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passmed qs > 18/06 > Flashcards

18/06 Flashcards

1
Q

cANCA

A

granulomatosis with polyangitis

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2
Q

pANCA

A

eosinophilic granulomatosis
Ulcerative colitis (70%)
Primary sclerosing cholangitis (70%)
Anti-GBM disease (25%)
Crohn’s disease (20%)

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3
Q

paradoxical rise in APTT and thrombocytopenia

A

APS

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4
Q

APS primary prophylaxis

A

low dose aspirin

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5
Q

APS secondary prophylaxis

A

initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4

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6
Q

APS tx of arterial thrombosis

A

lifelong warfarin target INR 2-3

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7
Q

azathioprine prior test

A

TPMT test

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8
Q

azathioprine adverse effects

A

bone marrow suppression
n/v
pancreatitis
> risk of non-melanoma skin cancer
but safe in preg !!

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9
Q

azathioprine drug interaction

A

allopurinol so lower doses needed

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10
Q

oral ulcers, genital ulcers and anterior uveitis

A

behcets

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11
Q

HLA B51

A

behcets

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12
Q

behcets pathergy test

A

puncture site following needle prick becomes inflamed with small pustule forming

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13
Q

bisphosphonates MOA

A

inhibit osteoclasts by reducing recruitment and promoting apoptosis

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14
Q

bisphosphonates adverse effects

A

oesophageal reactions
osteonecrosis of the jaw
> risk atypical stress fractures
acute phase response
hypocalcaemia

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15
Q

important check before starting bisphosphonates

A

Hypocalcemia/vitamin D deficiency should be corrected before

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16
Q

benign ‘overgrowth’ of bone, most typically occuring on the skull

A

osteoma

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17
Q

cartilage-capped bony projection on the external surface of a bone

A

osteochondroma

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18
Q

X-ray shows a ‘double bubble’ or ‘soap bubble’ appearance

A

giant cell tumour

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19
Q

occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure
codman triangle and sunburst appearance
Rb gene

A

osteosarcoma

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20
Q

small round blue cell tumour
onion skin appearance

A

ewings sarcoma

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21
Q

malignant tumour of cartilage

A

chondrosarcoma

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22
Q

CFS mx

A

specialist service
energy mx
physical activity and exercise
CBT

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23
Q

denosumab MOA

A

human monoclonal antibody that prevents the development of osteoclasts by inhibiting RANKL

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24
Q

prevention of skeletal-related events (i.e. pathological fractures)

A

denosumab

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25
Q

drug induced lupus antibodies

A

ANA +ve, dsDNA -ve
anti-histone
anti-ro anti-smith

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26
Q

drug induced lupus

A

procainamide
hydralazine

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27
Q

consequence of ileaocaecal resection in crohns

A

b12 def

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28
Q

Normal/raised total gas transfer with raised transfer coefficient

A

asthma or pulmonary haemorrhage

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29
Q

when should dex not be given in meningitis

A

suspected menigococcal septicaemia

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30
Q

ehlers danlos syndrome

A

type III collagen

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31
Q

fibromyalgia diagnosis

A

American College of Rheumatology
classification criteria which lists 9 pairs of tender points on the body
If a patient is tender in at least 11 of these 18 points it makes a diagnosis of fibromyalgia more likely

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32
Q

fibromyalgia mx

A

explanation
aerobic exercise: has the strongest evidence base
cognitive behavioural therapy
medication: pregabalin, duloxetine, amitriptyline

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33
Q

gout precipitating drug

A

thiazides

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34
Q

HLA-DQ2/DQ8

A

coeliac disease

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35
Q

HLA-DR2

A

narcolepsy
good pastures

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36
Q

marfans syndrome

A

protein fibrillin 1

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37
Q

methotrexate adverse effects

A

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis

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38
Q

methotrexate co-prescription

A

folic acid 5mg once weekly

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39
Q

methotrexate interactions

A

trimethoprim or co-trimoxazole
high dose aspirin

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40
Q

methotrexate toxicity

A

folinic acid

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41
Q

myopathies

A

symmetrical muscle weakness (proximal>distal)

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42
Q

DIP, PIP joints

A

OA

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43
Q

MCP, PIP joints

A

RA

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44
Q

osteomalacia invx

A

low vit D, calcium and phosphate
raised alkaline phosphatase
xray - translucent bands

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45
Q

what is z score adjusted for

A

age, gender and ethnic factors

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46
Q

bones affected pagets

A

skull, spine/pelvis, and long bones of the lower extremities

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47
Q

mx of pagets

A

bisphosphonate

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48
Q

polymyositis antibodies

A

anti-synthestase
anti-JO1

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49
Q

DIPs affected

A

OA or PSORIATIC

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50
Q

raynauds mx

A

CCB eg nifedipine

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51
Q

post STI form of reactive arthritia

A

chlamydia

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52
Q

what invx should be done in all pts with suspected rheumatoid

A

xrays of hands and feet

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53
Q

supraspinatus

A

aBDucts arm before deltoid
Most commonly injured

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54
Q

infraspinatus

A

Rotates arm laterally

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55
Q

teres minor

A

aDDucts & rotates arm laterally

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56
Q

subscapularis

A

aDDuct & rotates arm medially

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57
Q

malignancy from sjogrens

A

lymphoid

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58
Q

stills disease diagnosis

A

Yamaguchi criteria

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59
Q

cautions sulfasalazine

A

G6PD deficiency
allergy to aspirin or sulphonamides (cross-sensitivity)

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60
Q

adverse effects sulfasalazine

A

oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

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61
Q

SLE

A

type 3 hypersensitivity reaction

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62
Q

what does raised CRP in sle indicate

A

infection as levels are usually normal during flares

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63
Q

sle complement c3 c4 levels

A

usually low during active disease

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64
Q

limited cutaneous systemic sclerosis

A

face and distal limbs predominately
anti-centromere antibodies

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65
Q

diffuse cutaneous systemic sclerosis

A

trunk and proximal limbs
anti-scl70

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66
Q

evolving visual loss temporal arteritis tx

A

IV methylprednisolone

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67
Q

SAMA

A

ipratropium

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68
Q

what meds can trigger haemolysis in G6PD def

A

sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas

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69
Q

UC most commonly affected area

A

rectum

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70
Q

bradycardia mx

A

atropine, up to a maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion

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71
Q

post heel pain

A

achilles tendon disorder

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72
Q

achilles tendon disorder RF

A

quinolone eg ciprofloxacin use
hypercholesterolaemia

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73
Q

adhesive capsulitis assoc

A

diabetes

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74
Q

otawa rules for ankle xray

A

pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone
bony tenderness at the medial malleolar zone
inability to walk four weight bearing steps immediately after the injury and in the emergency department

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75
Q

weber type A fracture

A

below the syndesmosis

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76
Q

weber type B fracture

A

start at the level of the tibial plafond and may extend proximally to involve the syndesmosis

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77
Q

weber type c fracture

A

above the syndesmosis which may itself be damaged

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78
Q

Maisonneuve fracture

A

spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, surgery is required

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79
Q

AVN of the hip causes

A

long-term steroid use
chemotherapy
alcohol excess
trauma

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80
Q

avn hip invx of choice

A

mri

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81
Q

most freq loc of biceps rupture

A

proximal
long tendon which attaches to the glenoid

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82
Q

biceps rupture invx

A

USS

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83
Q

wasting in carpal tunnel

A

thenar eminence

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84
Q

carpal tunnel EPS findings

A

motor + sensory: prolongation of the action potential

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85
Q

carpal tunnel mx

A

6 wk trial of conservative mx if mild-mod
steroid inj + wrist splints at night

if severe or trial failed
surgical decompression (flexor retinaculum division)

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86
Q

tinels sign

A

tapping causes paraesthesia

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87
Q

phalens sign

A

flexion of wrist causes symptoms

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88
Q

colles fracture

A

Dorsally Displaced Distal radius → Dinner fork Deformity

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89
Q

complication colles fracture

A

median nerve injury: acute carpal tunnel syndrome presenting with weakness or loss of thumb or index finger flexion

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90
Q

De Quervain’s tenosynovitis

A

pain on radial side of wrist
finklesteins test

91
Q

duputryens contracture affected fingers

A

ring and pinkie

92
Q

duputryens contracture causes

A

+ve FH
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

93
Q

smiths fracture

A

reverse colles fracture caused by falling backwards
Volar angulation of distal radius fragment (Garden spade deformity)

94
Q

bennets fracture

A

Intra-articular fracture of the first carpometacarpal joint

95
Q

bartons fracture

A

Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation

96
Q

fat embolism invx

A

CTPA

97
Q

greater trochanter pain syndrome/trochanteric bursitis

A

pain over the lateral side of hip/thigh
tenderness on palpation of the greater trochanter

98
Q

T1DM UGI symptoms and erratic blood glucose

A

gastroparesis -> metoclopramide

99
Q

hip disclocation

A

POSTERIOR - shortened, adducted and internally rotated leg

100
Q

hip fracture

A

shortened and externally rotated leg

101
Q

classification of hip fracture

A

garden system

102
Q

undisplaced intracapsular hip fracture

A

internal fixation, or hemiarthroplasty if unfit

103
Q

displaced intracapsular hip fracture

A

arthroplasty (total hip replacement or hemiarthroplasty)
THR if prev fit and well well

104
Q

extracapsular fracture - stable intertorchanteric

A

dynamic hip screw

105
Q

extracapsular fracture - reverse oblique, transverse or subtrochanteric

A

intramedullary device

106
Q

iliopsoas abscess invx

A

CT abdo

107
Q

iopsoas abscess mx

A

IV abx
percutaneous drainage
if this fails -> surgery

108
Q

lateral knee pain in runner

A

iliotibial band syndrome

109
Q

unhappy knee triad following lateral blow to knee damage

A

anterior cruciate ligament
medial collateral ligament
meniscus

110
Q

twisting injuries

A

ACL or menisci

111
Q

dashboard injuries

A

PCL

112
Q

skiiing/valgus stress

A

MCL

113
Q

chondromallacia patellae

A

Teenage girls, following an injury to knee e.g. Dislocation patella
Typical history of pain on going downstairs or at rest

114
Q

tibial plateau fractures

A

Schatzker Classification

115
Q

buttock claudication and impotence

A

leriche syndrome

116
Q

spina stenosis diagnosis

A

MRI

117
Q

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

A

L3

118
Q

sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

A

L4

119
Q

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

A

L5

120
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

A

S1

121
Q

Injury results in a positive Trendelenburg sign

A

superior gluteal nerve

122
Q

lumbar spinal stenosis

A

central canal is narrowed by tumour, disk prolapse or other similar degenerative changes

123
Q

lumbar spinal stenosis tx

A

laminectomy

124
Q

pain is aggravated by wrist flexion and pronation

A

medial epicondylitis

125
Q

froments sign

A

ulnar nerve palsy

126
Q

osteomyelitis in sickle cell pts

A

salmonella

127
Q

?osteoporotic vertebral fracture invx

A

xray

128
Q

salter harris I

A

Fracture through the physis only (x-ray often normal)

129
Q

salter harris II

A

Fracture through the physis and metaphysis (up the way)

130
Q

salter harris III

A

Fracture through the physis and epiphysis to include the joint (down the way)

131
Q

salter harris IV

A

Fracture involving the physis, metaphysis and epiphysis

132
Q

salter harris V

A

Crush injury involving the physis (x-ray may resemble type I, and appear normal)

133
Q

heel pain in adults

A

plantar fasciitis

134
Q

rib fracture invx

A

ct chest

135
Q

proximal scaphoid pole fractures

A

surgical fixation

136
Q

shoulder dislocation

A

ANTERIOR

137
Q

Painful arc of abduction between 60 and 120 degrees
Tenderness over anterior acromion

A

supraspinatus tendonitis

138
Q

humeral neck fracture/dislocation

A

axillary nerve

139
Q

humeral midshaft fracture

A

radial nerve

140
Q

medial epicondyle fracture

A

ulnar nerve

141
Q

thumb, middle, or ring finger

A

trigger finger

142
Q

talipes equinovarus tx

A

ponseti method

143
Q

pulled elbow tx

A

passively supination of the elbow joint whilst the elbow is flexed to 90 degrees

144
Q

AACG

A

hypermetropia

145
Q

OAG

A

myopia

146
Q

osteomyelitis kids

A

metaphysis

147
Q

osteomyelitis adults

A

epiphysis

148
Q

adrenaline dose anaphylaxis

A

0.5ml 1:1,000 IM

149
Q

adrenaline dose cardiac arrest

A

10ml 1:10,000 IV or 1ml of 1:1000 IV

150
Q

mx of accidental adrenaline injection

A

local infiltration of phentolamine

151
Q

disulfram

A

promotes abstinence

152
Q

acamprosate

A

reduces craving

153
Q

main SE of alpha blockers

A

postural hypotension

154
Q

slate gray appearance

A

amiodarone

155
Q

beta blocker overdose

A

atropine
in resistant cases glucagon may be used

156
Q

cocaine toxicity

A

benzos

157
Q

when should digoxin levels be measured if suspected toxicity

A

within 8 to 12 hours of the last dose

158
Q

statins

A

LFTs

159
Q

ACEi

A

U+Es

160
Q

amiodarone

A

TFT, LFT

161
Q

methorexate

A

FBC, LFT, U&E

162
Q

azathioprine

A

FBC, LFT

163
Q

lithium

A

Lithium level, TFT, U&E

164
Q

valproate

A

LFT

165
Q

glitazones

A

LFT

166
Q

invasive diarrhoea

A

cipro

167
Q

CK in PMR

A

normal

168
Q

allergic contact dermatitis

A

type IV hypersensitivity

169
Q

Otitis externa in diabetics

A

treat with cipro to cover pseudomonas

170
Q

haemophilia

A

APTT increased
PT normal
bleeding time normal

171
Q

von willebrands

A

APTT increased
PT normal
bleeding time increased

172
Q

vit K def

A

APTT increased
PT increased
bleeding time normal

173
Q

acute intermittent porphyria enzyme defect

A

porphobilinogen deaminase

174
Q

abdominal, neuro and neuropsychiatric symptoms in 20-40 year olds
urine turns deep red on standing

A

acute intermittent porphyria

175
Q

acute intermittent porphyria tx

A

IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available

176
Q

assoc with t(15;17)
fusion of PML and RAR-alpha genes
presents younger than other types of AML (average = 25 years old)
Auer rods (seen with myeloperoxidase stain)
DIC or thrombocytopenia often at presentation
good prognosis

A

Acute promyelocytic leukaemia M3

177
Q

APS pregnancy mx

A

low-dose aspirin once the pregnancy is confirmed on urine testing
low molecular weight heparin once a fetal heart is seen on ultrasound. This is usually discontinued at 34 weeks gestation

178
Q

blood film: spherocytes and reticulocytes
positive direct antiglobulin test (Coombs’ test).

A

AI haemolytic anaemia

179
Q

antibody in warm AIHA

A

IgG

180
Q

antibody cold AIHA

A

IgM

181
Q

warm AIHA tx

A

steroids (+/- rituximab)

182
Q

absence of beta globulin chains
HbA2 & HbF raised

A

beta thalassaemia major

183
Q

beta thalassaemia major tx

A

repeated transfusion + iron chelation therapy

184
Q

microcytosis disproportionate to anaemia

A

beta thalassaemia trait

185
Q

target cells

A

Sickle-cell/thalassaemia
Iron-deficiency anaemia
Hyposplenism
Liver disease

186
Q

‘Tear-drop’ poikilocytes

A

myelofibrosis

187
Q

spherocytes

A

Hereditary spherocytosis
Autoimmune hemolytic anaemia

188
Q

basophillic stippling

A

Lead poisoning
Thalassaemia
Sideroblastic anaemia
Myelodysplasia

189
Q

howell jolly bodys

A

hyposplenism

190
Q

heinz bodies

A

G6PD def
alpha thalassaemia

191
Q

schistocytes/helmet cells

A

Intravascular haemolysis
Mechanical heart valve
Disseminated intravascular coagulation

192
Q

‘Pencil’ poikilocytes

A

iron deficiency anaemia

193
Q

hypersegmented neutrophils

A

megaloblastic anaemia

194
Q

blood transfusion anaphylaxis cause

A

Can be caused by patients with IgA deficiency who have anti-IgA antibodies

195
Q

RBC transfusion threshold in pts without ACS

A

70

196
Q

RBC transfusion threshold in pts with ACS

A

80

197
Q

burkitts lymphoma genetics

A

c-myc gene translocation, usually t(8:14)

198
Q

starry sky appearance

A

burkitts lymphoma

199
Q

CLL richters transformation

A

-> high grade lymphoma

200
Q

smudge cells/smear cells

A

CLL

201
Q

CLL invx

A

immunophenotyping: most cases can be identified using a panel of antibodies specific for CD5, CD19, CD20 and CD23

202
Q

CML genetics

A

translocation between the long arm of chromosome 9 and 22 - t(9:22)(q34; q11) -> BCR-ABL gene -> tyrosine kinase activity in excess of normal

203
Q

CML transformation

A

blast transformation -> AML, ALL

204
Q

CML tx

A

imatinib

205
Q

dabigatran MOA

A

direct thrombin inhibitor

206
Q

rivaroxaban, apixaban and edoxaban MOA

A

direct XA inhibitors

207
Q

apixaban and rivaroxaban reversal

A

Andexanet alfa

208
Q

dabigatran reversal

A

Idarucizumab

209
Q

DIC picture

A

↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
schistocytes due to microangiopathic haemolytic anaemia

210
Q

most common inherited thrombophilia

A

factor V leiden/activated protein C resistance

211
Q

heinz bodies, bite and blister cells

A

G6PD

212
Q

G6PD diagnosis

A

G6PD enzyme assay 3 months after an acute episode of haemolysis

213
Q

drugs causing haemolysis in G6PD

A

anti-malarials: primaquine
ciprofloxacin
sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

214
Q

acute GVHD

A

within 100 days of transplantation

215
Q

chronic GVHD

A

after 100 days following transplantation

216
Q

t(9;22) - Philadelphia chromosome

A

CML

217
Q

t(15;17)

A

acute promyelocytic leukaemia (M3)

218
Q

t(8;14)

A

burkitts lyphoma

219
Q

t(11;14)

A

mantle cell lymphoma

220
Q

t(14;18)

A

follicular lymphoma

221
Q

hereditary spherocytosis long term tx

A

folate replacement
splenectomy

222
Q

reed sternberg cell

A

hodgkins lymphoma

223
Q

hodgkins lymphoma tx

A

chemo - ABVD or BEACOPP

passmed qs (18 decks)

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