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A. REVISION FROM QBANKS > 17/10/2024 > Flashcards

17/10/2024 Flashcards

(58 cards)

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1
Q

Which cancer is Hashimoto’s thyroiditis associated with?

A

MALT lymphoma

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2
Q

What biologic therapies are indicated for crohns and rheumatoid diseases?

A

TNF alpha inhibitors

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3
Q

Examples of TNF alpha inhibitors?

A

Adalimumab
Infliximab
Etanercept

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4
Q

What biologic therapies are indicated for CMl and GI stromal tumours?

A

Tyrosine kinase inhibitors

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5
Q

Example of tyrosine kinase inhibitor?

A

Imatinib

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6
Q

Management of uterine fibroids?

A

Medical with GnRH agonists in the short term to shrink the fibroids
Surgical is long term e.g. myomectomy, hysterectomy, hysteroscopic endometrial ablation or uterine artery embolisation

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7
Q

Is TLCO up or down in emphysema?

A

Down as the damage to the alveoli means reduced area for gas exchange to occur

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8
Q

What are 95% of gastric MALT lymphomas associated with?

A

H.pylori

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9
Q

Tx of gastric MALT lymphoma?

A

H.pylori eradication e.g. PPI & amoxillin & clarithromycin

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10
Q

In what circumstance can testicular torsion have a persevered cremasteric reflex?

A

When there is torsion of the testicular appendage

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11
Q

Whats the most common cancer in men aged 20-30?

A

Testicular cancer

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12
Q

Most common type of testicular cancer?

A

Seminomas

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13
Q

Which markers are raised in Seminomas in testicular cancer?

A

HCG and LDH

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14
Q

How do you carry out the cremasteric reflex?

A

stroking the inner aspect of the thigh towards the groin, which causes the cremasteric muscle within the scrotum to contract and thereby elevate the ipsilateral testis and scrotum.

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15
Q

In the management of DKA, at what point would you add 10% dextrose?

A

When blood glucose is <14mmol/L

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16
Q

What is the definition of resolution of DKA?

A

PH >7.3
Ketones <0.6
Bicarbonate >15

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17
Q

By how much does Barrett’s oesophagus increase the risk of oesophageal adenocarcinoma?

A

50-100 fold increased risk

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18
Q

Is Barrett’s symptomatic?

A

No but most pts have concurrent GORD

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19
Q

Outline management of Barrett’s oesophagus?

A

Lifestyle: weight loss, stop smoking, small regular meals etc
High dose PPI e.g. 40mg BD esomeprazole
Endoscopic surveillance every 2-3 years if long-segment or 3-5 years if short segment (i.e. <3cm)

If dysplasia is ever found then endoscopic Tx with ablation or mucosal resection is done

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20
Q

What is the HbA1c of pre-diabetes>?

A

42-47mmol/mol

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21
Q

What is impaired fasting glucose?

A

Fasting glucose level of 6.1-6.9 - a form of pre-diabetes
Due to hepatic insulin resistance

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22
Q

What is impaired glucose tolerance?

A

An OGTT test result of 2 hour blood glucose of 7.9-11.0 or a fasdting glucose of <7.0
A form of pre-diabetes
Due to muscle insulin resistance

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23
Q

Tx of first degree heart block?

A

asymptomatic first-degree heart block is relatively common and does not need treatment

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24
Q

Outline the 2 types of second-degree heart block?

Study These Flashcards
A

type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs
type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex

25
What is the characteristic ecg finding in first-degree heart block?
PR interval >200ms (<5 small squares)
26
Management of status epilepticus in hospital ?
IV lorazepam is usually used. Can be repeated once after 5-10 minutes If ongoing then consider second line - levetiracetam (or..phenytoin or sodium valproate) If refractory status (no response within 45 minutes from onset) - induction of GA or phenobarbital
27
Amnagement of autoimmune encephalitis?
IV aciclovir is usually started in all cases of suspect encephalitis If autoimmune is suspected them steroids and IV immunoglobulins
28
Which subtype of breast cancer usually causes an abnormal proliferation of small, round cells arranged in a uniform pattern?
Lobular carcinoma
29
Which subtype of breast cancer usually causes irregularly distributed cells with atypically large nuclei?
Ductal carcinoma
30
Investigations for endometriosis?
Urine pregnancy test TVUS is unlikely to show anything but is important to screen for other pathology so if Sx are significant pt should be referred for a laparoscopy as the gold-standard investigation
31
Management of endometriosis-related pain?
Consider short trial of paracetamol and/or NSAID If this doesnt help then -> hormonal treatment e.g. COCP or progestogen If this doesnt work then refer to secondary care
32
Secondary care management options for endometriosis?
Medical: GnRH analogues can be used to induce a pseudo menopause - note this doesnt have a significant impact on fertility rates Surgical: Laparoscopic excision or ablation of endometriosis + adhesiolysis - has shown to improve chances of conception Ovarian cystectomy for endometriomas is recommended Hysterectomy performed laparoscopically may be done
33
What is surgical menopause?
If your ovaries are removed during a hysterectomy, you'll go through the menopause immediately after the operation, regardless of your age. This is known as a surgical menopause. Hysterectomy with oophorectomy: Immediate surgical menopause because no ovaries = no hormones. Hysterectomy without oophorectomy: No periods, but not necessarily in menopause until the ovaries stop producing hormones, which may happen earlier due to the surgery.
34
Serum osmolality in HHS?
>320
35
Management of secretions in palliative care?
Avoid fluid overload and educate family that pt is not likely troubled by secretions hyoscine hydrobromide or hyoscine butylbromide is generally used first-line (these are Anticholinergics)
36
What % of IgA nephropathy pts will progress to end stage renal disease in 10-25 years?
30%
37
What are the types of polycthemia?
Relative e.g. dehydration or stress in gaisbock syndrome Primary i.e. polycythemia rubra vera Secondary e.g. COPD, high altitude, OSA, excessive EPO in renal cancer, hepatoma etc
38
How can you differentiate between true polycythemia and relative polycythemia?
Red cell mass studies can be used In true polycythaemia the total red cell mass in males > 35 ml/kg and in women > 32 ml/kg whereas in relative there isnt actually any increase in RBCs so red cell mass would be normal
39
What is polycythemia vera?
A myeloproliferative disorder caused by clonal proliferation of a marrow stem cell leading to an increase in red cell volume. Most cases have a mutation in JAK2 Rare and tends to present in adults 60-70
40
Sx of polycthemia vera?
pruritus, typically after a hot bath Headaches, dizziness and sweating Fatigue Tinnitus Erythromelalgia: burning pain, warmth and redness in hands and feet Ruddy complexion Blurred vision temporarily due to hyper-viscosity Gout splenomegaly hypertension hyperviscosity: some pts present with arterial and venous thrombosis] If secondary… Loom for Sx of COPD, OSA, renal artery stenosis or renal tumours and hepatomas.
41
What is secondary polycythemia?
When a high number of erythrocytes are produced in a physiological response to chronic hypoxia (COPD etc), local renal hypoxia or excess EPO production i.e. secondary to EPO-secreting tumours
42
What investigations should be performed for suspected polycythemia vera?
Urinalysis for secondary renal causes FBC - Hb and haematocrit raised. Also likely to see a rise in neutrophils and thrombocytes Blood film - assess for features of leukaemia JAk2 mutation Serum ferritin - should be normal or low due to increased demand for iron U&Es LFTs Serum EPO
43
How is polycthemia vera treated in secondary care?
Venesection to maintain haematocrit <0.45 Aspirin 75mg daily and if considered high risk of thrombosis pharmacological cytoreductive therapy is recommended e.g. hydroxycarbamide
44
Prognosis of polycthemia vera?
thrombotic events are a significant cause of morbidity and mortality 5-15% of patients progress to myelofibrosis 5-15% of patients progress to acute leukaemia (risk increased with chemotherapy treatment)
45
How can doxazosin cause postural hypotension?
It’s an alpha blocker so it inhibits postsynaptic alpha 1 receptors on vascular smooth muscles = decreases systemic peripheral vascular resistance = reducing blood pressure
46
Most common precipitating factor for digoxin toxicity?
Hypokalaemia - digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects This is why drugs like thiazide & loop diuretics can precipitate it
47
Tx of digoxin toxicity?
Stop digoxin Digibind correct arrhythmias monitor potassium
48
Causes of hyposplenism?
splenectomy sickle-cell coeliac disease & dermatitis herpetiformis Graves' disease systemic lupus erythematosus amyloid
49
Blood film findings in hyposplenism?
Howell-jolly bodies - nuclear remnants which are usually removed by the spleen Siderocytes and spiculated spherocytes
50
What ABx can be used to treat campylobacter jejuni gastroenteritis if it’s severe?
Clarithromycin
51
What is ovarian hyperstimulation syndrome?
an iatrogenic and potentially life-threatening complication of superovulation caused by vasoactive products released by hyperstimulated ovaries. This results in increased membrane permeability and loss of fluid from the intravascular compartment It’s seen following gonadotropin or hCG treatment. Up to 1/3rd of women who are having IVF may experience a mild form of OHSS
52
Risk factors for ovarian hyperstimulation syndrome?
Young age Previous history of OHSS Lean physique PCOS Multiple pregnancies
53
Symptoms of ovarian hyperstimulation syndrome?
Abdominal swelling, abdominal pain, nausea and vomiting Severe - thrombosis, renal and liver dysfunction, acute RDS
54
Causes of serotonin syndrome?
SSRI MAOIs Ecstacy Amphetamines
55
Features of serotonin syndrome?
Within hours of taking a new drug or increasing the dose neuromuscular excitation - hyperreflexia, myoclonus, rigidity, tremor autonomic nervous system excitation - hyperthermia, sweating, dilated pupil altered mental state - confusion
56
Management of an acute anal fissure (<1 week Hx)?
Soften stool with fibre in diet, increase fluid intake and use bulk forming laxatives such as isphagula husk Lubricants before defecation e.g. Vaseline Topical anaesthetics can be used Analgesia
57
Management of a chronic anal fissure?
In addition to lifestyle… Rectal GTN ointment to aid healing for 6-8 weeks BD If no improvement after 8 weeks then consider secondary care referral to consider surgery (sphincterotomy) or botulinum toxin
58
What is a sphincterotomy?
Tx of anal fissures Makes a small cut to reach anal sphincter. Small cut in sphincter to relax it and stop it going into spasm which will allow the fissure to heal

A. REVISION FROM QBANKS (13 decks)

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