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Miscellaneous > Y3 AFT 1 > Flashcards

Y3 AFT 1 Flashcards

1
Q

What are the main types of MND?

A

Amyotrophic lateral sclerosis

Primary lateral sclerosis

Progressive bulbar palsy

Progressive muscular atrophy

Progressive pseudobulbar palsy

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2
Q

What clinical features contribute to LMN signs?

A

Muscle fasciculations and weakness.

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3
Q

What clinical features contribute to UMN signs?

A

Increased tone and brisk reflexes

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4
Q

What is the most common type of MND? Does this have upper or lower motor nuerone signs?

A

ALS (amyotrophic lateral sclerosis) which is characterised by a combination of upper and lower motor neurone signs.

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5
Q

What is ALS associated with and what feature of the hands would raise suspicion for having ALS?

A

ALS is also associated with frontotemporal dementia and should be highly suspected in those with thenar atrophy.

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6
Q

Progressive muscular atrophy presents only with LMN signs. True/false?

A

True

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7
Q

Primary lateral sclerosis presents only with LMN signs. True/false?

A

False

Presents with ONLY UMN signs

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8
Q

What is the cause of progressive bulbar palsy and pseudobulbar palsy and how do the effects differ?

A

Caused by damage to cranial nerves 9,10 and 12 and presents with dysphagia.

Bulbar palsy causes reduced jaw and gag reflexes and tongue fasciculations.

Pseudobulbar palsy causes slow speech and brisk jaw reflex.

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9
Q

What is the cause of vascular parkinsonism?

A

Caused by small strokes and infarcts which could have gone by unnoticed and untreated if patient lives alone.

Usually comes on slowly

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10
Q

What does a poor response to levodopa indicate?

A

Multiple system atrophy

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11
Q

What are some symptoms that can be seen in multiple system atrophy?

A

Erectile dysfunction, constipation or postural symptoms

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12
Q

How does drug-induced parkinsonism present itself?

A

Tends to occur a few weeks after starting one of the following medications:

Chlorpromazine, haloperidol, lithium, valproic acid, metoclopramide.

If patient has been taking 1 of these medications for a while, it is unlikely to be the cause.

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13
Q

What is metabolic syndrome?

A

A condition that includes a cluster of risk factors specific for cardiovascular disease.

The cluster of metabolic factors include abdominal obesity, high blood pressure, impaired fasting glucose, high triglyceride levels, and low HDL cholesterol levels.

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14
Q

What group of medications leads to metabolic syndrome (risk factors for CVD)?

A

Atypical (2nd gen) antipsychotics

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15
Q

What is akathisia?

A

Restlessness, particularly in the legs.

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16
Q

What are acute dystonic reactions?

A

Acute dystonic reactions are involuntary spasms that begin early after exposure to antipsychotics (hours to days).

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17
Q

What features does a total anterior circulation stroke require for diagnosis?

A

A total anterior circulation stroke requires all of the following for diagnosis:

  • Unilateral weakness +/ sensory deficit of face, arm and leg
  • Homogenous hemianopia
  • Higher cerebral dysfunction (dysphagia - difficulty swallowing)
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18
Q

What features does a partial anterior circulation stroke require for diagnosis?

A

A partial anterior circulation stroke requires 2/3 of the following for diagnosis:

  • Unilateral weakness +/ sensory deficit of face, arm and leg
  • Homogenous hemianopia
  • Higher cerebral dysfunction (dysphagia- difficulty swallowing)
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19
Q

What are the features required for a posterior circulation stroke?

A

A posterior circulation syndrome stroke requires one of the following:

  • Cranial nerve palsy and contralateral motor/sensory deficit
  • Bilateral motor/sensory deficits
  • Eye movement disorder
  • Cerebellar dysfunction
  • Isolated homonymous hemianopia
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20
Q

What are the features required for a lacunar stroke?

A

A lacunar syndrome stroke requires one of the following:

  • Pure sensory stroke
  • Pure motor stroke
  • Ataxic hemiparesis
  • Sensorymotor stroke
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21
Q

What are the features of a lacunar stroke?

A

present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

strong association with hypertension

common sites include the basal ganglia, thalamus and internal capsule

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22
Q

What is isolated hemiparesis?

A

Isolated hemiparesis refers to weakness or partial paralysis affecting one side of the body, typically involving the arm, leg, and sometimes the face, on the same side.

Isolated hemiparesis means that weakness is the primary symptom, without other significant neurological deficits such as sensory loss, visual disturbances, or altered mental status.

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23
Q

What is ataxic hemiparesis?

A

Ataxic hemiparesis is a condition characterized by weakness on one side of the body combined with incoordination of movements, resulting in difficulties with walking, balance, and fine motor tasks.

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24
Q

Features of a pure sensory stroke?

A

Primary Symptom: Loss or impairment of sensation.

Motor Function: Remains intact; no weakness or paralysis.

Cause: Typically due to ischemia affecting sensory pathways or cortex.

Presentation: Numbness, tingling, or loss of sensation on one side of the body.

Common Associated Stroke Type: Lacunar stroke (small vessel infarction).

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25
Q

Features of pure motor stroke?

A

Primary Symptom: Weakness or paralysis.

Sensory Function: Remains intact; no loss of sensation.

Cause: Usually caused by ischemia affecting motor pathways or cortex.

Presentation: Weakness or paralysis on one side of the body, often affecting face, arm, and/or leg.

Common Associated Stroke Type: Large vessel stroke (occlusion of major cerebral artery).

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26
Q

What muscles of the hand are supplied by the median nerve (Mnemonic: LOAF)?

A

Lateral two lumbricals

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

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27
Q

What is the main presentation for oligodendrocytoma?

A

Seizures

Also present with headaches and blurred vision (from raised ICP).

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28
Q

Where in the brain do oligodendrocytes commonly occur?

A

Commonly occur in the frontal lobe.

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29
Q

What is the histological appearance for oligodendrocytoma?

A

A fried egg appearance can be seen on histology (regular cells with spherical nuclei containing finely granular chromatin surrounded by a halo of cytoplasm).

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30
Q

What is the most common brain tumour type?

A

Astrocytoma

Grade 1 usually affects children

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31
Q

Features of pituitary carcinoma?

A

Presents with bilateral hemianopia and panhypopituitarism (pale, no axillary hair)

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32
Q

Features of schwannoma?

A

A schwannoma tends to present with bilateral conductive hearing loss and is associated with the condition neurofibromatosis (specifically neurofibromatosis type 2).

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33
Q

What is seen on histology of myeloma?

A

Clear cells (the tumour cells contained cytoplasmic vacuoles that produced a clear histologic appearance).

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34
Q

When does brain herniation occur?

A

Brain herniation occurs when an uncontrolled raised ICP causes brain tissue to shift from its normal position inside the skull.

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35
Q

What can brain herniation lead to?

A

This can lead to compression of arteries, nerves or key structures depending on where the herniation occurs within the brain.

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36
Q

What is uncal herniation?

A

When the temporal lobe herniates posteriorly. It can impinge on the 3rd cranial nerve causing 3rd nerve palsy.

An example feature of 3rd nerve palsy is a fixed, dilated pupil known as “blown out pupils”.

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37
Q

What is a subflacine herniation?

A

Occurs when one half of the cerebrum herniates across the midline.

It can cause compression of the anterior cerebral artery and lead to motor and/or sensory weakness.

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38
Q

What is a cerebellar tonsillar herniation?

A

Occurs when the cerebellum moves inferiorly and compresses the medulla which can lead to respiratory distress and death.

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39
Q

What is a central herniation?

A

Occurs when the central part of the brain is inferiorly compressed towards the brainstem.

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40
Q

What is a transcalverial herniation?

A

Transcalverial herniation is where there is a defect within the skull and a part of the brain herniates out through that opening.

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41
Q

What is first line treatment for an absence seizure?

A

Usually ethosuximide or sodium valproate.

Sodium valproate usually contraindicated in women of childbearing age during to teratogenic effects.

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42
Q

What is first line treatment for generalised treatment for tonic-clonic seizure?

A

Sodium valproate or lamotrigine.

Lamotrigine used particularly in women of childbearing age.

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43
Q

What is second line treatment for generalised tonic clonic seizure?

A

Levetiracetam or topiramate

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44
Q

What is first line treatment for myoclonic seizure?

A

Sodium valproate

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45
Q

What is second line treatment for myoclonic seizure?

A

Levetiracetam

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46
Q

What is first line treatment for a focal seizure?

A

Lamotrigine/carbamazepine

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47
Q

What is second line treatment for a focal seizure?

A

Sodium valproate if patient is male or is female and unable to have children.

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48
Q

What is a focal seizure?

A

Partial seizures (or focal seizures) occur in an isolated brain area, often in the temporal lobes.

They affect hearing, speech, memory and emotions.

Patients remain awake during partial seizures.

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49
Q

What is the clinical presentation for a focal seizure?

A

Varies depending on the location of the abnormal electrical activity:

Déjà vu
Strange smells, tastes, sight or sound sensations
Unusual emotions
Abnormal behaviours

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50
Q

Difference between tonic and atonic seizure?

A

Tonic seizures involve a sudden onset of increased muscle tone, where the entire body stiffens. This results in a fall if the patient is standing, usually backwards. They last only a few seconds, or at most a few minutes.

Atonic seizures (causing “drop attacks”) involve a sudden loss of muscle tone, often resulting in a fall. They last only briefly, and patients are usually aware during the episodes. They often begin in childhood.

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51
Q

What are the side-effects that could occur with SSRI’s?

A

Throbbing headache, nausea, and vomiting. Worst in the morning and improved by standing up.

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52
Q

What are some additional side-effects of SSRI’s?

A

Other side effects include reduces libido, vivid dreams, transient increase in suicidal thoughts and increased anxiety.

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53
Q

What type of drug is mirtazapine?

A

Atypical antidepressant

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54
Q

Why is mirtazapine sometimes used alongside SSRI’s?

A

Can be used in addition to SSRIs to block the side effects of SSRIs and therefore is a good additional pharmacological option.

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55
Q

What type of drugs are amitriptyline and imipramine?

A

Tricyclic antidepressants

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56
Q

Venlafaxine and duloxetine are examples of SSRI’s. True/false?

A

False

They are SNRI’s (serotonin and noradrenaline re-uptake inhibitors).

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57
Q

What type of drug is imipramine and what are some of the side-effects associated with it?

A

Imipramine is a tricyclic antidepressant

Has associated anticholinergic side-effects:
Dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating

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58
Q

What are some anticholinergic side-effects?

A

“Can’t pee, can’t see, can’t spit, can’t sh*t”

Urinary retention
Blurred vision
Dry mouth
Constipation

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59
Q

Mirtazapine is an atypical antidepressant, how does it work and what side-effect can it cause?

A

Acts as an antagonist to the presynaptic alpha-2-adrenergic receptors leading to an increased release of serotonin and norepinephrine.

It does not cause anti-cholinergic side effects but does cause weight gain

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60
Q

What are monoamine oxidase inhibitors?

A

A class of drugs that inhibit the activity of monoamine oxidase enzymes, which are responsible for breaking down neurotransmitters such as serotonin, dopamine, and norepinephrine (noradrenaline) in the brain.

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61
Q

What are the 2 types of monoamine oxidase inhibitors?

A

Monoamine oxidase A and monoamine oxidase B inhibitors

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62
Q

What are MAO-A inhibitors and examples?

A

These inhibitors primarily target MAO-A, leading to increased levels of serotonin, norepinephrine, and dopamine in the brain.

Examples of MAO-A inhibitors include:
Moclobemide
Phenelzine
Tranylcypromine

63
Q

What are MAO-B inhibitors and examples?

A

These inhibitors primarily target MAO-B, leading to increased levels of dopamine in the brain.

Examples of MAO-B inhibitors include:
Selegiline
Rasagiline
Safinamide

64
Q

Overall use for monoamine oxidase inhibitors?

A

MAO inhibitors, whether selective for MAO-A or MAO-B, work by preventing the breakdown of neurotransmitters, thereby increasing their levels in the brain.

They are used in the treatment of various psychiatric and neurological disorders, including depression, Parkinson’s disease, and anxiety disorders.

65
Q

What are features that would show a high risk assessment level for anroexia nervosa?

A
  • BMI less than 13 with weight loss more than 1kg per week
  • Prolonged QT syndrome, HR less than 40, BP systolic less than 80
  • Core temperature less than 34 ºC
  • Unable to rise from squat without using arms for leverage
  • Cognitive impairment
66
Q

What are some other physical findings that would be found in a patient with anorexia nervosa?

A
  • Muscle wasting
  • Hair loss
  • Lanugo hair (“fine, downy, pigmented hairs on the back, abdomen and forearms”)
  • Cold, blue peripheries
  • Bruising
  • Bradycardia, hypotension
  • Hypercarotenaemia (increased carotenoids leading to yellowish skin appearance)
67
Q

What are the risk factors for puerperal psychosis?

A

Bipolar disorder (50%), previous puerperal psychosis, 1st degree relative with history.

68
Q

What can absence of P waves on ECG be an indication of?

A

Heart block

69
Q

First degree heart block features?

A

In this type, there is a delay in the conduction of electrical signals from the atria to the ventricles.

On an ECG, it is characterised by a prolonged PR interval (the time between the start of the P wave and the start of the QRS complex), typically greater than 0.20 seconds.

It is often asymptomatic and usually does not require treatment unless there are other underlying heart conditions.

70
Q

What is the underlying pathology of second degree heart block?

A

In second-degree heart block, some electrical signals from the atria fail to reach the ventricles.

71
Q

What are the 2 types of second degree heart block?

A

Type I (Wenckebach): Characterized by a progressive lengthening of the PR interval until a QRS complex is dropped (missing).

Type II: In this type, occasional dropped beats (missing QRS complexes) occur without a progressive lengthening of the PR interval.

72
Q

Third degree heart block features?

A

In complete heart block, there is a complete failure of electrical signals from the atria to reach the ventricles.

On an ECG, there is no association between the P waves and the QRS complexes.

It often results in a slow, irregular heartbeat and can cause symptoms such as dizziness, fatigue, and fainting.

Treatment may involve the use of a pacemaker to regulate the heart rhythm.

73
Q

What can peaked T waves on ECG indicate?

A

Hyperkalaemia

74
Q

What is the average rate for supraventricular tachycardias?

A

150-220 bpm

75
Q

What does a “snowstorm appearance” indicate on ultrasound of pelvis?

A

Molar pregnancy

76
Q

What are features that differentiate a normal pregnancy from a molar pregnancy?

A

More severe morning sickness

Vaginal bleeding

Increased enlargement of the uterus

Abnormally high hCG

Thyrotoxicosis (hCG can mimic TSH and stimulate the thyroid to produce excess T3 and T4)

77
Q

What is a cancer that occurs when cells that were part of a normal pregnancy or a molar pregnancy become cancerous?

A

Choriocarcinoma

78
Q

Management of molar pregnancy?

A

Involves evacuation of the uterus to remove the mole.

The products of conception need to be sent for histological examination to confirm a molar pregnancy.

Patients should be referred to the gestational trophoblastic disease centre for management and follow up.

The hCG levels are monitored until they return to normal.

Occasionally the mole can metastasise, and the patient may require systemic chemotherapy.

79
Q

Treatment of ectopic pregnancy?

A

The treatment for ectopic pregnancy is either medical using IM (intramuscular) methotrexate or surgical through a laparoscopic salpingectomy.

If the ectopic pregnancy is ruptured, then a laparotomy is indicated.

80
Q

First line investigation for suspected endometriosis?

A

Transvaginal ultrasound exam (used regardless of pelvic examination findings).

81
Q

Can a pelvic MRI be used for diagnosing endometriosis?

A

No

A pelvic MRI should not be used as a primary diagnostic tool and instead should be used to assess the extent of the endometriosis.

82
Q

What is the gold-standard investigation for endometriosis?

A

Laparoscopy

83
Q

What are the 3 types of urinary incontinence?

A

Stress incontinence (leakage when coughing or laughing or jumping etc)

Overflow incontinence (due to bladder outlet obstruction)

Urge incontinence (due to overactive detrusor muscle)

84
Q

First line management for urge incontinence?

A

The first line management option for urge incontinence is bladder retraining exercises for minimum of 6 weeks.

Then try bladder stabilising drugs with antimuscarinics as first line i.e. oxybutynin.

85
Q

When can miragebron be used instead of oxybutynin in urge incontinence?

A

Mirabegron can be used in urge incontinence if there is a concern about anticholinergic side effects in frail elderly patients.

86
Q

First line management for stress incontinence?

A

Pelvic floor exercises for at least 3 months.

Then can try surgical procedures such as retro-pubic mid-urethral tape procedures.

Duloxetine is offered to woman who decline surgical procedures.

87
Q

First line management for overflow incontinence?

A

Dependent on the cause.

Typically, it is caused by large prostates obstruction.

If a bladder is palpable then they need to go see a nephrologist/urologist and a catheter will be used to void the bladder.

88
Q

What are the most common causes of pelvic inflammatory disease?

A

Chlamydia and gonorrhoea

89
Q

What is a first line priority in a patient with PID?

A

Urinary pregnancy test

90
Q

Are blood cultures used for PID?

A

Only when patient appears systemically unwell i.e. abnormal HR and BP.

To look for signs of infection

91
Q

What is vasa praevia?

A

When the foetal vessels lie over the internal os.

These vessels can then rupture during labour and cause bleeding.

92
Q

Signs of vasa praevia?

A

Bleeding, rupture of membranes and foetal bradycardia.

93
Q

What can diagnose vasa praevia?

A

Transvaginal ultrasound

94
Q

Treatment of vasa praevia?

A

Treatment is emergency caesarean section if in labour (or have continuous bleeding).

95
Q

What can be used to stop bleeding in PPH?

A

Synctocinon aka synthetic oxytocin

96
Q

Features of brenner epithelial ovarian tumour?

A

This tumour is often found incidentally during surgery or on pelvic examination.

They classically have transitional epithelium (native to the bladder not the ovaries) and coffee bean nuclei.

97
Q

Features of clear cell epithelial ovarian tumours?

A

Clear cell ovarian tumours have a hobnail cells on pathology,

Contains a bulbous nucleus and nuclear projections into the cytoplasm.

98
Q

Features of endometroid epithelial ovarian tumours?

A

Endometrial tumours are associated with endometriosis and chocolate cysts.

99
Q

Physiologically, which hormone inhibits contractility in the late stages of pregnancy?

A

Progesterone

100
Q

What is the role of oestrogen in late pregnancy stages?

A

Increase contractility of uterus

101
Q

How does oxytocin influence contractions in late pregnancy?

A

Oxytocin increases contractions and excitability and in labour produces prostaglandins which create even more powerful contractions.

Mechanical stretch of the uterine muscles and the cervix also cause increased contractability and further oxytocin release.

102
Q

What are the 4 components of the tetralogy of fallot?

A

Pulmonary stenosis

Ventricular septal defect

Overriding aorta

Hypertrophic right ventricle

103
Q

Underlying cause of pulmonary stenosis?

A

Pulmonary Stenosis is caused by a thickening of the pulmonary valve which makes It harder for blood to travel through it.

So the degree of stenosis determines how hard it is for blood to be pumped to the lungs and therefore how severe the heart is functionally damaged.

104
Q

Underlying cause of right ventricular hypertrophy?

A

Right ventricular hypertrophy is caused by the pulmonary stenosis and therefore the degree of stenosis impacts the degree of hypertrophy.

The narrowing of the lumen of the pulmonary valve makes the right ventricle work even harder to pump the blood through it and so the muscle gets bigger and results in hypertrophy.

105
Q

What does ventricular septal defect cause?

A

Causes mixing of oxygenated and deoxygenated blood.

106
Q

How does overriding aorta contribute to a cyanotic baby in TOF?

A

The aorta normally receives blood from the left ventricle however in TOF it is receiving blood from both the left and right ventricle.

The deoxygenated blood can now go into the aorta as well as the pulmonary artery (and it often takes the path of least resistance which because of the pulmonary stenosis is the aorta) and results in an overall cyanotic baby.

107
Q

What is the CAGE questionnaire used for?

A

Assessment of alcohol dependance

108
Q

What is pre-eclampsia?

A

New high blood pressure (hypertension) in pregnancy with end stage organ dysfunction.

Occurs with proteinuria, swelling, headaches and blurred vision.

Usually occurs after 20 weeks gestation

109
Q

When does pre-eclampsia typically occur in gestation?

A

Usually after 20 weeks

110
Q

What is the main triad of features for pre-eclampsia?

A

Proteinuria (protein in urine)

Hypertension

Oedema

111
Q

What is chronic hypertension?

A

High blood pressure that exists before 20 weeks gestation and is longstanding.

NOT caused by placental dysfunction and is NOT classed as pre-eclampsia.

112
Q

What is gestational/pregnancy-induced hypertension?

A

Hypertension occurring after 20 weeks gestation WITHOUT proteinuria (protein in urine).

113
Q

What is eclampsia?

A

When seizures occur due to pre-eclampsia.

114
Q

What is pre-eclampsia?

A

Pregnancy-induced hypertension associated with organ damage, notably proteinuria.

115
Q

What are the high risk factors for pre-eclampsia?

A

Pre-existing hypertension

Previous hypertension in pregnancy

Existing autoimmune conditions (e.g. systemic lupus erythematosus)

Diabetes

Chronic kidney disease

116
Q

What are the moderate risk factors for pre-eclampsia?

A

Older than 40

BMI > 35

More than 10 years since previous pregnancy

Multiple pregnancy

First pregnancy

Family history of pre-eclampsia

117
Q

What are the pre-eclampsia risk factors used to assess for in pregnancy?

A

Used to determine which women are offered aspirin as prophylaxis for pre-eclampsia.

118
Q

Based on the pre-eclampsia risk factors, when is aspirin used as a prophylaxis?

A

If woman has ONE high risk factor

or

TWO or more moderate risk factors

119
Q

Pre-eclampsia symptoms?

A

Headache

Visual disturbance or blurriness

Nausea and vomiting

Upper abdominal or epigastric pain (this is due to liver swelling)

Oedema

Reduced urine output

Brisk reflexes

120
Q

What is the blood pressure limit for pre-eclampsia and what other features would show pre-eclampsia?

A

Systolic bp > 140
Diastolic bp > 90

Proteinuria (1+ or more on urine dipstick)

Organ dysfunction (e.g. raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)

Placental dysfunction (e.g. fetal growth restriction or abnormal Doppler studies)

121
Q

How is proteinuria quantified?

A

Urine protein:creatinine ratio (above 30mg/mmol is significant)

Urine albumin:creatinine ratio (above 8mg/mmol is significant)

122
Q

What protein can be assessed during 20-35 weeks of gestation to rule out pre-eclampsia?

A

Placental growth factor is a protein released by the placenta that functions to stimulate the development of new blood vessels.

In pre-eclampsia, the levels of PlGF are low.

123
Q

What is routinely monitored at every antenatal appointment for all pregnant women?

A

Blood pressure

Symptoms

Urine dipstick for proteinuria

124
Q

First, second and third line management options for hypertension in pre-eclampsia?

A

Labetolol is first-line as an antihypertensive

Nifedipine (modified-release) is commonly used second-line

Methyldopa is used third-line (needs to be stopped within two days of birth)

125
Q

What is eclampsia and it’s treatment?

A

Eclampsia refers to the seizures associated with pre-eclampsia.

IV magnesium sulphate is used to manage seizures associated with pre-eclampsia.

126
Q

HELLP syndrome is a combination of features that occurs as a complication of pre-eclampsia and eclampsia.

What are the key characteristic features?

A

HELLP is an acronym for the key characteristics:

Haemolysis
Elevated Liver enzymes
Low Platelets

127
Q

Features of optic neuritis (Mnemonic: CRAP)?

A

Mnemonic: CRAP

Central scotoma
Red desaturation/RAPD
Acuity decreased
Painful eye movements

128
Q

Use of anastrozole in breast pathology?

A

Anastrozole = aromatase inhibitor

It is prescribed to post-menopausal with oestrogen receptor positive breast cancer.

Aromatase inhibitors work by blocking the enzyme aromatase, which is responsible for converting androgens (male hormones) into oestrogen.

By blocking estrogen production, anastrozole helps to slow or stop the growth of estrogen-sensitive breast cancer cells.

129
Q

Use of tamoxifen in breast pathology?

A

Tamoxifen = oestrogen receptor antagonist

It is prescribed to premenopausal women with oestrogen receptor positive breast cancer. Can also be used in postmenopausal.

Tamoxifen works by blocking estrogen from attaching to estrogen receptors on breast cancer cells.

By interfering with the estrogen signaling pathway, tamoxifen helps to prevent estrogen from stimulating the growth of breast cancer cells.

130
Q

Anastrozole works by blocking oestrogen receptors. True/false?

A

False

Anastrozole inhibits oestrogen production, while tamoxifen blocks oestrogen receptors.

The choice between these medications depends on factors such as menopausal status and specific characteristics of the cancer.

131
Q

What factors influence the drug prescribed for oestrogen receptor positive breast cancer treatment?

A

Menopausal status, type of breast cancer, side effect profiles, treatment goals, and patient preferences.

132
Q

2 tests that can be done to determine if the breast cancer is oestrogen receptor positive?

A

Biopsy:

A biopsy is a procedure where a small sample of tissue is taken from the suspected tumor in the breast.
This sample is then sent to a laboratory for analysis.

Immunohistochemistry (IHC):

Immunohistochemistry is a technique used to detect specific proteins in tissue samples.
In the case of breast cancer, the tissue sample obtained from the biopsy is stained with special antibodies that specifically bind to estrogen receptors.

133
Q

Tamoxifen vs anastrozole menopausal status use?

A

Tamoxifen is commonly used in both premenopausal and postmenopausal women.

Anastrozole is typically used in postmenopausal women because it works by inhibiting oestrogen production, which is lower in postmenopausal women.

134
Q

What breast cancer types require tamoxifen or anastrozole?

When is tamoxifen preferred?

A

Both medications are primarily used for hormone receptor-positive breast cancer.

Tamoxifen may be preferred in certain cases, such as in younger premenopausal women or in women with a higher risk of blood clots, as it has a different side effect profile compared to anastrozole.

135
Q

Common side effects of tamoxifen?

A

Hot flashes

Night sweats

Vaginal dryness or discharge

Irregular menstrual periods (in premenopausal women)

Mood swings

136
Q

Less common side effects in tamoxifen?

A

Blood clots (deep vein thrombosis or pulmonary embolism)

Increased risk of endometrial cancer

Fatigue

Nausea

Weight gain

137
Q

Common side effects of anastrozole?

A

Joint pain or stiffness

Hot flashes

Muscle pain

Bone thinning (osteoporosis)

Fatigue

138
Q

Less common side effects of anastrozole?

A

Increased cholesterol levels

Mood changes

Nausea

Headache

Vaginal dryness

139
Q

Inheritance pattern for haemophilia?

A

Hemophilia is typically inherited in an X-linked recessive pattern, affecting males more commonly than females.

140
Q

Treatment for haemophilia?

A

Involves replacing the deficient clotting factor through intravenous infusions of clotting factor concentrates.

141
Q

What are some complications of haemophilia?

A

Complications of haemophilia include bleeding into joints (haemarthrosis), muscle bleeds, and potentially life-threatening internal bleeding.

142
Q

Inheritance pattern for von willebrand’s disease?

A

Von Willebrand disease can be inherited in an autosomal dominant or recessive pattern, affecting both males and females.

143
Q

Von willebrand disease has no effect on platelet function. True/false?

A

False

Von Willebrand disease primarily affects platelet function, leading to prolonged bleeding time and mucocutaneous bleeding (bleeding from the mucous membranes and skin).

144
Q

Treatment for Von Willebrand disease?

A

Treatment for vWD may involve desmopressin (DDAVP) to stimulate release of vWF and medications to increase vWF levels.

In severe cases, infusion of vWF-containing products or clotting factor concentrates may be required.

145
Q

Complications of Von Willebrand disease?

A

Complications of vWD include excessive bleeding during surgeries, dental procedures, or menstruation, and potentially life-threatening bleeding in severe cases.

146
Q

Purposes of aPTT and PT?

A

aPTT measures the time it takes for blood to clot through the intrinsic and common coagulation pathways after activation with a reagent (partial thromboplastin).

PT measures the time it takes for blood to clot through the extrinsic and common coagulation pathways.

147
Q

Main uses of aPTT?

A

aPTT is commonly used to monitor the effectiveness of heparin therapy

Assesses clotting function in patients with hemophilia or other coagulation disorders.

148
Q

Main uses of PT?

A

PT is commonly used to monitor the effectiveness of warfarin (a vitamin K antagonist) therapy

Assesses clotting function in patients with liver disease or vitamin K deficiency.

149
Q

Normal range for aPTT?

A

A normal range of 25-35 seconds.

150
Q

Normal range for PT?

A

A normal range of 11-13.5 seconds.

151
Q

What is a characteristic feature of trichomonas vaginalis?

A

“Strawberry cervix”, in this the cervix appears red and inflamed with raised papilla caused by microhaemorrhages.

There is often foul smelling discharge and associated abdominal pain.

152
Q

What is treatment of trichomonas vaginalis?

A

Antibiotics i.e. Metronidazole

153
Q

What is the mechanism of action for apixaban?

A

Apixaban inhibits factor Xa in the common pathway.

154
Q

What is the mechanism of action for warfarin?

A

Warfarin is a factor II, VII, IX and X inhibitor.

Miscellaneous (22 decks)

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