Medicine Flashcards
(159 cards)
1
Q
what vessel is occluded to give wallenberg syndrome?
what are the features?
A
verterbral artery/PICA
infarction of lateral medulla oblongata
- horner syndrome
- sensory - pain and temperature - ipsilateral face, contralateral body
- sensory - nystagmus, vertigo (CN VIII)
- cerebellar ataxia
2
Q
action on CYP 450: SSRIs and omeprazole
A
inhibtor
3
Q
which heart block has a constant PR interval with occasional missed beats?
A
Mobitz type 2
pacemaker indicated
conduction abnormalilty below the AV node
4
Q
how do you manage an aortic dissection?
A
pain control
IV beta blockers
+/- nitroprusside if the SBP remains >120
5
Q
what is the role of the d-xylose test?
A
d-xylose is a monosacheride that is absorbed without digestion in the small bowel
reduced levels in urine after oral challenge indicates absorption defect
those with enzymatic deficiency (pancreatic insufficiency) will have a normal d-xylose test as there is no needs for them in its digestion
6
Q
what is the diagnostic test for CLL?
A
flow cytometry showing clonal mature B cells
7
Q
what are the neoplasms associated with each of the MEN syndromes?
A
MEN1 - pituitary, pancreas, parathyroids
MEN2A - parathyroids, medullary thyroid, phaeochromocytoma
MEN2B - mucosal neuroma, medullary thyroid, phaeochromocytoma, marfanoid body habitus
8
Q
beta2 microglobulin is a prognostic factor in which disease?
A
multiple myeloma
9
Q
what are the values for Ca Phos and PTH in vitamin D deficiency?
A
low Ca, low Phos, high PTH
found in low sunlight, malabsorption, poor dietary intake
10
Q
what are the indications for IE antibacterial prophylaxis during dental/surgical procedures?
A
only with particularly high risk heart conditions such as:
- previous IE
- metalic heart valve
- unrepaired CHD/CHD repair with tissue or residual defect
- valvular lesion in a transplanted heart
11
Q
what do you have to replace in pituitary insufficiency?
A
cortisone (hydrocortisone)
thyroxine
testosterone/oestrogen
recombinant human growth hormone
12
Q
what is the adverse effect of aromataze inhibitors used in breast cancer treatment that has to be monitored before and during therapy?
A
osteoporosis
DEXA scanning
13
Q
what are the medical treatment options for hepatorenal syndrome?
A
midodrine, octreotide, norepinepherine
14
Q
what is the target of autoantibodies in guillan-barre syndrome?
A
myelin on peripheral nerve fibres
don’t be fooled by high CSF protein!
15
Q
what disease are the following all risk factors for?
- famle, caucasian
- HLA-DRB1
- cold climate, living in the West (Europe/USA)
- low vitamin D levels
- smoking
A
multiple sclerosis
16
Q
which medication lead to increase in creatinine without any damage to the kidney?
A
trimethoprim, cimetidine, febuxostat
17
Q
what are the complications of quincy?
A
airway obstruction
spread of abscess into the parapharyngeal space and involvement of the carotid sheath
18
Q
what is the management of carpel tunnel syndrome?
A
nocturnal wrist splinting
steroid injections as a temporary measure
surgical decompression
NSAIDs will not provide relief
19
Q
what is the important serum:ascites albumin gradient number?
what are the causes of a high SAAG?
A
>= 1.1
high = portal hypertension
- budd-chiari syndrome
- cardiac failure
- cirrhosis
20
Q
what is the medical therapy for virilization in women?
A
OCP
spironolactone/finasteride (anti-androgen)
metformin (only in PCOS)
21
Q
what must you pay attention to when prescribing hydroxyurea?
A
do not prescribe when WBC is low
22
Q
what is the adverse effect of platin-based chemotherapy that has to be monitoring during therapy?
A
ototoxicity
baseline and interval audiometry
23
Q
what is the mechanism by which epilepsy leads to brain damage?
what is the hallmark pathological pattern of brain damage secondary to prolonged SE?
A
excitatory cytotoxicity
cerebral cortical laminar necrosis
24
Q
low C3/4, RhF, hepatitis C or lymphoproliferative disorders are consistent with…
A
mixed cryoglobulinaemia
small vessel leukocytoclastic vasculitis, immune complex deposition and palpable purpura
25
what are the treatment options for latent TB ?
* isoniazid and rifapentine q1 week for **12 weeks**
* rifampin daily for **4 months**
* isoniazid daily for **9 months** daily or twice weekly
26
knowing the relative risk attributable to a given factor, how do you calculate the attributable risk percentage?
ARP = (RR - 1.0)/RR
27
what are the FSH/LH levels in Klienfelter syndrome and Kallman syndrome?
Kleinfelter (XXY, tall) - high FSH and LH but androgen insufficiency due to insensitivity to gonadotrophs
Kallman syndrome (KAL-1 mutation, anosmia, renal agenesis in 50% of patients) - low FSH and LH due to deficiency in GnRH
28
what is the mechanism of pruritis following a warm shower in polycythemia vera?
increased number of **basophils** release histamine
29
when are fibrates recommended as therapy for hypertriglyceridaemia?
in the prevention of acute pancreatitis
## Footnote
**serum trig \> 1000 mg/dL**
30
what do thalidomide and lenalidomide increase the risk of that must be prevented during therapy?
thrombosis
31
what is Beck's triad?
hypotension, muffled heard sounds and elevated JVP
32
what do dysmorphic red cells indicate on urinalysis?
glomerular haematuria
33
above what size thyroid nodule must FNA be performed?
1.5 cm as long as **TSH/T4 are normal**
34
how do you treat vasospastic angina?
CCB (preventive)
nitrates (abortive)
35
what is an important contraindication to 5-HT receptor antagonist anti-emetics?
long QT syndrome
use neurokinin-1 (NK) receptor antagonists instead in chemotherapy nausea
36
how high does BUN have to be usually to precipitate uraemic pericarditis?
what is the treatment?
\>60
haemodialysis
37
what does ruxolitinib do?
inhibitor of **JAK2** and can be used in polycythemia vera if hydroxyurea fails to control haematocrit
38
likely cause of large volume pleural effusion with:
* high protein (\>4 g/dL)
* lymphocytes
* low glucose (\<60 mg/dL)
tuberculosis
39
along with systemic chemotherapy, what should be added spicifically in ALL to prevent recurrence?
intrathecal methotrexate stops CNS recurrence of the cancer
40
in a healthy individual, what are the pathogens likely to cause a brain abscess?
* strep viridans*
* staph aureus*
41
what is the best test for parvovirus B19 infection?
treatment?
PCR for viral DNA
IV Ig
42
contralateral loss of sensation and parasthaesias resolving into allodynia/episodic pain
what is the name of this stroke syndrome and where is the lesion?
Dejerine-Roussy syndrome
sensory thalamic nuclei
43
if cushing's syndrome cannot be adequately cured with surgery (inoperable, metastases) what are the medical therapies that can be used?
mitotane - cytotoxic to adrenal tissue, inhibits steroidogenesis, metastatic disease
pasireotide (SSA analog) - inhibits release of ACTH if the pitutary adenoma cannot be resected
44
non-anion gap metabolic acidosis with mild hyperkalaemia and only mild CKD
type 4 renal tubular acidosis
JGA failure and low renin/adosterone leads to reduced excretion of H and K from the collecting duct
45
when are pembrolizumab and nivolumab useful in the treatment of lung cancer?
in cases with elevated programmed death (PD) biomarker
more effective and better tolerated than platinum-based therapy in NSCLC
46
pronator drift is a sign of disease in which system?
why is it a sensitive test?
pyramidal/corticospinal tracts
UMN lesions affect the supinator muscles \> pronators
47
lung cancer screening
low-dose CT chest
adults 55-80 who have a 30 pack-year history and quit within the last 15 years. stop scanning when they have not smoked for at least 15 years.
48
what can be given to prevent the recurrence of uric acid stones? how does this work?
potassium citrate
alkalinises the urine, citrate directly blocks stone formation
49
what effect do loop diuretics have on acid-base balance? How does this mechanism work?
will make the patient slightly alkalotic
increased delivery of Na to the DCT leads to exchange of K+ and H+ ions into the urine and promotes more acid being lost
volume contraction leads to aldosterone secretion which contributes to more Na exchange in the DCT as well
50
what conditions/electrolyte abnormalitis increase the risk of calciphylaxis?
hyperphosphataemia
hyperPTH
end-stage renal disease (haemodialysis)
51
AAA screening
one time US abdomen for men who have ever smoked \>100 cigarettes
selective screening for men 55-65 who have **never** smoked
52
what is the sequence of pathophysiologic events in diabetic nephropathy?
glomerular hyperfiltration
thickening of the basement membrane (first finding that can be quantified)
mesangial swelling/expansion
nodular sclerosis
53
what is the diagnostic test for paget's disease of the bone?
NM technetium scan with high uptake in the bone
symptomatic? treat with bisphosphonates, NSAIDs
2nd line - calcitonin
54
what is the ulnar nerve paradox
ulnar nerve innervates flexor digitorum profundus
proximal lesion - paralysis of FDP - fingers held in neutral paralysis
distal lesion - healthy FDP, not antagonised - flexion deformity clinically worse at the fingers
**closer to the Paw, worse the Claw**
55
what are the preferred treatment options for cancer-associated cachexia?
progesterone analogs and steroids
if the patient has a longer life expectancy then go for progesterone as they have fewer side effects
56
what is the treatment for symptomatic hyperthyroidism in the first instance?
when are anti-thyroid drugs recommended over RAI/thyroidectomy?
if symptoms are severe then always beta blockade and anti-thyroid drugs in advance of definitive treatment with RAI/thyroidectomy
ATDs alone in older patients with limited life expectancy or pregnancy (only PTU in the 1st trimester)
57
which immunodeficiency is associated with anaphylaxis when given blood transfusions?
IgA deficiency
develop IgE against IgA and can have fatal anaphylaxis
should wear medic alert bracelets and be given IgA-deficient blood products
58
what are the findings associated with lobar haemorrhage in the following sites:
* frontal lobe
* parietal lobe
* occipital lobe?
* frontal = contralateral hemiparesis
* parietal = contralateral hemisensory loss
* occipital = homonymous hemianopsia
59
what is the most accurate test for CML?
What is the treatment for it in the first instance?
What is the treatment for leukostasis reaction?
start with BCR-ABL PCR or FISH
Tyr Kinase inhibitors imatinib (Gleevec), dasatinib, nilotinib
leukapheresis
60
what are the lipid abnormalities commonly seen in hypothyroidism?
what are some other common biochemical abnormalities seen with hypothyroidism that are usually asymptomatic (3)?
elevated LDL (decreased surface LDL receptors)
less commonly, elevated triglycerides (decreased lipoprotein lipase activity)
hyponatraemia, elevated CK, transaminitis
61
other than NSAIDs, what do you use to treat pericarditis?
what is the added value of this medication?
cochicine
decreases the rate of recurrence
62
tuberculosis screening
screen in at-risk populations.
* ethnic origin: china, vietnam, mexico, india, phillipines
* people who live in high-risk congregate settings (homeless shelters)
* healthcare workers
tests available are:
* tuberculin skin test
* inteferon-gamma release assay (T-SPOT, QuantiFERON)
63
what is the most effective intervention in slowing the progression of diabetic nephropathy?
tight blood pressure control \<140/90
aim for 120/80
64
what are the unfavourable metabolic side effects of thiazide diuretics?
hyperglycaemia, increased LDL cholesterol, hypocalcaemia, hyperuricaemia (gout)
65
what is the treatment for acute kidney rejection days after transplant?
IV steroids
66
how do you treat acromegaly?
1. transphenoidal recection of adenoma (70% cure)
2. cabergoline (DA agonist), octreotide, pegvisomant
3. radiation therapy
67
what are the distinct features of uric acid stones?
what are the conditions that would increase the risk of these forming?
radiolucent, small, rhomboid yellow/brown crystals
diabetes, gout, myeloproliferative disorders
68
if you add amiodarone for a patient on digoxin, what adjustment should you make?
25-50% reduction
69
what is the rank order of non-pharmacologic intervention for reducing blood pressure?
weight loss
DASH diet
exercise
dietary sodium
smoking
70
how does oral oestrogen affect circulating thyroid levels?
oral tablets affect the liver and increase thyroid binding globulin levels leading to higher doses of levothyroxine required to maintain the patient euthyroid
71
which electrolyte abnormality is assoicated with difficulty in correcting hypokalaemia?
what is the mechanism?
hypomagnesaemia
failure of the collecting tubule ROMK channels leading to excessive urinary potassium loss
72
what is first-line treatment of trigeminal neuralgia?
carbemazepine, oxcarbazepine
73
what are the treatments for restless leg syndrome?
pramipexole (dopamine agonist)
2nd line: gabapentin
74
which area of the brain is affected by Wilson syndrome?
basal ganglia
75
what are the clinical findings on examination of tabes dorsalis?
which areas of the cord are responsible for which findings?
**posterior columns** - sensory ataxia, positive romberg test, decrease proprioception/vibration
**nerve roots** - decreased pain/temperature, sensation and diminished reflexes
76
Kimmelstiel-Wilson nodules in the glomerulus identifies which disease?
diabetic nephropathy
77
what is the epidemiology of otosclerosis?
young adults aged 20-30
female \> male (?autoimmune)
78
REM sleep disorder is associated with which neurodegenerative condition(s)?
Parkinson's disease/LBD
multisystem atrophy
79
what electrolyte abnormalities precipitate diabetes insipidus?
hypokalaemia and hypercalcaemia
80
what are the dietary recommendations for patients with recurrent calcium oxalate kidney stones?
increase fluid intake
decrease dietary sodium
normal dietary calcium
81
what are the sequence of acid-base disturbances following salicylate toxicity?
respiratory alkalosis - tachypnoea, stimulation of the medulla
metabolic acidosis - uncoupling of oxidative phosphorylation
near normal pH after a few hours
82
what is the number of neutrophils in ascitic tap that indicates SBP?
\>250 cells/mm3
83
what side effect is most commonly associated with the NNRTI efavirenz?
delerium, lucid dreams, insomnia, depression/anxiety
can be experienced in up to 50% patients
use cautiously in those with a histroy of psychiatric disturbance
84
what is the presentation of chagas disease?
what is the pathogen responsible?
megacolon/megaoesophagus and cardiac disease
*trypanosoma cruzi,* a protozoan
85
what is Winter's formula for the expected PaCO2 in metabolic acidosis?
PaCO2 = 1.5 x (HCO3-) + 8 +/- 2
86
what is the difference in work up between pupil-sparing and non pupil-sparing CN III palsy?
non pupil-sparing = mass effect requiring CT head and CT/MR angiography
pupil-sparing = diabetic requiring HbA1c
87
what is common to find between Glanzman thrombasthenia and Bernard-Soulier syndrome?
normal plts, normal vWF assay
BS syndrome has **giant platelets**
88
what is the reference range for aldosterone/renin ratio?
\<20
89
what does electrical alternans refer to?
the beat-to-beat variation in QRS complex amplitude seen in pericardial effusion thought to result from the swining of the heart within the pericardium
90
CRC screening in patients with inflammatory bowel disease
8-10 years after the onset of the disease
can start 12-15 years if only the left side of the colon is affected
repeat every 1-3 years
91
what are the most common adverse effects of these chemotherapeutic agents:
* doxorubicin
* vincristine
* bleomycin
* cyclophosphamide
* cisplatin
* doxo - cardiotoxic
* vincristine - neuropathy
* bleomycin - pulmonary fibrosis
* cyclophosphamide - haemorrhagic cystitis
* cisplatin - nephrotoxic, ototoxic, neurotoxic
92
what is the new definition of status epilepticus?
single seizure lasting more than 5 minutes
\>= 2 seizures without fully regaining consciousness
93
action on CYP 450: antibiotics and antifungals (metronidazole)
inhibitor
94
what is the mechanism by while malapsorbative disease leads to renal stone formation?
increased fatty acids in the gut, binding of calcium to the fat, decreased calcium available to bind oxalate, hyperoxaliuria
oxalte stone formation
95
other than vision loss, what is the most common complication of temporal arteritis?
10-20% develop aortic aneurysm
96
where are the abberant signals initiated in
atrial fibrillation
atrial flutter
pulmonary veins
tricuspid annulus/cavotricuspid isthmus
97
what happens to the aldosterone level in panhypopituitarism?
remains normal as it is controlled by the RAAS system
98
what are the complications of radioiodine ablation therapy in Graves disease?
permanent hypothyroidism
worsening of thyroid eye disease
99
how does magnesium affect circulating calcium levels?
Mg is needed for the release of PTH
hypomagnesaemia results in hypoPTH and low Ca
hypomagnesaemia also reduces the reabsorption of Ca in the kindey leading to increased renal losses
100
CRC screening for patients with HNPCC
colonoscopy at age 20-25 and repeat every 1-2 years
101
how do you treat TTP?
plasma exchange
glucocorticoids
rituximab
102
how do you treat hepatin-induced thrombocytopenia?
do you give platelet transfusion?
stop heparin
factor Xa inhibitors - agatroban, bivalirudin, fondaparinux
remember, this is a **thrombophilia** and thromosis is more likely. adding platelets will increase the risk/severity of clots
103
what is the referral criteria for carotid end-arterectomy?
70-99% stenosis of the carotid
symptomatic (TIA or ischaemic stroke)
life expectancy \> 5 years
104
what is the fasting glucose level minimum for diagnosis of diabetes?
HbA1c?
125
\>6.5 %
105
haemolytic anaemia, cytopenia and venous thromboses in weird places - what is the diagnosis?
what is the test for this?
paroxysmal nocturnal dyspnoea
test with flow cytometry for the absence of **CD55 and CD59**
106
what is the ristocetin cofactor assay used for?
test of vWF dysfunction
to test for von Willebrand disease
aka vWF activity assay
107
damage to which structure leads to subdural haematoma
shearing of low pressure cortical bridging veins
108
what is the treatment for WPW syndrome with rapid ventricular response?
assess haemodynamic stability?
yes - procainamide or ibutilide
no - cardioversion
109
what is the acid base disturbance associated with asipirin toxicity?
what are the other features of salicylate poisoning?
respiratory alkalosis and metabolic acidosis
tinnitus, fever and tachypnoea
110
what is the adverse effect of bleomycin that requires monitoring before and during therapy?
pulmonary fibrosis - monitor with PFTs
111
what is abiraterone?
a 17-hydroxylase inhibitor that halts all androgen production in the adrenals used to decrease mortality (risk -30%) and progression of **metastatic prostate cancer**
112
how do you treat HOCM medically?
avoidance of volume overload
beta-blockers or calcium-channel blockers
113
screening for BRCA mutations?
women with a family history of breast, ovarian, tubal or peritoneal cancer should be offered genetic screening for harmful BRCA mutations. if positive, they should receive genetic counceling
114
between pap smear, colonoscopy and mammography, which has the lowest proven mortality benefit?
pap smear
115
NSAIDs and ACE-I, which one constricts which arteriole to/from the glomerulus?
NSAIDs - afferent
ACE-I efferent
116
what is medical therapy for patient with intermittent claudication who have failed aspirin and exercise therapy?
cilostazol (antiplatelet and vasodilator)
117
what is the upper limit of normal for total protein in 24 hour urine sample?
how does P/Cr ratio equate to total protein in 24 horus?
150 mg / 24 hrs
0.1 = 100 mg, 1 = 1 g , 2 = 2 g
118
CRC screening for individuals with family history of CRC or adenomatous polyps
note **FH** **positive** refers to 1 family member with CRC younger than 60 or 2 family members of any age
use colonoscopy at age 40 or 10 years before the youngest age of onset of CRC in the affected family member
repeat every 5 years
119
in hodgkin lymphoma, is lymphocyte predominant or depleted associated with better prognosis?
lymphocyte predominant - better prognosis
120
what is the treatment of methaemoglobinaemia?
what are the contraindications to first line therapy and what can be used instead?
methylene blue
CI = G6PD deficiency; use high dose vitamin C instead
121
which treatment for hyperthyroidism will worsen the thyroid eye disease?
radioiodine ablation
use prednisolone and anti-thyroid drugs to minimise this effect
122
how long should you wait following uncomplicated MI to resume normal sexual activity?
at least 2 weeks
check for recurrent angina, arrhythymias or worsening ventricular function
123
what is the mechanism of hepatorenal syndrome?
liver cirrhosis leads to splanchnic arterial dilation which leads to an overall decrease is systemic vascular resistance
subsequent RAAS activation leads to renal vasoconstriction and decreased perfusion of the glomeruli
124
what is the treatment for warm AIHA and cold AIHA?
* *warm** - steroids, IV Ig, splenectomy, immunomodulators
i. e. rituximab, cyclophosphamide, cyclosporin, MMF
* *cold** - keep the patient warm, rituximab, plasmapheresis, immunosuppression
i. e. cyclophosphamide, cyclosporin
note that **steroids and splenectomy** do not work in cold AIHA
125
what is the adverse effect of trastuzumab (Herceptin) that has to be monitored before and during therapy?
type II cardiotoxicity
myocardial stunning/hibernation
likely to be reversible
echocardiogram before and during therapy
126
what is the ladder of treatment for acne?
1. topical retinoids and benzoyl peroxide
2. topical antibiotics
3. oral antibiotics
4. oral retinoids
127
what are the aetiologies of SIADH
* cerebral pathology (seizure, stroke)
* lung (pneumonia)
* tumour (small cell lung CA)
* medications (carbemazepine, SSRIs, NSAIDs)
* pain and/or nausea
128
in hyperthyroidism, what does increased radioactive iodine uptake (RAIU) suggest about the mechanism/pathology?
what would decreased thyroglobulin suggest?
increase RAIU = increased denovo synthesis
decreased = release of pre-formed T3/4
low thyroglobulin = exogenous thyroid hormone
129
what is the vitamin deficiency in carcinoid syndrome and how does this occur?
pellagra - niacin deficiency
tumour consumes tryptophan in the production of serotonin, which is also the substrate for B3 producion
130
what is the treatment of essential thrombocytosi?
asymptomatic and plts \< 1500 - not indicated
symptomatic or plts \>1500 - hydroxyurea, anagrelide 2nd line if RBCs are suppressed with therapy
131
in a patient with AIDS
solitary, weakly ring-enhancing mass in the periventricular area
what pathology does this suggest?
What is the most specific CSF test to confirm the diagnosis?
primary CNS lymphoma
PCR for EBV DNA
132
why are beta-blockers contraindicated in cocaine-induced coronary vasospasm?
they will lead to unapposed alpha-adrenergic action and worsen vasoconstriction, putting the myocardium at increased risk of ischaemia
133
what is aliskiren?
direct renin inhibitor
134
abortive therapies for migraine
preventive therapies for migraine
**abortive**: triptans, NSAIDs, acetaminophen, antiemetics, ergotamines
**preventive**: topiramate, divalproex, TCA antidepressants, beta-blockers (propranolol)
135
what is the most common type of nephrotic syndome seen in Hodgkin lymphoma?
minimal change disease
unlike other solid cancers in which membranous nephropathy is more common
136
what is the most common genetic abnormality in myelodysplastic syndrome? how does this affect management?
what is the most distinct abnormality on blood film?
5q deletion
better prognosis, will respond well to lenalidomide
pelger-huet cells (bilobed neutrophil)
137
how is measured calcium level affected by serum pH?
alkalosis - less H+ binding to albumin, more Ca++ bound to albumin and lower fee Ca++
acidosis - more H+ displaces Ca++ from albumin leading to higher levels of free Ca++
138
what systemic condition is associated with porphyria cutanea tarda?
hepatitis C
139
what pathologies are associated with:
* red cell casts
* white cell casts
* eosinophil casts
* broad, waxy casts
* granular/muddy brown casts
* glomerulonephritis
* pyelonephritis
* allergic (acute) interstitial nephritis
* CKD
* acute tubular necrosis
140
intensive HbA1c control (6-7%) in diabetes is intended to reduce the risk of what?
microvascular complications (nephropathy, retinopathy)
141
alternative complement pathway activation from persistent action of C3 convertase secondary to IgG binding is the mechanism of which disease?
type 2 membranoproliferative disease
the IgG is referred to as *C3 nephritic factor*
there is only complement deposition in the glomerulus, no immune complexes or immunoglobulins even though the disease is IgG-mediated
142
what is the fluid treatment of choice in hypovolaemic hyponatraemia?
normal saline
once the patient is euvolaemic you can switch to 5% dextrose
143
what are the PT and aPTT in antiphospholipid syndrome with lupus anticoagulant present?
PT - normal
aPTT - spuriously elevated that does not correct by mixing serum
the LA spuriously increases the aPTT by binding the phospholipids typically used in the lab assays. it is an artefact and does not reflect the **prothrombotic** *in vivo* effect
144
action on CYP 450: oral contraceptives
inducer
145
following MI, which vessel would be occluded to lead to the following complications:
LV free wall rupture
papillary muscle rupture
right heart failure
intraventricular septum rupture
LAD
RCA
RCA
LAD
146
what are the indications for starting statin therapy?
clinically significant ASCVD (ACS, stable angina, revascularisation, stroke, TIAs or PAD)
LDL \> 190
age 40-75 with diabetes
\>7.5% 10-year risk with pooled cohort equations
147
how should VQ scans be interpreted
Normal VQ scan - PE excluded
Low probability VQ scan, low pretest probability - PE excluded
High probability VQ scan, high pretest probability - PE confirmed
any other combination - needs further testing
148
what is the vitamin deficiency that leads to wernicke encephalopthy?
vitamin B1 - thiamine
149
which suptype of acute leukaemia is associated with DIC?
how do you treat this leukaemia?
M3 acute myeloid leukaemia
-promyelocytic
treat with ATRA
150
what is the best initial and most specific test for sickle cell disease?
BI - peripheral blood smear
MS - haemoglobin electrophoresis
151
action on CYP 450: carbemazepine and phenytoin
inducer
152
what is the pattern of cardiomyopathy seen in acromegaly?
concentric thickening of the LV wall leading to restrictive CM and global hypokinesis
153
what is the significance of eosinophils found in urine on microscopy?
allergic reaction
acute interstitial nephritis
**NB** NSAID nephropathy does not lead to eosinophils
154
thrombophilia screen should be performed before starting which breast cancer chemotherapeutic agent?
tamoxifen
usually just test for factor V leiden
155
CRC screening in a patient with classic FAP
start at age 10-12 and repeat annually
156
action on CYP 450: paracetamol and NSAIDs
inhibitor
157
following abrupt discontinuation of steroids, what are the levels of ACTH and cortisol likely to be?
low ACTH (HPA axis dysfunction) and low cortisol (adrenal atrophy)
158
what are the different associations with cold AIHA and cyroglobulinaemia?
cold AIHA - EBV, mycoplasma, waldenstrom macroglobulinaemia
cryoglobulins - HCV, joint pain, glomerulonephritis
159
parkland formula for burns
4ml x TBSA x weight
50% in first 8 hours
50% over next 16 hours
aim for UO \> 0.5 ml/kg
