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P4 > 2.0 > Flashcards

2.0 Flashcards

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
Q

triad for budd-chari

Ix

A

abdo pain
ascites - portal HTN
tender hepatomegaly

USS - doppler flow

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26
Q

what kind of lymphoma does coeliacs increase the risk of?

A

enteropathy-associated T cell lymphoma

EATL

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27
Q

what pathogen is MALT lymphoma associated with>?

A

h pylori

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28
Q

UC Mx

A

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)
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29
Q

criteria to classifiy severity of UC

A

truelove & witt - NICE recommended

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30
Q

how to differentiate between acute liver failure + chronic liver cirrhosis?

A 
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
Q

Primary biliary cholangitis

A
  1. IgM
  2. Anti-mitochondrila
  3. antibodies
    middle aged females
32
Q

diagnostic features for spontaneous bacterial peritonitis

A

e.coli

paracentesis - neutrophil > 250

33
Q

difference between peutz-jeghers syndrome + hereditary haemorrhagic telangiectasia?

A

PJS - benign hamartomatous polyps in the GI tract
- Dominant

HHT - mucous involved but without intestinal polyps
- iron-deficiency

34
Q

RFs for developing c.diff

Mx: 1st / 2nd

A
  • use of 2nd / 3rd gen cephalosporins
  • PPIs

1 - metronidazole
2 - vancomycin
Severe - IV vanc + metron

35
Q

coeliac diagnosis

immunology:

histology

A
  • endomyseal IgA
  • tran-tissueglutamase (TTG) antibodies IgA

villous atrophy
crypt hyperplasia
intraepithelial lymphocytes

36
Q

how to classifsy pancreatic severity?

A 
pao2 - <8
age >55
neutrophilia >15
calcium 
renal fucntion - urea
enzymes LDH, AST
albumin >32
sugar >10
37
Q

what is gilbert’s

A

when the body doesn’t process bilirubin properly

  • isolated bilirubin in response to physiological stress

No treatment required

38
Q

what is hepatorenal syndrome?

A
  1. vasoactive mediators –> splanchnic vasodialation
  2. reduced systemic vascular resistance –> kidney hypoperfusion
  3. RAAS activated
  4. renal vasoconstriction
39
Q

Mx of hepatorenal syndrome

A
  1. vasopressin analogues (terlipressisn) - vasoconstriction
  2. transjugular intrahepatic portsysyemic shunt
  3. volume expansion with 20% albumin
40
Q

what diseases are associated with h.pylori

A
  • duodenal ulcers (most common)
  • gastric cancer
  • MALT
  • atrophic gastritis
41
Q

what is triple Mx for h-pylori

confirmation test

A

PPI + amox + clarithromycin

PP + metron + clarithromycin

urea breath test

42
Q

wilsons criteria

A
  • reduced serum caeruloplasmin
  • reduced serum copper
  • increased 24hr urinary copper excretion
43
Q

Wilson’s MX

A

penicillamine - chelates copper

44
Q

types of hepatorenal syndrome

A

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
Q

in liver cirrhosis what are the most specific markers of disease - blood tests?

A
  1. thrombocytopenia (low platelets) –> lack of thrombopoetin (TPO) syntheised in the liver

TPO –> stimulates platelet production

  1. AST - reliable + durable marker for degree of necroinflammation activity (raised x10)
46
Q

difference between dysphagia + odynophagia

A

dysphagia - difficulty on swallowing

odynophagia - pain on swallowing

47
Q

metoclopromide - action and uses

A

D2 receptor antagonist
pro-kinetic
useful to use in autonomic neuropathy in T2DM

don’t use in parkinson’s or bowel obstruction

48
Q

what bloods would you see for autoimmune hepatitis

A

raised ALT / AST

low ALP

49
Q

patient with hep C

investigation of choice for liver cirrhosis

A

transient elastography (fibro scan)

50
Q

what is haematochezia

A

passage of fresh blood from the rectum

–> indicating a lower GI bleed

51
Q

what is thiamine used for in the body?

A

sugar + aminoacid catabolism

52
Q

conditions associate with thiamine deficiency?

A

wernicker’s –> korsakoff’s

dry beriberi - peripheral neuropathy
wet beriberi - dilated cardiopathy

53
Q

what is ITP?

A

idiopathic thrombocytopenic purpuria

  • low platelets following infection
  • increased bleeding time

diagnosis of exclusion

Mx:

  • dont give platelets
  • give steroids
54
Q

what is TTP?

A

thrombotic thrombocytopenic purpuria

terrible partners

  • low platelets
  • anaemia
  • renal
  • temp rise
  • neuro
  • ER
  • schistocytes
55
Q

what is HUS?

A

haemolytic uraemic syndrome

trigger due to E.coli

  1. kidney failure
  2. bloody diahorrea
  3. creatinine rise

schistocytes

56
Q

what is DIC?

A

inappropriate activation of clotting cascade:
- consumption of platelets + clotting factors

Triggered by trauma / sepsis

low platelets
low fibrinogen

raised PT
raised D-dimer

57
Q

how the you grade encephalopathy?

A

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
Q

what LFTs point towards alcoholic liver disease?

A

AST > ALT

GGT

59
Q

what is autonomic dysreflexia?

A

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
Q

what are manometry studies?

A

evaluates the sphincter function / muscles of the oesophagus

determine a safe swallow

used before fundoplication

61
Q

haemochromatosis bloods

A
  • raised transferrin saturation
  • raised ferritin
  • low TIBC

excess iron accumalation
–> more iron to bind to tbe transferrin

62
Q

describe what they do:

  • ferritin
  • transferritin
  • total iron binding capcity
A

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
Q

what tests are checked before giving azathiopurine therapy?

A

thiopurine methyltransferase (TMPT) activity

this enzyme metabolises thiopurines

64
Q

which specific liver test demonstrates the ability of hepatoctes carrying out their synthetic function?

A

albumin

PT

65
Q

what is the child pugh?

list them

A

estimates cirrohsis severity

ascites
encephalopathy
INR
albumin 
bilirubin
66
Q

clinical features of acute liver failure

A

jaundice

fetor hepaticus - breath of the death / seen in portal HTN

67
Q

what antigens / antibodies signify chronic Hep B infection

A

chronic:

  • anti-HBc IgG
  • anti

IgM anti-HBc = implies current infection

68
Q

when is prophylactic abx given to patients with ascites?

Mx

A

for risk of developing spontaneous bacterial peritonitis

  • ascites
  • low SAAG > 11

oral ciprofloxacin –> e.coli

69
Q

Mx for haemochromatosis

A

regular venesection

70
Q

symptoms of irritable bowel syndrome

A
  • pain relieved by defecation
  • altered bowel habit
  • abdominal bloating
  • passage of mucus
  • symptoms made worse by eating / at night
71
Q

in a picture of microcystic anaemia - how do you detemine between anaemia of chronic disease and iron def?

A

iron studies undergone:

High TIBC in IDA

low / normal TIBC = IDA

72
Q

mechanism of action of loperimide

A

acts on u-opioid receptors

–> reducing gastric motility

73
Q

Ix for NAFLD

A

enhanced liver fibrosis (ELF)

P4 (11 decks)

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