ml

Answer 3

Resolved chronic hepatitis B (past infection

Question 4

FIrst line test C.diff

Answer 4

C diff cytotoxin assay

Question 5

Type of Varices that bleeds the most?

Answer 5

IGV 1
- least GOV1/IGV 2

Question 6

Which cause and what mutation cetuximab useful in and what is target of drug?

Answer 6

Colorectal cancer
wild type K-ras
binds to EGFR and inhibitors activation of wild type K-ras. If K-ras mutatant then eGFR can’t control.

Question 7

Action of Gastrin?

Answer 7

Increases HCL, decrease pH
Increase pepsinogen and IF section
Increase gastric motility
Stimulates growth of gastric mucosa

Question 8

ILD associated with tuberous sclerosis?
its characteristics?

Answer 8

Lymphangioleiomyomatosis - LAM - multisystem disease associated with TS, effects women of child bearing age. Renal angiomyolipoma, thoracic or abdominal chylous effusion. CT - multiple thin walled cysts throughout lungs.

Pulmonary Langerhan’s cell histiocytosis
> young adults who smoke, with CT finding of nodules and small irregular shaped cysts.

Question 9

MRI findings: name disease
Frontal lobe atrophy
Unilateral temporal lobe enhancement on T2/Flair
Midbrain atrophy producing a humming bird sing on sagittal view
Caudate and putamen T2 hyperintensity, and diffusion restriction on DWI/ADC

Answer 9

1. FTD
2. herpes simplex encephalitis or limbic encephalitis
3. Progressive supranuclear palsy
4. Creutzfeldt Jakob disease - rapid onset dementia behavioural change myoclonus EEG shows generalised periodic sharp wave pattern.

Question 10

ECG findings for ARrhythmogenic Right Venticular Dysplasia (ARVD)

Answer 10

V1-5 T wave inversion and epsilon waves (small positive inflection at end of WRS)
Presents with palpitations, syncope or SCD > brouhgt on by exercise or catecholamine excess
fibro-fatty replacement of RV myocardium = Cardiomyopathy

Question 11

How long for long QT?

Answer 11

> 500 msec
treat all with beta blockers
LQTS 1 - KCNQ1 muts, often exercise induced especially swimming. Broad base T-waves.
LQTS 2 - KCNH2/HERG gene, emotion arousal precipitate. T wave low amplitude, hump.
LQT3 - gain of function mut in SCN5A, events during sleep. Long St segment, tall peaked t wave.

Question 12

SHort QT?

Answer 12

high risk SCD
autosomal dominant
AF at young age, increased risk of VF

Question 13

Wolff Park Whtie

Answer 13

Ventriular preexciatation (Short pR and delta wave)
Sym tachycardia. AF is life threatening turn into VF

Question 14

Arrhythmogenic Right Vent Dysplasia (ARVD)

Answer 14

Autosomal dominant
fibro-fatty inflitration RV, poor RV function presved LV function
Seen on Cardiac MRI
akineitc dyskietic bulding apical RV
ECG:LBB or RBBB - T wave inversion V1 to V3

Question 15

Brugada

Answer 15

Autosomal domiant
Peak prevalnce SCD 4th decade
pseudo RBBB with ST seg elevation of ECG, Ventriuclar arrythmias
can brin gon ECG changes with flecainide challenge
Loss of function mut in SCN5A

Question 16

HOCM

Answer 16

Autosmal domiannt
Mutation in cardiac B myosin heavy chain
echo lvh, sepal.
Tx beta blocker
LV wall thickness >30mm increase risk.
avoid dig and diuretics.

Question 17

Cardiac Hormones that promote growth, vasoconstriction. Na/h2o retention

Answer 17

angiotensin 2
aldosterone
endothelin
NA

Question 18

Contraindications to fibrinolysis use in ST segment elevation?

Answer 18

• active bleeding
• significant closed head or facial trauma last 3/12
• suspected aortic dissection (neuro symptoms)
• Any prior intracranial haemorrhage
• Ischaemic stroke within 3/12
• known structural cerebral vascular lesion
• known malignant intracranial neoplasm

ALL other relative
eg HTN >180, preg, traumatic/prolonged CPR, recent major surg, active peptic ulcer, current use anti-caogulates.