Diseases

Question 1

Pathology of DKA

Answer 1

Hyperglycaemia but no insulin so cells enter starvation like state
Fat is metabolised into free fatty acids -> metabolic acidosis

Question 2

DKA triggers

Answer 2

Infection, medication compliance, surgery, pancreatitis, antipsychotics

Question 3

Specific care for diabetes

Answer 3

Lifestyle (especially diet - low glycemic index food)
Statin - if high cholesterol
Acei / AR2 blockers
Footcare - use a mirror
If prone to hypoglycaemia you need to inform dvla

Question 4

What level do you want HbA1c to be at

Answer 4

Below 6.5%

Question 5

Treat hypoglycaemia

Answer 5

Oral sugar
Dextrose
Glucagon injection

Question 6

Causes of meningitis

Answer 6

NHS
N meningitidis
Haem influenzae
Strep pneumoniae

Question 7

How does MS work

Answer 7

Autoimmune T cell mediated plaques of demylienation -> axon loss
Heals but not completely -> relapsing and remitting

Question 8

Needed for diagnosis of MS

Answer 8

2 events lasting over 1 hour separated by at least 30mins

Question 9

Ms risk factors

Answer 9

Female, 30,white

Question 10

Symptoms of ms

Usual presentation is

Answer 10

Cerebellar, brain stem, unilateral optic neuritis, limb tingling / weakness, sudden onset weakness
Mono symptomatic

Question 11

Ms link to

Answer 11

Trigeminal neuralgia

Question 12

2 Ms signs

Answer 12

Utoffs - heat exacerbates

Lermettes - flex neck -> electric shock down spine

Question 13

How is ms diagnosed

Answer 13

Clinically
Can use lumbar puncture to look for olyclonal bands of IgG
Evoked potential

Question 14

Where else other then ms would olyclonal bands of IgG be found ?
How to differentiate

Answer 14

SLE

Do a blood test and Ms would not have olyclonal in blood

Question 15

Treatment of MS

Answer 15

Acute relapse - methylprednisolone
Regular - b interferons
Natafluzamab - monoclonal antibody against T cells

Question 16

Risk with giving immunosuppressants

Answer 16

Infections

Question 17

ms symptoms ?

Treatment

Answer 17

Spasticity - diazepam , baclofen 
Tremor - Botox 
Incontinence 
Dysphagia
Constipation 
Diplopia 
Truncal and limb ataxia (need protection from falls) 

Keep happy, de stress, inform DVLA

Question 18

Where do UMN fibres run from -> to

Answer 18

Pre central gyrus -> anterior horn cells

Question 19

Where do LMN run from to

Answer 19

Anterior horn cell - peripheral nerve

Question 20

Usual cause of MND

Answer 20

Idiopathic

Genetic link

Question 21

What is never affected in MND

Answer 21

Sensory, eye, sphincter

Question 22

What happens in MND

Answer 22

Loss of motor neurones in motor cortex, CN nuclei, anterior horn cells
(Depending on type)

Question 23

Most common type of MND

Answer 23

Amyotrophic lateral sclerosis

Question 24

AML signs and symptoms

Answer 24

UMN and LMN 
Wasting, fasiculations, pronator drift 
Brisk reflexes 
Emotional liability 
Whole muscle groups affected

Question 25

Bulbar palsy affects

Answer 25

CN 9-12 LMN Normal jaw jerk Tongue fasiculations, swallowing difficulty, speech problems

Question 26

Pseudo bulbar palsy affects

Answer 26

UMN No fasiculations, jaw jerk is brisk, slow speech and tongue Emotional Incontinence

Question 27

Muscular atrophy affects

Answer 27

LMN only - anterior horn cells | Distal muscles affected first

Question 28

PLS is

Answer 28

Pseudobulbar palsy and spastic leg weakness UMN Loss of betz cells in motor cortex

Question 29

Risk factors for MND

Answer 29

Over 40, male

Question 30

Symptoms of MND

Answer 30

``` Stumbling gait Weak abduction of shoulders (hair washing) Weak grip Foot drop Aspiration pneumonia Drooling - amytriptiline Dysphagia Spasticity - diazepam Breathing difficulty ```

Question 31

Symptoms of DKA

Answer 31

Reduced consciousness, dehydration, abdo pain, cusmal breathing, sweet smelling breath

Question 32

What is coeliac disease

Answer 32

Autoimmune T cell mediated destruction of (usually) terminal ileum

Question 33

What HLA in coeliac

Answer 33

HLADQ2

Question 34

What happens in coeliac

Answer 34

Gliardin is demylenated by tissue transglutamase | -> stimulates inflammation

Question 35

How to test for coeliac

Answer 35

Biopsy of terminal ileum | Need to be eating gluten for 6 weeks prior

Question 36

What's seen in a coeliac biopsy

Answer 36

Decreased duodenal folds Vilous atrophy Crypt hyperplasia

Question 37

Why do you have a blood test with coeliac

Answer 37

Risk of b12 deficiency

Question 38

Symptoms of coeliac

Answer 38

Steatorrhoea Abdo pain, distension Anaemia Weight loss

Question 39

Complications of coeliac

Answer 39

``` Osteoporosis- vit d deficient Ataxia - b12 deficient Mouth ulcers - iron deficiency Infertility Lymphoma Dermatitis on extensor surfaces Secondary lactose intolerance ```

Question 40

Treatment of coeliac

Answer 40

Gluten free diet | Wheat barley need to be excluded

Question 41

Eg of coeliac diet

Answer 41

``` Foods with gluten free stamp meat fish fruit and vegetables rice potatoes lentils. ```

Question 42

What to do if coeliac symptoms get bad by a ccidently eating gluten

Answer 42

Keep hydrated | If severe speak to GP

Question 43

How to limit coeliac malabsorption problems

Answer 43

Supplements

Question 44

Causes of confusion in elderly

Answer 44

Any infection eg pneumonia / uti Hepatic encephalopathy Raised urea (jaundice / ckd)