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1
Q

ACR values and when to refer

A

3 or more is significant
if 3-70, repeat test

refer:
- ACR 70 or more
- ACR 30 or more with persistent haematuria and no UTI
- ACR 3-29 with persistent haematuria and risk factors e.g. declining eGFR, CVD

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2
Q

managing proteinuria in CKD

A
  • ACEi if ACR > 30 and HTN
  • ACEi if ACR > 70 regardless of BP
  • SGLT2i
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3
Q

causes of diffuse proliferative glomerulonephritis

A

post strep
SLE

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4
Q

ECG territories

A

V1-V4: anteroseptal, LAD
II, III, aVF: inferior, R coronary
V1-V6, I, aVL: anterolateral, prox LAD
I, aVL: lateral, left cx
V1-V3: posterior, L cx, RCA

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5
Q

causes of metabolic acidosis

A

normal anion gap:
GI bicarb loss
RTA
acetazolamide, ammonium chloride
addison’s

raised anion gap:
lactate (shock, sepsis, hypoxia, metformin)
ketones (DKA, alcohol)
urate (renal failure)
acid poisoning (salicylates, methanol)

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6
Q

types of renal tubular acidosis

A

1 (distal):
- inability to secrete H+
- hypokalaemia, nephrocalcinosis
- RA, CLE, sjogrens, toxicity

2 (prox):
- reduced bicarb reabsorption in PCT
- hypokalaemia, osteomalacia
- fanconi, wilsons, carbonic anhydrase inhib

3 (mixed):
- carbonic anhydrase deficiency, hypokalaemia
- rare

4 (hyperkalaemic):
- reduced aldosterone, reduced PCT ammonia excretion
- hypoaldosteronism, diabetes

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7
Q

Multiple Endocrine Neoplasia

A

1: 3Ps
parathyroid, pituitary, pancreas
adrenal and thyroid
MEN1 gene

2a: 2Ps
parathyroid, phaeochromocytoma
medullary thyroid ca
RET oncogone

MEN 2b: 1P
phaeochromocytoma
marfinoid, neuromas, medullary thyroid
RET oncogene

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8
Q

causes of drug induced lupus

A

hydralazine
isoniazid
procainamide
minocycline
phenytoin

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9
Q

managing steroid induced osteporosis

A

offer bone protection if > 65y or fragility #
DEXA if < 65y

T between 0 and -1.5: repeat DEXA in 1-3y
T < - 1.5: offer bone protection

alendronate, calcium + vit D

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10
Q

causes of erythema multiforme

A

HSV, Orf
idiopathic
mycoplasma, strep
penicillin, sulfonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapine
SLE, sarcoid, malignancy

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11
Q

gaucher’s disease features

A

defective glucocerebrosidase
most common lipid storage disorder
hepatosplenomegaly, aseptic necrosis of femur

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12
Q

tay sachs features

A

defective hexosaminidase A
accumulation of GM2 ganglioside within lysosomes
developmental delay, cherry red spot on macula
normal sized liver and spleen

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13
Q

niemann pick features

A

defective sphingomyelinase
hepatosplenomegaly, cherry red spot on macula

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14
Q

krabbes disease features

A

defective galactocerebrosidase
peripheral neuropathy, optic atrophy, globoid cells

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15
Q

fabry disease features

A

peripheral neuropathy (burning sensation)
angiokeratomas, lens opacities
proteinuria
x linked recessive

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16
Q

neurofibromatosis vs tuberous sclerosis

A

NF: iris hamartomas (lisch nodules), phaeochromocytoma
TS: retinal hamartomas, developmental problems, renal angiomyolipomata

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17
Q

webers syndrome

A

stroke from branches of posterior cerebral artery supplying midbrain
ipsi CNIII palsy
contralateral upper and lower weakness

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18
Q

diagnostic thresholds for gestational diabetes

A

fasting glucose 5.6 or more
2h glucose 7.8 or more

target fasting glucose: 5.3

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19
Q

MODY inheritance

A

Autosomal dominant

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20
Q

wernicke and korsakoff syndrome are a result of damage to what areas of brain?

A

medial thalamus and mamillary bodies of hypothalamus

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21
Q

what drugs may exacerbate myaesthenia gravis?

A

penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoin
gent, macrolides, quinolones, tetracyclines

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22
Q

site of lesion causing bitemporal hemianopia

A

upper quadrant defect: pituitary
lower quadrant defect: craniopharnygioma

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23
Q

demyelinating vs axonal peripheral neuropathies

A

axonal:
alcohol, DM, vasculitis, HSMN type 2, B12 def (may also be demyelinating)

demyelinating:
GBS, HSMN type 1, paraprotein neuropathy, amiodarone, chronic inflam demyelinating polyneuropathy

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24
Q

examples of G protein coupled receptors

A

generally slow transmission, metabolic processes

Gs (stimulates adenylate cyclase to increase cAMP): beta1, beta2, H2, D1, V2, ACTH, LH, FSH, PTH, PGs

Gi (inhibits adenylate cyclase to decrease cAMP): M2, alpha2, D2, GABAB

Gq (activates phospholipase C): alpha1, H1, V1, M1, M3

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25
examples of ligand gated ion channel receptors
generally fast responses nicotinic acetylcholine, GABAA, GABAC, glutamate
26
RAAS and where the hormones are secreted from
adrenal cortex GFR ACD zona Glomerulosa: Aldosterone, mineralocorticoids zona Fasciculata: Cortisol, glucocorticoids zona Reticularis: androgrens, DHEA
27
nucleolus vs ribosome vs nucleus
nucleus: DNA maintenance, RNA transcription, RNA splicing ribosome: RNA translation > proteins nucleolus: ribosome production
28
T helper 1 vs T helper 2 cells
Th1: cell mediated response and type IV hypersensitivity, secrete IFN gamma, IL2, IL3 Th2: antibody (humoral) immunity e.g. IgE in asthma, secrete IL4, IL5, IL6, IL10, IL13
29
how to calculate standard error of the mean
standard deviation/sq root of n
30
causes of drug induced thrombocytopenia
quinine abciximab furosemide penicillins, sulfonamides, rifampicin carbamazepine, valproate NSAIDs, heparin linezolid
31
lyme disease management
doxy (amox if c/i e.g. pregnant) ceftriaxone if disseminated
32
what drugs can cause toxic epidermal necrolysis?
phenytoin, carbamazepine sulfonamides allopurinol penicillins NSAIDs
33
chloramphenicol mechanism
binds to 50S > inhibits peptidyl transferase
34
mechanism of macrolides
binds to 50S > inhibits translocation
35
causes of autoimmune haemolytic anaemia
warm: SLE, lymphoma, CLL, methyldopa cold: lymphoma, mycoplasma, EBV
36
diagnosing paroxysmal nocturnal haemolysis
flow cytometry- low levels of CD59, CD55 mx: anticoag, eculizumab, stem cell
37
leukaemioid reaction
caused by severe infection, haemolysis, haemorrhage or metastatic cancer with marrow infiltration > immature cells pushed out into circulation high ALP toxic granulation (dohle bodies) in white cells left shift of neutrophils
38
membranoproliferative
type1: cryoglobulinaemia, hepC type 2: partial lipodystrophy
39
CLL treatment
FCR fludarabine + cyclophosphamide + rituximab
40
apremilast
PDE4 inhibitor (reduces hydrolysis of cAMP) used for psoriatic arthropathy
41
criteria for starting statin in T1DM
over 40y or diabetes > 10y or established nephropathy or other CVD risk factors
42
management of multifocal atrial tachycardia
correct hypoxia and electrolytes rate limiting CCB
43
mechanism of thiazide diuretics
block NaCl symptorter > inhibit Na reabsorption at beginning of DCT increased delivery of sodium to distal DCT
44
conditions associated w/ pseudogout
haemochromatosis acromegaly wilsons hyperPTH low Mg, low PO4
45
codeine to morphine
divide by 10
46
tramadol to morphine
divide by 10
47
morphine to oxycodone
divide by 1.5 to 2
48
PO morphine to SC diamorphine
divide by 3
49
parts of JVP waveform
A- atrial contraction (large in TS, PS, pHTN; absent in AF) cannon A- complete HB, VT, V ectopics, nodal rhythm, single chamber pacing C- tricuspid closure V- passive filling against closed tricuspid. (giant in TR) X descent- fall in atrial pressure during ventricular systole Y descent- opening of tricuspid valve
50
dipyridamole mechanism
non specific phosphodiesterase inhibitor decreases cellular uptake of adenosine
51
which part of nephron is impermeable to water?
ascending limb of Henle
52
inducing remission in UC
mild/mod: rectal aminosalicylate > add PO aminosalicylate > add corticosteroid extensive disease: rectal aminosalicylate + PO aminosalicylate > PO aminosalicylate + PO steroid severe colitis: IV steroids or ciclosporin
53
maintaining remission in UC
mild/mod: topical aminosalicylate mild/mod extensive or left sided: PO aminosalicylate severe or 2 exacerbations last year: PO azathioprine or mercaptopurine
54
inducing and maintaining remission in crohn's
glucocorticoids 5 ASA drugs second line azathioprine/mercaptopurine/MTX add ons infliximab metronidazole for isolated perianal disease maintaining: azathioprine/mercaptopurine 1st line, MTX second line
55
rapidly progressive glomerulonephritis
AKA crescenteric causes: Goodpastures, ANCA vasculitis
56
membranoproliferative glomerulonephritis
AKA mesangiocapillary presents as mixed nephrotic/nephritic 1: cryoglobulinaemia, hep C 2: partial lipodystrophy
57
glucose and protein in CSF in meningitis
protein: high in bacterial/TB and fungal normal/high in viral glucose: < 1/2 plasma in bacterial/TB 60-80% plasma in viral. lower in HSV and mumps
58
amiodarone induced thyrotoxicosis
type 1: goitre present, excess iodine. mx w/ carbimazole or percholate type 2: destructive. no goitre. mx w/ steroids stop amiodarone in both types
59
addisons investigations
ACTH stimulation test hyperK, hypoNa, metabolic acidosis
60
cushing's investigations
dexa suppression test 24h urinary cortisol x2 hypoK metabolic alkalosis
61
drugs that can exacerbate MG
penicillamine procainamide, quinidine beta blockers aminoglycosides, macrolides, quinolones, tetracylines phenytoin lithium
62
ciclosporin and tacrolimus mechanism
inhibit calcineurin in T cells > decrease IL2
63
mycophenolate mofetil mechanism
inhibits inosine monophosphate dehydrogenase
64
cutanea larva migrans mx
thiabendazole
65
PRV may progress into what?
AML or myelofibrosis
66
tetanus management
immunoglobulin + metronidazole IV
67
leprosy management
rifampicin + dapsone + clofazimine 12 months
68
sarcoidosis indications for steroids
CXR stage 2/3 disease and symptomatic hypercalcaemia eye/heart/neuro involvement
69
TB management
active TB: 2 months RIPE then 4 months R+I latent TB: 3 months RIP or 6 months IP
70
features of MS
mid-late diastolic murmur loud S1 low volume pulse opening snap if leaflets are still mobile longer murmur if more severe AF from left atrial enlargement
71
causes of diabetes insipidus
nephrogenic: ADH receptor or aquaporin 2 channel defects hypercalcaemia hypokalaemia lithium demeclocycline tubulointerstitial disease (obstruction, sickle cell, pyelonephritis) cranial: head injury, pituitary surgery, craniopharyngiomas histiocytosis X, sarcoidosis DIDMOAD haemochromatosis
72
causes of membranous GN
hep B, malaria, syphilis malignancy gold, penicillamine SLE, RA, AI thyroiditis
73
drugs to avoid in HOCM
nitrates ACEi inotropes
74
argyll robertson pupil
small bilaterally accommodates but doesn't react to light may occur in syphilis, wernickes
75
adie's tonic pupil
80% unilateral dilated once constricted it remains small for a long time slowly reactive to accommodation but poorly reactive to light holmes adie syndrome includes absent knee/ankle reflexes
76
causes of horners syndrome
central (anhidrosis of face, arm, trunk): stroke, syringomyelia, MS, tumour, encephalitis preganglionic (anhidrosis of face): pancoast tumour, thyroidectomy, trauma, cervical rib post ganglionic (no anhidrosis): carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, cluster headache
77
drugs working on nuclear receptors
prednisolone thyroxine must be lipid soluble

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