GIM exam Easter 2018 Flashcards
(161 cards)
1
Q
Cellulitis - antibiotic
A
Flucloxacillin
- clarithromycin for penicillin allergy
2
Q
Dermatome to dorsum of foot
A
3
Q
What does ART stand for (with HIV topic)
and associated problems?
A
anti-retroviral therapy
- resistance to drugs
- side effects, drug intolerance
- adherence problems from complex regime
- drug interactions
- cost
4
Q
What’s a cause of loud borborygmi?
(movement of fluid and gas)
A
small-bowel obstruction/ dysmotility if associated with colicky discomfort.
5
Q
What conditions can cause upper motor neurone symptoms?
A
- stroke
- MS
- traumatic brain injury
- cerebral palsy
6
Q
Important things that affect vit D absorption (except for the obvious)
A
- age
- absorption is in first part of SI, therefore digestive disorders
- condition of the Kidneys
7
Q
Reasons to do a lumbar puncture
A
- investigating bacterial meningitis
*
8
Q
what is a cardinal feature of bronchitis?
A
a productive cough.
(usually self resolving and viral)
- an infection of the main airways (bronchi)
Chronic bronchitis features in COPD
9
Q
What is the ROME III criteria?
A
Criteria for diagnosing IBS
Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with two or more of the following:
- Improvement with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in appearance of stool.
10
Q
What type of headache is common first thing in the morning?
A
migraine
11
Q
A
The hallux dorsiflexes, and the other toes fan out; this is Babinski’s sign;
damage to the central nervous system.
Stimulate from heel upwards.
12
Q
ACNE - antibiotic
A
doxycycline - tetracyclines
if not responding; erythromycin
13
Q
Dermatome to Upper inner arm
A
14
Q
Suspected subarachnoid haemorrhage headache diagnosis
A
CT scan (reliability 95-98% only)
If CT negative, LP > 12 hours following onset of symptoms.
LP: uniform RBC in bottles suggests SAH
Presence of bilirubin suggests bleed. Bilirubin will give the csf a yellowish colour and is due to the breakdown of RBCs. Called xanthochromia.
15
Q
What is bioavailability?
A
Bioavailability :
A subcategory of absorption and is the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs.
By definition, when a medication is administered intravenously, its bioavailability is 100%.
16
Q
UTI - antibiotic
A
nitrofurantoin
trimethoprim
17
Q
Characteristics of cluster headaches
A
severe, unilateral, retro-orbital
clustered over time
variable duration (10-60 mins)
autonomic symptoms; tearing (>> lacrimation), red eye, nasal congestion (rhinorrhoea)
attacks often at night
much more commen in MEN (9:1)
18
Q
Pathophysiology of pleural effusion due to LVF
A
back up of fluids increases pulmonary pressure resulting in pulmonary oedema in the alveoli, fluid in the interstitial fluid, and finally into the pleural cavity.
19
Q
What’s the common cause of esophageal varices?
A
cirrhosis and consequences of portal hypertension
20
Q
What is cor pulmonale?
A
Pulmonary heart disease.
Occurs in 25% of patients with COPD.
Caused by pulmonary hypertension causing enlargement of the right ventricle.
21
Q
Buerger’s disease
(thomboangiitis obliterans)
A
Occurs in young men who smoke
This pain may occur when you use your hands or feet and eases when you stop that activity (claudication), or when you’re at rest
Inflammation along a vein just below the skin’s surface (due to a blood clot in the vein)
Gangrene
22
Q
Possible antibiotics for meningitis
A
Cefolaxime
Benzylpenicillin
Chloramphenicol
23
Q
How is HIV infection diagnosed?
A
Detection of anti-HIV antibodies by ELISA (enyme-linked immunosorbent assay).
24
Q
Felty’s syndrome (important)
A
Rare autoimmune disease
Splenomegaly
neutropenia
RhA
25
C. diff - antibiotic
metronidazole
or vancomycin (glycopeptide) . Nephrotoxic
26
Characteristics of **tension** headaches
* mild to moderate (fuzzy head); dull generalized headache
* **_bilateral_**
* **_non-pulsatile_**
* **exert bandlike pressure**
* **no nausea**
poor response to over the counter analgesia
27
28
What is the **TIMI** score?
Estimates **mortality** for patients with **unstable angina and non-ST elevation MI.**
29
What is Boerhaave syndrome?
10% of esophageal perforations which occur due to vomiting.
full-thickness tear in the esophageal wall
high morbidity and mortality and is fatal without treatment
30
What are the clinical features of a PE?
* **sudden and unexplained dyspnoea.** This maybe the **only symptom**, especially in the elderly.
* IMP\> pleuritic chest pain and haemoptyosis are present only when infarction has occured. PE can be silent!
31
32
What is Proctitis?
Proctitis is an **inflammation of the lining of the rectum.**
Proctitis can cause rectal pain and the continuous sensation that you need to have a bowel movement
33
RhA diagnostic criteria
**morning stiffness \>\> 60 mins**
stiffness after rest
\>\> six weeks duration
DIP joints spared
Volar subluxation
Swan neck/ boutonniere, guttering between bones
RhA attacks connective tissue (therefore tendinous sheaths); fingers stay in flexion/ extension
34
Dermatome to Toes 1-3
35
Central upper abdominal radiating through to the back and partially relieved by sitting forwards is...
pancreatitis
36
What is found here?
* **_SOLID_**:
* lymph nodes, cervical rib
* * **_CYSTIC_**:
* cystic hygroma (lymphangioma)
* Pharyngeal pouch
* Subclavian aneurysm
*
37
What is achalasia?
What is a dange of this?
1. Oesophageal aperistalsis
2. Impaired relaxation of the lower oesophageal sphincter.
Progressive overflow of secretions and food, esp. at night and can cause aspiratory pneumonia.
38
Upper motor neurone signs
Increase in muscular tone (spasticity)
Increase in reflexes (hyperflexia)
++ Babinski sign
39
Takayasu's disease (rare)
Takayasu arteritis is a rare, systemic, inflammatory **large-vessel vasculitis** of unknown etiology; affects **women of childbearing age.**
Gradual stenosis of arteries dues to inflammatory attacks.
* Pain with use of an arm or leg (called “**claudication**”),
* high BP
distinguish between narrowing due to vasculitis and due to atherosclerosis
Diagnosis; **angiogram (X-ray with dye**), CT angiography
Tx: **steroids**, immune suppresants
40
Upper motor neurone lesion, upper....
face sparing.
41
What are the two types of leukaemia?
**acute lymphoblastic leukaemia** (ALL) - lymphoid cell line
**myeloid cell line** - Acute Myeloid Leukaemia (AML)
42
What happens to Functional Residual Capacity with emphysema?
**_Increased_** because
REDUCED elastic recoil, and therefore less resistance to the elastic recoil of the chest.
43
Which part of the GI tract is Crohn's disease?
anywhere
| (abdominal cramping + diarrhoea)
44
Sudden onset headache could be:
meningitis
subarachnoid haemorrhage
migraine
45
Typically symptoms of intestinal obstruction
* abdominal colic
* vomiting
* constipation **WITHOUT the passing of wind**
* distension
* **increased bowel sounds**
* Marked tenderness
46
What is bacterial vaginosis?
* Commonest cause of vaginal discharge (often recurrent)
* Overgrowth of commensals - anaerobes, mycoplasmas & Gardnerella vaginalis
* NOT sexually transmitted though may exacerbate
METRONIDAZOLE
47
What is a common cause of melaena.
NB\> melaena is due to an upper GI bleed
peptic ulceration
48
Testing the **_median nerve_**
NB. **Thumb opposition; C8, T1 nerve roots**
* test; altered sensation over thumb, index, middle fingers
* any thenar eminence wasting?
* _hand palm up on flat surface_. Px moves thumb vertically against resistance (**abductor pollicis brevis**)
* **opponens pollicis**; try and pull _thumb and ring finger apart_
49
Common AIDS-defining illnesses in the West
* Pneumocystis jirovecii
* oesophageal candidiasis
* tuberculosis
* herpes simplex/ zoster - repeated infections
* + others
ALONG WITH; systemic features weight loss, persistent fever or persistent diarrhoea.
50
What is the **GRACE** score?
A scoring system to risk stratifiy patients with **diagnosed ACS** to estimate their **in-hospital and 6-month to 3-year mortality**
51
CAP - antibiotic
amoxicillin
or doxycycline/ clarithromycin
52
How does PCP present? - pneumocystis carinii (jirovecii) pneumonia
* non-productive cough
* fever
* dyspnoea
- subacute, symptoms last 3-4 weeks.
CXR normal in 90% of cases.
53
Name some lower motor neurone conditions
Guillain-Barre syndrome
C. botulism
polio
cauda equina syndrome
amyotrophic lateral sclerosis
54
Epigastric pain that is not tender on palpation and has autonomic symptoms could be....
MI
55
Syphilis - antibiotic
**Benzylpenicillin**
or
Doxycycline
56
Dermatome to medial malleolus
57
Diagram of Lung Volumes
58
Dermatome to the thumb
59
Dermatome to Toes 4 and 5; lateral malleolus
60
Dermatome to Inner Forearm
61
**Small bony nodules** (osteophytes) at the **DIP and PIP joints** are characteristic of what?
**OA**
**DIP - Herberden's nodes**
**PIP - Bouchard's nodes**
62
Characteristics of **migraines**
* often **unilateral. Recurrent**
* **usually pulsatile**
* builds up over minutes to hours
* **occurs with or with aura**
* **associations** include; **nausea &** **vomiting**, **photophobia**, sound sensitivity, family history
* exacerbation with physical activity
* triggers; cheese, chocolate, etc.
NB. neurological exam should be negative
63
What are the signs and symptoms of peritonitis?
**severe abdominal pain**, **tenderness and guarding**.
(rigidity - invol contraction of abdo muscles)
**Worse for movement** as the inflammed peritoneum moves.
**REBOUND pain** (Blumberg sign) as the peritoneum snaps back into place after palpation.
fever, weight loss
64
Endocarditis - antibiotic
Gentamicin and Penicillin G
65
Another name for Broca's aphasia?
Expressive aphasia
66
Acute asthma attack
Salbutamol nebs
add ipratropium bromide if not working well.
Give steroids (orally, IM, IV)
67
Name some cystic lumps
* **Branchial cyst**
* Cystic degeneration of tumour
* **Larynogocoele**
68
NYHA
69
70
What are typical signs and symptoms of **acute leukaemia?**
1. _Bone marrow failure_ symptoms; **anemia, leukopenia, thrombocytopenia.** Therefore; SOB, fatigue, bacterial infections, bleeding, bruises. Possibly DIC.
2. Systemic; malaise, weight loss, sweats are common
71
What is **pseudomembranous colitis?**
Also called antibiotic-associated colitis or C. difficile colitis, is i**nflammation of the colon** associated with an overgrowth Clostridium difficile.
This overgrowth of C. difficile is most often related to recent antibiotic use.
72
What's the story?
**Zollinger–Ellison syndrome (ZES)** is a disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers.
Symptoms include abdominal pain and diarrhea.
The syndrome is caused by a neuroendocrine tumor that secretes a **gastrin.** The tumor causes excessive production of gastric acid.
73
Dermatome to knee
74
What symptoms could indicate a median nerve pathology?
the thumb and lateral two and a half fingers affected (numbness)
wasting of thenar eminence
weakness of thumb abduction
75
Immediate management of acute leukaemia
* often very ill px vulnerable to infections and/or bleeding.
* **IV antibiotics**
* **platelets** and **fresh frozen plasma** for bleeding
* **blood transfusion** for anaemia
\* even if fever is caused by disease and not infection, treat with antibiotics because b.
76
Deformities of the finger in RhA
| (diagram)
77
Dermatome to middle finger
78
Symptoms of meningitis
* high temperature of 38C or more
* **headache**
* blotchy rash that doesn't fade when a glass is rolled over - septicaemia (
* often not present)
* **stiff neck**
* photophobia, drowsiness, seizures, **confusion**,
* aching muscles & joints,
* cold hands & feet, tachypnoea
79
Name **opportunistic** HIV infections
* PCP - pneumocystis jirovecii
* **cytomegalovirus** (CMV) in late-stage infection (CD4 \<50) - main problem progressive **_retinitis_** (85%)
* **toxoplasmosis** - protozoa infection. Causes encephalitis (80%) in late HIV
* Kaposi's sarcoma (herpes virus 8)
* + others
80
What are the tests for Coeliac disease?
Total immunoglobulin A (**IgA**)
**IgA Tissue transglutaminase antibody** (shortened to **tTG**)
+ eat gluten in more than one meal every day for six weeks prior to testing.
GOLD standard; **duodenal biopsies** with IEL ( increased number of **intraepithelial lymphocytes** is typical of active celiac disease)
81
Parotid tail lump - Solid
What other solid lumps are there?
* lymph node
* tumours
* vagal schwannoma
82
What is **seroconversion**?
* **Period of time during which HIV antibodies develop and become detectable.**
* takes place within a few weeks of initial infection.
* It is often accompanied by **flu-like symptoms** including f**ever, rash, muscle aches and swollen lymph nodes**. These symptoms are **_not_** a reliable way to identify seroconversion or to diagnose HIV infection.
83
Lung volumes diagram
84
What is a **pharyneal pouch?**
A **diverticulum** of the mucosa of the pharynx.
Dysphagia, and sense of a lump in the throat
_Trapped food:_
**Regurgitation**, r_eappearance of ingested food in the mouth_
**Cough**, due to food regurgitated into the airway
**Halitosis**, smelly breath, as stagnant food is digested by microorganisms
Infection
85
Neisseria Gonorrhoea - antibiotic
Ceftriaxone
86
What is the important of lactate in ABG?
by-product of **anaerobic respiration.**
Good indicator of _poor tissue perfusion._
87
What could CTS be associated with?
pregnancy
diabetes
hypothyroidism
88
What does raised PSA indicate?
Prostate cancer/ benign hypertrophy
other examination; PR, biopsy
89
Name for rectal bleeding
haematochezia
90
**Investigations** for acute leukaemia
**FBC**; _anaemia and thrombocytopenia_, \<\< WBCs (or normal , or raised). If _raised_ then cells are mainly **primitive white cells** (blasts).
**Coagulation profile**; _prolonged clotting times_
Blood cultures; infection risk
**CXR**; mediastinal mass on ALL of T-cell lineage.
+ others
**GOLD** standards to **differentiate** ALL from AML; bone marrow aspirations, trephine biopsy.
91
**protozoan** parasite that causes **malaria**
**Plasmodium falciparum**
92
Coeliac disease and gluten... what's the story?
**gluten \> villous atrophy \> malabsorption**
* Familial component
* T Cell mediated autoimmune inflammation of the small bowel.
93
What is the definitive examination for a PE?
**CT pulmonary angiogram (CTPA)** computed tomography using a contrast dye to obtain an image of the pulmonary arteries.
94
Lower motor neurone signs
* **absence of reflexes**
* muscle fasciculations
* atrophy of muscles
* **decrease muscular tone**
95
HIV is caused by what type of virus?
**blood-borne RNA retrovirus**
* intercourse, drug use
* maternal-child transmission
* transfusion of blood products
96
What's this? And info
BCC is a _non-melanoma_ skin cancer, and is the **most common type (\> 80%) of all skin cancer**.
BCC are sometimes referred to as ‘rodent ulcers’.
Common on areas that are exposed to the sun, such as your **face, head, neck and ears**
97
Kussmaul breathing is a deep sighing pattern to decrease CO2 levels and is commonly seen with....
**Diabetic ketoacidosis**
98
Which part of the GI tract is ulcerative colitis?
colon and rectum only
(abdominal cramping + diarrhoea)
99
What is FNAC?
Fine Needle Aspiration for Cytology
- may be used for neck lumps
100
Define acute leukaemia
**Clonal haematopoietic stem cell/ progenitor disorder** characterized by the **rapid accumulation** of **immature progenitor cells** (blasts) and **impaired normal marrow function.**
101
Mallory-Weiss tears
- when?
**alcoholic ‘dry heaves’,** retching, severe coughing.
**tears** at the oesophagogastric junction by a sudden **increase in intra-abdominal pressure**
102
RhA nodules characteristics
Made from fibroblasts.
Pinky colour.
Blood supply on the outside only; can become necrotic.
Locations; extensor surfaces of elbows, forearms and hands
103
What's this? + info.
**Thyroglossal cysts**
**asymptomatic midline neck mass** at or below the level of the hyoid bone, above the thyroid cartilage.
Most often in the **midline**
They may present in childhood (less than 50%) or, usually as a young adult
M**ove up when the tongue is protruded** & with **swallowing**- cysts attached to the base of the tongue by the **thyroglossal tract**.
104
Symptoms of **temporal arteritis**
visual loss; **blood supply to retina is affected.**
One-sided headache, **very tender scalp; tender brushing hair**
_Typically new and continuous headache_ with those over **_50 yrs_**. **Gradual onset** (wks-mtns)
**Pain in jaw with chewing**; jaw claudication
**Can cause clots leading to stroke.**
* **ESR** often raised (\>100)
105
What is respiratory acidosis?
Acidosis due to an **inability** of the lungs to excrete CO2 adequately.
106
What is a **pannus**?
**hypertrophied synovium,**
containing inflammatory cells that release **collagenolytic enzymes**
causing loss of bone and cartilage (chronic RhA)
107
What's the common cause of this?
**cirrhosis**,
the consequences of **portal hypertension.**
Commonly these **bleed**.
lower **1/3** of the oesophagus
108
109
Which shoulder dislocation is most common?
**Anterior** - 95%
Usually caused by a direct blow to, or **fall on, an outstretched arm.**
The patient typically holds his/her arm externally rotated and slightly abducted.
110
Management of Benign prostatic hypertrophy
alpha-adrenergic blockers; prazosin
alpha adrenoceptor antagonists; tamsulosin
or finasteride (inhibitor of testosterone, reduces prostatic hypertrophy)
TURP: **T**rans**U**rethral **R**esection of the **P**rostate.
111
**POUND** mneumonic
* **P**ulsatile
* 4-72 h**O**urs duration
* **U**nilateral
* **N**ausea or vomiting
* **D**isabling intensity
112
Some characteristics of CTS
* more common in **women**
* tingling in hand
* **symptoms often occur at night**
* px may hand hand and arm out of bed for relief
* associated with.... (3)
* thenar muscle wasting
113
What is the **ankle-brachial pressure index (ABPI)**
The ratio of the blood pressure at the ankle to the blood pressure in the upper arm.
Lower blood pressure in the leg suggests blocked arteries due to **peripheral artery disease (PAD)**
Unreliable with calcification of arteries (e.g. diabetes)
114
Which type of leukaemia has a peak age of onset of **_four_** years?
ALL - **acute lymphoblastic leukaemia**
70-80% cure rate for children.
115
Immediate Stroke/ TIA management
* CT scan to rule out haemorrhagic cause
* thrombolysis (3 hr window from onset of symptoms?)
* antiplatelet therapy
116
What is tenesmus?
Sensation of needing to defaecate although the rectum is **empty**.
(could be rectal inflammation of tumour)
117
What is pharmacokinetics?
Pharmacokinetics is the study of how **_an organism affects a drug._**
**Absorption** is part of pharmacokinetics.
IV - max bioavailability.
118
**infectious esophagitis.**
Common cause?
Candida albicans
HIV/ cancer patients
119
Characteristics of **essential/ benign/ idiopathic tremor.**
* cause unknown
* symmetrical (Parkinson's is _asymmetric_)
* happens on **movement** or **postural** (due to sustained muscular tone). EG. Rattling of a teacup.
* _DOESN'T HAPPEN AT REST_ (unlike PARKINSON'S)
120
Some possible red flags for neck lumps
**Dark colour** suggestive of malignant melanoma,
ulceration,
**_skin fixation,_**
bleeding, or
**hard texture**
121
RhA on XR - characteristics
White sclerotic changes - spongy bone looks whiter.
Subluxation of MCP
Wrist/ hand displacement
Thumb - Z deformity
122
Dermatome to little finger?
123
meningitis - antibiotic
benzylpenicillin
124
Headache; **red flags**
* **new onset or changes in headache in px over 50 years old**
* thunderclap
* f**ocal neurological symptoms**
* abnormal neurological examination
* **headache that changes with posture**
* wakes up px during night
* **worse for valsalva manoeuvre**
* thrombosis risks
* **jaw claudication**
* neck stiffness with fever
* **new onset with cancer/ HIV px**
125
Emphysema and Lung volumes - what's the story
Emphysema, **functional respiratory capacity** is **increased**, _because the lungs are more compliant._ **Total lung capacity** also increases, largely as a result of **increased functional residual capacity.**
126
Chlamydia - antibiotic
Azithromycin
127
What lumps move with swallowing?
**SOLID:**
Goitre
lymph node
**CYSTIC**:
Thyroid cyst
128
definitive tx of acute leukaemia and side effects?
**cytotoxic drugs**
* hair loss, nausea & vomiting, sore mouth, bone marrow failure.
* _severe infection_
**radiotherapy, & some cases; stem cell transplantation. Destroy stem cells and reinfuse.**
129
What and where and how?
melanoma - cutaneous malignant **melanoma** is a **cancer of the pigment cells of the skin**
common backs (men), legs (women)
Usual skin type suspects. Sunbeds and sudden intense sun exposure BAD.
130
What could cause wrist drop?
Radial nerve compression
131
Where does pain radiate with acute cholecystitis?
from right hypochondrial region to shoulder/ interscapular region.
132
Nerve involved with CTS?
median
133
Which type of cells does HIV virus infect?
**CD4-bearing T lymphocytes** and monocytes/ macrophages
134
What is the age group for AML (acute myeloid leukaemia)?
more common with _increasing age_, with peak age onset of **70 years**.
135
Causes of **purpura**
| (pathophysiology)
**Platelet disorders (thrombocytopenic purpura)**
**Vascular disorders (nonthrombocytopenic purpura)**
Microvascular injury, as seen in **senile (old age) purpura**, when blood vessels are more easily damaged
**Hypertensive** states
**Vasculitis**, as in the case of Henoch–Schönlein purpura
**Coagulation disorders**
**Disseminated intravascular coagulation (DIC)**
**Scurvy** (vitamin C deficiency) - defect in collagen synthesis results in weakened capillary walls and cells
**Meningococcemia**
**Cocaine use** with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent **levamisole** can cause purpura of the ears, face, trunk, or extremities. Levamisole is purportedly a common cutting agent.
136
Referred pain (diagram)
137
What condition can sometimes mimic cellulitis and is an medical emergency?
**Necrotising Fasciitis**
Important clues; pain, tenderness and systemic illness out of proportion to the localised physical signs.
**Bullae and ecchymotic skin lesions** also point to this condition (not normally found with cellulitis)
138
Necrotising fasciitis of submandibular space is called....
Ludwig's angina
139
Smoking is protective for which condition?
ulcerative colitis
140
What is a SAH (subarachnoid haemorrhage)?
Subarachnoid haemorrhage (SAH) is usually the result of bleeding from a berry aneurysm in the Circle of Willis.
141
Subarachnoid haemorrhaging; can it present with meningeal irritation?
Yes
142
What does the oculomotor nerve supply?
eye muscles
upper eyelid muscle (levator palpebrae superioris)
Muscles responsible for **pupil contriction.**
symtoms; strabismus, diplopia, ptosis, mydriasis
143
What is aplastic anaemia?
a potentially life-threatening failure of haemopoisesis characterised by pancytopenia and hypcelullar bone marrow.
incidence; 2/1, 000, 000
Blood tests will show; **normcytic anaemia, leukopenia and thrombocytopenia.**
144
What is normal pressure hydrocephalus?
**\>\> csf in the brain's ventricles**. The _brain ventricles enlarge_ and can cause symptoms related to surrounding tissue compression.
Age group; 60s and 70s.
'**wet, wobbly and whacky**' which represent urinary incontinence, gait ataxia, and dementia respectively.
145
two main Causes of acute pancreatitis
**Gall stones**
**Ethanol**
146
what is the **Herxheimer's reaction**?
It is believed to be caused by the **release of endotoxin-like substances** when large numbers of **Treponema pallidum** are killed by **antibiotics** (treatment of **syphilis**)
147
What's the test for Quervain's tenosynovitis?
148
What is the most important treatment for prevention of neonatal respiratory distress syndrome?
Natural **maternal glucocorticosteroids** are very important for surfactant production in the foetus, and therefore **synthetic steroids** are the first line agents for preventing NRDS in pregnancies at risk of pre-term birth
149
what is the best time of the day to take simvastatin?
(Statins inhibit the action of HMG-CoA reductase)
HMG-CoA reductase is the rate-limiting enzyme in hepatic cholesterol synthesis
Statins should be taken at night as this is when the majority of cholesterol synthesis takes place.
This is especially true for simvastatin which has a shorter half-life than other statins
150
What are the symptoms of **otosclerosis**?
Otosclerosis (OTSC) is a condition in which there's abnormal bone growth inside the ear. It's a fairly common cause of hearing loss in young adults.
The main symptoms are progressive hearing loss and tinnitus. Hearing loss is bilateral in ~70% of cases.
Vestibular symptoms are usually absent.
151
what is Glue ear?
**otitis media with effusion**
peaks at **2 years** of age
**hearing loss** is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
secondary problems such as **speech and language delay**, behavioural or balance problems may also be seen
152
What is Paget's disease of the bones and how is it treated?
Paget’s disease is a condition of excessive bone remodelling by osteoclasts, followed by disordered formation of new bone. The mainstay of treatment for Paget’s disease is **bisphosphonates** as they **inhibit osteoblastic activity.**
153
What's the management of primary pneumothorax?
* if the rim of air is **\< 2cm** and the patient **is not short of breath** then **discharge** should be considered ( consider other medical factors)
otherwise **aspiration** should be attempted
if this fails (**defined as \> 2 cm or still short of breath**) then a **chest drain** should be inserted
patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men
154
What would affect the results of a urea breath test?
Urea breath test -
no antibiotics in past 4 weeks,
no antisecretory drugs (e.g. PPI) in past 2 weeks
155
What type of urinary incontinence is the most associated with amitriptyline?
Overflow incontinence
Amitriptyline belongs to the drug class of tricyclic antidepressants (TCAs). TCAs have anticholinergic effects which may lead to **urinary retention**, leading to frequent leaking.
156
What is urge incontinence?
Urge incontinence is due to **detrusor over-activity** and could be treated with an antimuscarinic drug
157
What are the most common groups of groups that cause hyponatriaemia?
thiazide diuretics,
selective serotonin reuptake inhibitors (SSRIs),
proton pump inhibitors,
angiotensin-converting enzyme (ACE) inhibitors
and loop diuretics.
158
What are some of the clinical characteristics of anorexia nerviosa?
hypokalaemia is the most common electrolyte abnormality.
They usually have high cholesterol levels in the blood.
bradycardia, hypotension, and cold-intolerance.
yellow tinge on the skin (hypercarotenaemia)
Possibly lanugo hair due to loss of body fat.
159
What is Cushing's disease?
Cushing's disease which results from increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary, often caused as a result of a pituitary adenoma.
160
How does Heparin work?
It activates (hyperpotentiates) antithrombin III
nat
161
What is the most common cause of brain metastases?
Ca of Lungs
