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2.0 Flashcards

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1
Q

what can cause spider naevi

A

liver disease
pregnancy
COCP

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2
Q

sqaumous cell carcinoma RF

A

smoking
immunosuppression
actinic keratoses
bowen’s disease

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3
Q

diagnostic ABPI scores

A

normal 0.9 - 1.3
<0.9 - peripheral arterial disease
<0.5 - severe disease
<0.3 - critical limb ischaemia

> 1.3 - arterial calcification / peripheral artery disease

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4
Q

toxic epidermial necroslyis causing drugs

A

penicillins
allopurinol
phenyoin
sulfonylureas

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5
Q

pellagra

A

nacin deficiency

dementia
diarrhoea
dermatitis

possible consquence of isonazid therapy

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6
Q

psoriasis Mx

A

1 - topical steroid + vit D analogue ]

2 - vit D x2 dosage

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7
Q

Bullous pemphigoid

A

autoimmune subepidermal blistering

pruritus
vesicle eruptions

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8
Q

onychomycosis

A

fungal nail infection

Mx Oral terbafine

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9
Q

Impetigo

A

topical fusidic acid

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10
Q

polymorphic eruption of pregnancy

A

steroid + emollient

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11
Q

define erythroderma

complications

A

used to describe when 90% of BSA is affected

dehydration
infection
heart failure - SOB

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12
Q

lichen planus

A

purple
papules
polygonal
rashes on felxor surfaces

mucous involvement - 50% white lace on buccal mucosa

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13
Q

what causes hirsitism

A

PCOS
cushing
congential adrenal hyperplasia

Mx:

  • weight loss
  • COCP
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14
Q

what causes hypertichosis

A

anorexia nervosa

ciclosporin

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15
Q

types of autoimmune hepatitis

A

type 1

  • ANA
  • Anti-smooth muscle antibodies
  • affects adults and chidlren

type 2
- anti-liver / kidney
microsomal type 1 antibodies
- affects children only

type 3

  • soluble liver kidney antigen
  • affects middle age
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16
Q

red flags for gastric cancer

A
  • new onset dyspepsia > 55 yrs
  • unexplained weight loss
  • unexplained persistent vomiting
  • progressive worsening dysphagia
  • odynophagia
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17
Q

what is sister mary joseph node?

A

metastatic umbilical lesion

signifies advanced malginancy

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18
Q

what is the peabody’s sign?

A

found in DVT patients

calf muscle spasm occurring on elevation and foot extension of the affected leg - positive test

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19
Q

what investigation is best for looking at mural invasion for malignant oesophageal stricture?

A

endoscopic USS

better than CT/MRI
- USS can display all the layers of the wall of the oesophagus

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20
Q

features of mesenteric ischaemia

A

affects small bowel
emboli pathology –> more severe than ischaemic colitis –> significany occlusion to arteries

abdo pain
Increased WCC due to increased lactate

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21
Q

features of ischaemic colitis

A

affects large bowel (splenic flexure most common)
less severe than mesenteric ichaemic –> transient occlusion
bloody diarrhoea
thumb printing - muscoal oedema/haem

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22
Q

why do coeliac patients have regular immunisations?

A
  1. Chronic folate deficiency –> results in hyposplenism
  2. hence offered pneumococcal vaccine
  3. result of excessive loss of lymphocytes via the damaged GI tract
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23
Q

types of colon cancer

A

sporadic (95%)

hereditary non-polyposis coclrectal carcinoma

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24
Q

Crohns MX

A

Inducing

  1. IV glucocorticoids
  2. 5-ASA (mesalazine)
  3. Azathioprine

Maintaining

  1. Stop smoking
  2. Azathioprine / mercaptopruine
  3. Methotrexate

80% of patients will eventually have surgery

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25
triad for budd-chari Ix
abdo pain ascites - portal HTN tender hepatomegaly USS - doppler flow
26
what kind of lymphoma does coeliacs increase the risk of?
enteropathy-associated T cell lymphoma EATL
27
what pathogen is MALT lymphoma associated with>?
h pylori
28
UC Mx
Inducing - proctitis = oral aminosalicylates - proctosigmotis (+ colitis) = oral aminosalicylates + topical - Systemic /Severe = IV hydrocortisone Maintaining - distal = oral / topical aminosalicyalte (mesalazine) - extensive (oral aminosalicylate) - refractory (2+ exacerbations in the past year) = thiopurine (azthiopurines)
29
criteria to classifiy severity of UC
truelove & witt - NICE recommended
30
how to differentiate between acute liver failure + chronic liver cirrhosis?
``` acute liver failure triad 1. encepthalopathy 2. coagulopathy 3. jaundice ``` not in CLC: - raised PT - raised bilirubin - presence of encephalopathy CLC 1. Thrombocytopenia 2. Significantly raised AST (x10)
31
Primary biliary cholangitis
1. IgM 2. Anti-mitochondrila 3. antibodies middle aged females
32
diagnostic features for spontaneous bacterial peritonitis
e.coli | paracentesis - neutrophil > 250
33
difference between peutz-jeghers syndrome + hereditary haemorrhagic telangiectasia?
PJS - benign hamartomatous polyps in the GI tract - Dominant HHT - mucous involved but without intestinal polyps - iron-deficiency
34
RFs for developing c.diff Mx: 1st / 2nd
- use of 2nd / 3rd gen cephalosporins - PPIs 1 - metronidazole 2 - vancomycin Severe - IV vanc + metron
35
coeliac diagnosis immunology: histology
- endomyseal IgA - tran-tissueglutamase (TTG) antibodies IgA villous atrophy crypt hyperplasia intraepithelial lymphocytes
36
how to classifsy pancreatic severity?
``` pao2 - <8 age >55 neutrophilia >15 calcium renal fucntion - urea enzymes LDH, AST albumin >32 sugar >10 ```
37
what is gilbert's
when the body doesn't process bilirubin properly - isolated bilirubin in response to physiological stress No treatment required
38
what is hepatorenal syndrome?
1. vasoactive mediators --> splanchnic vasodialation 2. reduced systemic vascular resistance --> kidney hypoperfusion 3. RAAS activated 4. renal vasoconstriction
39
Mx of hepatorenal syndrome
1. vasopressin analogues (terlipressisn) - vasoconstriction 2. transjugular intrahepatic portsysyemic shunt 3. volume expansion with 20% albumin
40
what diseases are associated with h.pylori
- duodenal ulcers (most common) - gastric cancer - MALT - atrophic gastritis
41
what is triple Mx for h-pylori confirmation test
PPI + amox + clarithromycin PP + metron + clarithromycin urea breath test
42
wilsons criteria
- reduced serum caeruloplasmin - reduced serum copper - increased 24hr urinary copper excretion
43
Wilson's MX
penicillamine - chelates copper
44
types of hepatorenal syndrome
type 1 - rapid progression (2 weeks) - upper GI bleed - Significant AKI (creatinine raised +220) - associated with impaired cardiac / liver / encephalopathy type 2 - gradual decline
45
in liver cirrhosis what are the most specific markers of disease - blood tests?
1. thrombocytopenia (low platelets) --> lack of thrombopoetin (TPO) syntheised in the liver TPO --> stimulates platelet production 2. AST - reliable + durable marker for degree of necroinflammation activity (raised x10)
46
difference between dysphagia + odynophagia
dysphagia - difficulty on swallowing odynophagia - pain on swallowing
47
metoclopromide - action and uses
D2 receptor antagonist pro-kinetic useful to use in autonomic neuropathy in T2DM don't use in parkinson's or bowel obstruction
48
what bloods would you see for autoimmune hepatitis
raised ALT / AST | low ALP
49
patient with hep C investigation of choice for liver cirrhosis
transient elastography (fibro scan)
50
what is haematochezia
passage of fresh blood from the rectum --> indicating a lower GI bleed
51
what is thiamine used for in the body?
sugar + aminoacid catabolism
52
conditions associate with thiamine deficiency?
wernicker's --> korsakoff's dry beriberi - peripheral neuropathy wet beriberi - dilated cardiopathy
53
what is ITP?
idiopathic thrombocytopenic purpuria - low platelets following infection - increased bleeding time diagnosis of exclusion Mx: - dont give platelets - give steroids
54
what is TTP?
thrombotic thrombocytopenic purpuria terrible partners - low platelets - anaemia - renal - temp rise - neuro - ER - schistocytes
55
what is HUS?
haemolytic uraemic syndrome trigger due to E.coli 1. kidney failure 2. bloody diahorrea 3. creatinine rise schistocytes
56
what is DIC?
inappropriate activation of clotting cascade: - consumption of platelets + clotting factors Triggered by trauma / sepsis low platelets low fibrinogen raised PT raised D-dimer
57
how the you grade encephalopathy?
west-haven criteria 1 - changes in behaviour w/ minimal consciousness change 2 - Gross disorientation, drowsiness, asterixis 3 - Marked confusion, incohorent speech, sleeping most the time 4 - comatosed, unresponsive to pain decorticate - stiff with both arms decerebrate posturing - arms straight, toes pointed
58
what LFTs point towards alcoholic liver disease?
AST > ALT | GGT
59
what is autonomic dysreflexia?
only occurs above T6 due to triggers of facial impaction + urinary retention 1. Unopposed sympathetic stimulation - HTN - Flushing - Sweating (above the level of the lesion)
60
what are manometry studies?
evaluates the sphincter function / muscles of the oesophagus determine a safe swallow used before fundoplication
61
haemochromatosis bloods
- raised transferrin saturation - raised ferritin - low TIBC excess iron accumalation --> more iron to bind to tbe transferrin
62
describe what they do: - ferritin - transferritin - total iron binding capcity
ferritin - intracellular iron stores transferritin - binds to iron to trasnsport it (saturation of transferritin increases in haemochromatosis) TIBC - the measure of iron binding sites (reduced, as there is increased saturation of iron)
63
what tests are checked before giving azathiopurine therapy?
thiopurine methyltransferase (TMPT) activity this enzyme metabolises thiopurines
64
which specific liver test demonstrates the ability of hepatoctes carrying out their synthetic function?
albumin | PT
65
what is the child pugh? list them
estimates cirrohsis severity ``` ascites encephalopathy INR albumin bilirubin ```
66
clinical features of acute liver failure
jaundice | fetor hepaticus - breath of the death / seen in portal HTN
67
what antigens / antibodies signify chronic Hep B infection
chronic: - anti-HBc IgG - anti IgM anti-HBc = implies current infection
68
when is prophylactic abx given to patients with ascites? Mx
for risk of developing spontaneous bacterial peritonitis - ascites - low SAAG > 11 oral ciprofloxacin --> e.coli
69
Mx for haemochromatosis
regular venesection
70
symptoms of irritable bowel syndrome
- pain relieved by defecation - altered bowel habit - abdominal bloating - passage of mucus - symptoms made worse by eating / at night
71
in a picture of microcystic anaemia - how do you detemine between anaemia of chronic disease and iron def?
iron studies undergone: High TIBC in IDA low / normal TIBC = IDA
72
mechanism of action of loperimide
acts on u-opioid receptors --> reducing gastric motility
73
Ix for NAFLD
enhanced liver fibrosis (ELF)

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