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MBChB4 > 17.02.24 > Flashcards

17.02.24 Flashcards

1
Q

Causes of false negative TB testing:

A

HIV, lymphoma, miliary TB, sarcoidosis and very young age <6months.

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2
Q

Different tests for active TB:

A

CXR - cavitating upper lobe lesions is classical of TB.

Sputum culture is gold standard, is more sensitive than a smear and NAAT. Can also assess drug sensitivities, but it takes 1-3 weeks to come back.

NAAT test is rapid, but less sensitive than culture.

Smear needs 3 specifimens, acid fast bacilli stain - but all mycobacteria will stain positive, not just TB.

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3
Q

Order of sensitivity of TB tests:

A

Sputum culture > NAAT > sputum smear

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4
Q

Diagnosis of TB:

A

CXR

3 deep sputum samples:
- one early morning for microscopy of acid fast bacilli
- mycobacteria culture
- drug sensitivity testing

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5
Q

Assessment of an upper GI bleed:

A

A-E, focus on haemodynamic status.

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6
Q

What medications are given in the acute management of a variceal haemorrhage?

A

Terlipressin and Co-amoxiclav

Prophylaxis = carvedilol

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7
Q

4 histological findings in Coeliac disease:

A

Villous atrophy.
Crypt hyperplasia.
Intraepithelial lymphocytes.
Lamina propria infiltration with lymphocytes.

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8
Q

Who should be screened for coeliac disease?

A

T1DM new diagnosis
Autoimmune thyroid disease new diagnosis
Dermatitis herptiformis
IBS
First degree relatives

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9
Q

Which HLA is Coeliac disease most associated with?

A

HLA-DQ2 & DQ8

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10
Q

Timeline and features of acute alcohol withdrawal:

A

6-12 hour = sweating, anxiety, tachycardia, tremor

36 hours = peak seizure

48-72 hours = delirium tremens inc course tremor, auditory and visual hallucinations, confusion, delusion, tachycardia and fever

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11
Q

Differentials for acute alcohol withdrawal:

A

TBI
Encephalopathy
Delirium

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12
Q

Indications for lorazepam over diazepam in acute alcohol withdrawal:

A

Evidence of liver disease e.g. encephalopathy, jaundice.

Other comorbdiity e.g. pneumonia, reduced GCS, COPD.

Over 70 years old.

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13
Q

Symptoms of Wernicke’s encephalopathy:

A

Confusion, decreased consciousness, ataxia, nystagmus, opthalmoplegia, hypothermia, hypotension

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14
Q

Treatment of Wernicke’s encephalopathy:

A

URGENT

Day 1-2: Start 2pairs of vials IV Pabrinex tds + check magnesium levels and correct

Day 3-5: 1 pair of vials tds

Day >5: oral thiamine if tolerated

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15
Q

What is the most sensitive and specific lab finding for diagnosis of cirrhosis in CLD?

A

Thrombocytopenia

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16
Q

Causes of liver cirrhosis:

A

NAFLD
HBV and HCV
Alcohol

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17
Q

Indications for a transient elastography / Fibroscan?

A

Diagnosed ALD
Diagnosed HCV
Men who drink >50 units and women over >35 units per week

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18
Q

Further investigations in patients with liver cirrhosis:

A

Upper endoscopy to check for varices in a new diagnosis

Liver US +/- AFP every 6 months for HCC

19
Q

What score is used in patients with NAFLD to assess for further cirrhosis investigations?

A

ELF

Combines 3 fibrosis markers into a single value.

> 10.51 = advanced liver fibrosis

20
Q

What investigation is indicated in an acute flare of UC?

A

Flexible sigmoidoscopy.

Can examine disease severity and effectiveness of ongoing treatment.

Colonoscopy contraindicated due to risk of rupture,

21
Q

Discuss relationship between anti-TTG, IgA and EMA.

A
22
Q

First line management for NAFLD:

A

WEIGHT LOSS

23
Q

Factors associated with NAFLD:

A

Obesity
Sudden weight loss / starvation
Jejunoileal bypass
Hyperlipidaemia
T2DM

24
Q

Features of NAFLD:

A

Usually asx
Hepatomegaly
ALT >AST
Increased echogenicity on US

25
Q

Which cancer does Coeliac disease increase the risk of?

A

enteropathy-associated T-cell lymphoma

Risk factors include poor adherence to gluten-free diet and late diagnosis.

26
Q

What are classic LFT findings in alcoholic hepatitis?

A

AST:ALT is 2:1
(>3:! = acute)

Gamma-GT elevated.

27
Q

Cause of acute liver decompensation:

A

Constipation, electrolyte imbalance, infection, dehydration, upper GI bleed or increased alcohol intake.

28
Q

Symptoms of coeliac disease that prompt investigation:

A

Tired all the time
Unexplained anaemia
Recurrent abdo pain and cramping or distension
FTT or faltering growth in children
Sudden weight loss
Chronic or intermittent diarrhoea

29
Q

6 Ps of acute limb ischaemia:

A

Pain
Pallor
Paraesthesia
Paralysis
Perishingly cold
Pulseless

30
Q

Complications of coeliac disease:

A

Anaemia
Hyposplenism
Osteoporosis and osteomalacia
Lactose intolerance
Enteropathy-assocaited t cell lymphoma

31
Q

Symptoms of pernicious anaemia / B12 deficiency:

A

Anaemia symptoms: pallor, SOB, lethargy
Neuro symptoms:
- Peripheral neuropathy e.g. pins and needles, paraesthesia, legs >arms
- SCDC: progressive weakness, ataxia and parasthesia leading to spasticity and paraplegia.
- Neuropsychiatric features: memory loss, poor concentration, confusion, depression, irritability.

32
Q

Indications for dialysis:

A

Diuretic resistant pulmonary oedema
Hyperkalaemia refractory to medical therapy
Metabolic acidosis refractory to medical therapy
Uraemic complications e.g. pericarditis, encephalopathy, bleeding
Dialysable toxins e.g. lithium, salicylates

33
Q

What conditions other than MS can oligoclonal bands be found in?

A

GBS
CNS infection e.g. HIV
Post CVA

34
Q

MS relapse management:

A

Methylprednisolone IV + PPI

Physio / OT
Review medication

35
Q

Modifiable risk factors for relapse or progression of MS:

A

Exercise
Smoking
Vaccinations

36
Q

First line drug for treating spasticity in MS:

A

Baclofen

Or gabapentin

37
Q

What is a common feature of MS, due to a frontal lobe lesion?

A

Emotional lability.

Can be treated with amitriptyline.

38
Q

Classic signs of ALS:

A

Mixed UMN and LMN signs - UMN in legs, LMN in arms.

Little sensory involvement.

Fasciculations, atrophy and absent reflexes = LMN

Spasticity, brisk reflexes, upgoing plantar = UMN

39
Q

4 types of MND:

A

Amyotrophic lateral sclerosis

Primary lateral sclerosis - UMN only

Progressive muscular atrophy - LMN only, best prognosis

Progressive bulbar palsy - worst prognosis. Palsy of tongue, chewing/swallowing and facial muscles due to loss of function of brainstem nuclei.

40
Q

Definition of vertigo:

A

False sensation that the body or environment is moving.

41
Q

Causes of vertigo:

A

Viral labrynthitis
Vestibular neuronitis
BPPV
Meniere’s disease
Acoustic neuroma
Vertebrobasilar ischaemia

42
Q

Managing bladder dysfunction in MS:

A

US KUB to assess bladder emptying.

If retention, self catheterisation.

If not, anticholinergics may improve symptoms e.g. oxybutynin

43
Q

Most common type of MS:

A

RRMS

44
Q
A

MBChB4 (15 decks)

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