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Misc 4 Flashcards

1
Q

Most common ocular manifestation for RA

A

Keratoconjunctivitis sicca

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2
Q

Aphasia

Non-fluent
Intact comprehension

A

Brocas aphasia
* Understanding intact but speech is effortful and slow
* Usually repetition is poor too
Lesion on lateral part of frontal lobe - the inferior frontal gyrus

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3
Q

Aphasia

Fluent speech and comprehension is intact
Repetition is impaired

A

Conduction aphasia
Lesion affecting arcuate fasciculus

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4
Q

Aphasia

Fluent speech
Comprehension impaired

A

Wernicke’s aphasia
* Nonsensical speech, word salad, word substitution, neologisms
* Fluency is not affected because arcuate fasciculus still there
* Repetition is impaired
* This is a lesion on the temporal lobe

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5
Q

Distinguish between shin lesions

Pyoderma grangrenosum
Necrobiosis lipoidica diabeticorum

A

Pyoderma gangrenosum
* initially small red papule
* later deep, red, necrotic ulcers with a violaceous border
* idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

Necrobiosis lipoidica diabeticorum
* shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

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6
Q

Management of urinary problems

Stress vs urge incontinence

A

Stress incontinence
* Pelvic floor exercises
* Surgical colposuspension
* Duloxetine if decline surgery which increases enhance contraction of urethral sphincter

Urge incontinence predominant
* Bladder retraining - gradual increase intervals between voiding
* Anti-muscarinics - oxybutinin IR, tolterodine
* Avoid oxybutinin in elderly womaen
* Mirabegron for elderly

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7
Q

Usual outcome for cohort study is

A

Relative risk
a statistical term that refers to your own risk of a disease compared to your risk if you do not have certain factors.

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8
Q

Normal pressure hydrocephalus

A

A classical triad of features is seen
1. urinary incontinence
2. dementia and bradyphrenia
3. gait abnormality (may be similar to Parkinson’s disease)

Reversible cause of dementia - reduced CSF absorption at arachnoid vilu

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9
Q

LADA vs MODY

A

Age for cut off for dx of T2DM is 45
MODY should be in <25 year olds
LADA - normal body habitus, autoimmune related DM, slower autoimmune process.

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10
Q

What is able to demonstrate publication bias in meta-analyses?

A

Funnel plot - scatter plot
* y axis study size, x axis treatment effect
* unbiased studies will scatter widely at bottom of graph with spread narrowing for larger studies
* If there is bias, asymmetrical appearance.

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11
Q

Management of atrial flutter

A

is similar to that of atrial fibrillation although medication may be less effective - amiodarone can be used.
atrial flutter is more sensitive to cardioversion however so lower energy levels may be used
* radiofrequency ablation of the tricuspid valve isthmus is curative for most patients - re-entrant circuit is in right atrium, will interrupt circuits re-entry.

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12
Q

Dentistry in warfarinarised patients

  • Admit to hospital and switch to LMWH
  • Switch to aspirin
  • Check INR 72h before and proceed if INR <4 or INR <2.5
A
  • Check INR 27H before
  • Proceed if iNR <4
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13
Q

What is NNT?
If NNT is 20, what is the NNT for 1000 patients?

A

NNT is a time-specific epidemiological measure of the number of patients who need to be treated in order to prevent one adverse outcome. A perfect NNT would be 1, where everyone improves with treatment, thus the higher the NNT, the less effective the treatment.

If NNT is 20, 1000 patients treated, there would be 50 fewer adverse outcomes

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14
Q

PNH best diagnostic test vs hereditary spherocytosis

A
  • PNH - Flow cytometry for CD59, CD55, gold standard
  • HS - EMA binding test
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15
Q

Juvenile myoclonic epilepsy

A
  • Generalised seizures in morning
  • Adolescent females with sleep deprivation or stress
  • Daytime absence seizure
  • Sudden, shock like myoclonic seizure may develop before GTN seizures
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16
Q

What is the pathophysiology behind loss of pubic hair and decreased libido in Addisons disease

A

Loss of libido and loss of pubic hair in Addisons disease is caused by DHEA deficiency
* Adrenal glands are main source of DHEA in females
* Loss of functioning adrenal tissue leads to androgen deficiency

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17
Q

Localisation of stroke

Contralateral hemiparesis and sensory loss
lower extremity >upper - what stroke is this?

A

anterior cerebral artery

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18
Q

Contralateral hemiparesis and sensory loss
Contralateral homonymous hemianopia +
upper extremity > lower extremity
Aphasia

A

Middle cerebral artery

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19
Q

Mercury poisoining

A
  • paraesthesia
    visual field defects
    hearing loss
    irritability
    renal tubular acidosis
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20
Q

Lead poisoning

A
  • Type 2 RTA

Features
abdominal pain
peripheral neuropathy (mainly motor)
neuropsychiatric features
fatigue
constipation
blue lines on gum margin (only 20% of adult patients, very rare in children)

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21
Q

Methanol poisoning

A

Visual symptoms blindness
Doesnt cause RTA

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22
Q

Distinguish between mitral and tricupsid regurgitation
Both cause pansystolic murmur

A
  • Mitral regurgitation loudest on expiration
  • Tricuspid regurgitation louder on inspiration (increase in venous return)
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23
Q

Investigating TB

When to use Mantoux test and when to use Quantiferon

A

Mantoux test is used to screen for latent TB
Quantiferon - if Mantoux is positive or equivocal, in high chance of flase negative tuberculin test

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24
Q

Down syndrome, risk increases with maternal age
What are the risks from age 20, 30, 35, 40, 45

A
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25
Which genetic disease is associated with increased risk of Crohns disease? Turners Downs Fragile X Patau Edwards
Turner syndrome
26
# Significance tests Type I error
* null hypothesis is rejected when it is true - i.e. Showing a difference between two groups when it doesn't exist, a false positive.
27
# Significance tests Type II error
the null hypothesis is accepted when it is false - i.e. Failing to spot a difference when one really exists, a false negative.
28
# Significance test What is the power of the study
The power of a study is the probability of (correctly) rejecting the null hypothesis when it is false, i.e. the probability of detecting a statistically significant difference
29
How do we calculate the power of a study
power = 1 - the probability of a type II error power can be increased by increasing the sample size
30
Upgaze palsy Conjugate nystagmus Lid retraction Light near dissociation on exam Which lesion is this in the brain?
Parinaud syndrome Lesion at dorsal midbrain MLF affected which results in upward gaze palsy Can be caused by brain tumours in midbrain or pineal gland MS Midbrain stroke
31
When might you consider pseudohyperkalaemia?
High cell counts in a ptient ie with malignancy * A serum potassium rise that occurs due to leakage from cells during or after blood is taken * Artefact - wont represent true serum K+ conc * Large number of platelets aggregate and degranulate
32
Angina management
First line - GTN prn, BB or CCB (verapamil or diltiazem) Second line - BB + nifedipine MR Third line - increase atenolol to max dose 100mg OD Fourth line - ivabradine, isosorbide mononitrate, nicorandil or ranolazine.
33
Defect in AIP vs PCT
Acute intermittent porphyria - porphobilinogen deaminase PCT - uroporphyrinogen decarboxylase
34
Factor V leiden
Caused by resistance to activated protein C Causing prothrombotic state
35
Turners syndrome vs CAH
Turner syndrome : short + primary amenorrhoea, 45 XO CAH - primary amenorrhoea 46 X,Y with no dysmorphic features
36
Congenital adrenal hyperplasia Describe underlying pathophysiology
Overview * group of autosomal recessive disorders * affect adrenal steroid biosynthesis * in response to resultant low cortisol levels the anterior pituitary secretes high levels of ACTH * ACTH stimulates the production of adrenal androgens that may virilize a female infant
37
# CAH Describe 21-hydroxylase deficiency presentation
virilisation of female genitalia precocious puberty in males 60-70% of patients have a salt-losing crisis at 1-3 wks of age
38
Management of bullous pemphigoid
Management referral to a dermatologist for biopsy and confirmation of diagnosis oral corticosteroids are the mainstay of treatment **topical corticosteroids, immunosuppressants and antibiotics are also used**
39
Pre-requisites of urea breath test
* No PPI for 2 weeks * No antibiotics for 4 weeks
40
Antibiotic management of C. Jejuni infections
Clarithromycin
41
Management of aspergilloma
Surgical resection of lesion
42
What shin lesion is ulcerative colitis more likely to have?
Pyoderma gangrenosum
43
Arthralgia in a man with haemochromatosis - what is the likely dx?
Pseudogout
44
Drug eluting stent in IHD on DAPT - suitable for surgery?
Operations should be delayed unless limb or life threatening as importance of 12 months on DAPT following DES is too high
45
Features suggesting VT rather than SVT with aberrant conduction
AV dissociation fusion or capture beats positive QRS concordance in chest leads marked left axis deviation history of IHD lack of response to adenosine or carotid sinus massage QRS > 160 ms
46
Management of a membranous glomerulonephritis What are characteristic biopsy findings?
Corticosteroids by themselves have not been shown to be effective in membranous glomerulonephritis. **ACE inhibitors have however been shown to reduce proteinuria.** Spike and dome appearance with subpeihtleial electron dense deposits
47
Describe how progressive supranuclear palsy would present
impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs) in an old man with dementia like symptoms and parkinsonism
48
# Genetic inheritance Expressivity vs penetrance
* Expressivity refers to the extent to which a particular genotype is expressed in the phenotype of an individual. Marfan's disease has a very varied expressivity, meaning different people affected by it can be affected very differently. * Penetrance refers to the proportion of the population who have a particular mutation also having the associated disease. An example would be BRCA-1, a mutation of which causes breast cancer in 80% of those affected, giving it a penetrance of 80%.
49
Z score vs T score
The T-score is a measure of the bone mineral density compared to a healthy young adult. The T-score can be used to diagnose osteoporosis (if less than -2.5), or osteopenia (if between -1 and -2.5). The Z-score is a measure of bone mineral density compared to the average of those of the same age, ethnicity, and gender. The Z-score is not used to diagnose osteoporosis, but is still useful in males under the age of 50 or premenopausal women, as a score of less than -2 suggests bone mineral density below the expected range.
50
Medical management for phaeochromocytoma
Surgery is the definitive management. The patient must first however be stabilized with medical management: * alpha-blocker (e.g. phenoxybenzamine), given before a * beta-blocker (e.g. propranolol)
51
Budd chiari syndrome
* Abdo pain and swelling, acute development of ascites + tender hepatomegaly * Underlying malignancy or procoagulant condition * Hepatic vein thrombosis * Ultrasound with doppler flow is very sensitive
52
Organophosphate poisoning
Organophosphates inhibit acetylcholinesterase enzymes, leading to upregulation of cholinergic transmission. As acetylcholine is the principal neurotransmitter for postganglionic neurons in the parasympathetic nervous system, a number of features of organophosphate poisoning represent over-activation of the parasympathetic nervous system (e.g. the excessive urination, defaecation, borderline bradycardia and miosis seen in this patient). In addition to this, the post-ganglionic fibres of sweat glands use cholinergic transmission, explaining the presence of diaphoresis in this patient.
53
Organophosphate poisoning
Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD) Salivation Lacrimation Urination Defecation/diarrhoea cardiovascular: hypotension, bradycardia also: small pupils, muscle fasciculation
54
Alports syndrome - inheritance pattern
X-linked dominant
55
Describe radiological appearance of cystine vs urate+xanthine stones
Renal stones on x-ray cystine stones: semi-opaque- may be seen urate + xanthine stones: radio-lucent - wont be seen
56
Which one of the following drugs cannot be cleared by haemodialysis? Aspirin, TCA, lithium, barbiturates, aminophylline
Tricyclic antidepressants (TCAs) are not effectively removed by haemodialysis due to their large volume of distribution and high protein binding. The volume of distribution is a measure of how well the drug spreads throughout the body, and drugs with a large volume of distribution like TCAs are distributed into various body tissues, rather than remaining in the blood where they could be cleared by dialysis. Also, drugs that have high protein binding, such as TCAs, remain attached to proteins in the blood and thus cannot be filtered out by dialysis.
57
How does ethanol work in treatment of ethylene glycol toxicity? How does fomepizol work?
Ethanol * works by competing with ethylene glycol for the enzyme alcohol dehydrogenase * this limits the formation of toxic metabolites (e.g. glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning Fomepizol -an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
58
# Lung cancers Types and classification
Non small cell: adenoca, large cell, squamous Adenocarcinoma * Non smoker, peripheral lesion Squamous cell lung cancer * Associated with smoking, hyperca, paraneoplastic features Alveolar cell carcinoma * Productive cough, copious sputum Small cell lung cancer * Most aggressive, usually mets at diagnosis, hyponat, central lesion, ACTH, ADH, Lambert eaton
59
Standard deviation in a normally distributed graph - what % of values lie within 1SD, 2SD, 3SD
Properties of the Normal distribution symmetrical i.e. Mean = mode = median 68.3% of values lie within 1 SD of the mean 95.4% of values lie within 2 SD of the mean 99.7% of values lie within 3 SD of the mean this is often reversed, so that within 1.96 SD of the mean lie 95% of the sample values
60
Myeloma Smouldering myeloma MGUS
SMM is the same as MGUS with respect to no CRBA symptoms. The difference is that one or more of the following is present: bone marrow aspirate shows >10% of plasma cell infiltrate, serum monoclonal protein > 30 g or urinary monoclonal protein >500 mg/24 h. MGUS
61
Difference between LA toxicity and adrenaline induced ischaemia
LA toxicity - use lipid emulsion Adrenaline induced ischaemia - phentolamine
62
# Hepatorenal syndrome Type 1 vs Type 2
Type 1: * Rapidly progressive Doubling of serum creatinine to > 221 µmol/L or a halving of the creatinine clearance to less than 20 ml/min over a period of less than 2 weeks Very poor prognosis Type 2 * Slowly progressive Prognosis poor, but patients may live for longer

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