Miscellaneous

Question 1

Gestational diabetes

Diagnostic thresholds for gestational diabetes
these have recently been updated by NICE

Answer 1

gestational diabetes is diagnosed if either:
1. fasting glucose is >= 5.6 mmol/L
2. 2-hour glucose is >= 7.8 mmol/L

Question 2

Management of GDM

Answer 2

f the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered
if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
if glucose targets are still not met insulin should be added to diet/exercise/metformin

Question 3

In gestational diabetes, when should insulin be offered

Answer 3

at first testing, plasma glucose >7

Question 4

Patient with hashimotos thyroiditis has a finding of hypo echoic mass in thyroid - cause?

Answer 4

Hashimoto’s thyroiditis is associated with thyroid lymphoma

Hashimoto’s thyroiditis is characterised by a chronic infiltration of the thyroid gland with B-lymphocytes, which are prone to undergo clonal proliferation. As such, the incidence of thyroid lymphoma is markedly increased amongst patients with Hashimoto’s thyroiditis compared to the general population.

Question 5

Measure: Sensitivity

Answer 5

Formula: TP / (TP + FN)
Plain English: Proportion of patients with the condition who have a positive test result.

Question 6

Measure: Specificity

Answer 6

Formula: TN / (TN + FP)
Plain English: Proportion of patients without the condition who have a negative test result.

Question 7

Measure: Positive Predictive Value

Answer 7

Formula: TP / (TP + FP)
Plain English: The chance that the patient has the condition if the diagnostic test is positive.

Question 8

Measure: Negative Predictive Value

Answer 8

Formula: TN / (TN + FN)
Plain English: The chance that the patient does not have the condition if the diagnostic test is negative.

Question 9

Measure: Likelihood Ratio for a Positive Test Result

Answer 9

Formula: Sensitivity / (1 - Specificity)
Plain English: How much the odds of the disease increase when a test is positive.

Question 10

What is the mechanism behind rapid depolarization in the cardiac action potential?

Answer 10

Rapid sodium influx occurs, and these channels automatically deactivate after a few milliseconds.

Question 11

What characterizes the early repolarization stage in cardiac action potential?

Answer 11

Early repolarization is marked by the efflux of potassium.

Question 12

What defines the plateau phase in the cardiac action potential?

Answer 12

The plateau phase involves a slow influx of calcium.

Question 13

What occurs during the final repolarization stage in cardiac action potential?

Answer 13

Final repolarization is achieved through the efflux of potassium.

Question 14

How is the restoration of ionic concentrations achieved in the cardiac action potential?

Answer 14

The restoration is accomplished by Na+/K+ ATPase, with slow entry of Na+ into the cell decreasing the potential difference until the threshold potential is reached, triggering a new action potential.

Question 15

Drugs causing lung fibrosis
name 5

Answer 15

Drugs causing lung fibrosis
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Question 16

NNT formula
Numbers needed to treat (NNT) is a measure that indicates how many patients would require an intervention to reduce the expected number of outcomes by one

Answer 16

It is calculated by 1/(Absolute risk reduction) and is rounded to the next highest whole number

Question 17

Experimental event rate vs control event rate

How can these be used to calculate absolute risk reduction?

Answer 17

Experimental event rate (EER) = (Number who had particular outcome with the intervention) / (Total number who had the intervention)

Control event rate (CER) = (Number who had a particular outcome with the control/ (Total number who had the control)

The absolute risk reduction (ARR) may be calculated by finding the absolute difference between the control event rate (CER) and the experimental event rate (EER). You will often find both versions of the above listed in different sources. In some ways in doesn’t matter which you use as you will end up with the same answer but from a technical point of view:

Question 18

Heparin

Answer 18

MOA: Activates anti-thrombin III

Question 18

Clopidogrel

Answer 18

Question 19

Abiciximab

Answer 19

Question 20

Dabigatran

Answer 20

Question 21

Rivaroxaban

Answer 21

Question 22

Horner syndrome
What are central lesions that can cause Horners syndrome

Answer 22

Question 23

What are pre-ganglionic lesions that can cause Horners syndrome

Answer 23

Question 24

What are post-ganglionic lesions that can cause Horner syndrome

Answer 24

Question 25

Drugs which are known to cause impaired glucose tolerance include: name 6 classes

Answer 25

Drugs which are known to cause impaired glucose tolerance include: thiazides, furosemide (less common) steroids tacrolimus, ciclosporin interferon-alpha nicotinic acid antipsychotics

Question 26

Multiple Endocrine Neoplasia (MEN) MEN type 1 MEN type IIa MEN type IIb Describe the genetic mutation of each

Answer 26

Question 27

Describe MEN type I

Answer 27

3 P's Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia Pituitary (70%) Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration) Also: adrenal and thyroid Most common presentation = hypercalcaemia

Question 28

Describe MEN type II and MEN type IIb

Answer 28

Question 29

Antithrombotic therapy of prosthetic heart valves Bioprosthetic vs Mechanical

Answer 29

Prosthetic heart valves - antithrombotic therapy: bioprosthetic: aspirin mechanical: warfarin + aspirin

Question 30

Peutz Jeghers syndrome

Answer 30

AD inheritance - LKB1or STK11 Condition characterised by numerous hamartomatous polyps in the gastrointestinal tract can cause SBO Pigmented lesions on lips, oral mucosa, face, palms and sole Increased risk of GI malignancy

Question 31

Odds ratio vs odds

Answer 31

Odds are a ratio of the number of people who incur a particular outcome to the number of people who do not incur the outcome. The odds ratio may be defined as the ratio of the odds of a particular outcome with experimental treatment and that of control. Odds - remember a ratio of the number of people who incur a particular outcome to the number of people who do not incur the outcome

Question 32

Wilsons disease presentation

Answer 32

Autosomal recessive disorder Caused by a defect in the ATP7B gene located on chromosome 13. 10-25 y/o Neurological presentation - chorea Hepatitis Kayser Fleischer rings RTA Haemolysis Blue nails

Question 33

Wilsons disease management

Answer 33

- penicillamine (chelates copper) has been the traditional first-line treatment trientine hydrochloride is an alternative chelating agent which may become first-line treatment in the future - tetrathiomolybdate is a newer agent that is currently under investigation

Question 34

CHA2DS2-VASC score

Answer 34

Question 35

Myoglobinuria + muscle pain and stiffness after exercise

Answer 35

McArdles disease Overview autosomal recessive type V glycogen storage disease caused by myophosphorylase deficiency this causes decreased muscle glycogenolysis Features muscle pain and stiffness following exercise muscle cramps myoglobinuria low lactate levels during exercise

Question 36

Describe Fanconi syndrome

Answer 36

Fanconi syndrome describes a generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule resulting in: type 2 (proximal) renal tubular acidosis polyuria aminoaciduria glycosuria phosphaturia osteomalacia

Question 37

Describe 5 causes of Fanconi syndrome

Answer 37

cystinosis (most common cause in children) Sjogren's syndrome multiple myeloma nephrotic syndrome Wilson's disease

Question 38

What is xanthogranulomatous pyelonephritis

Answer 38

Xanthogranulomatous pyelonephritis is a rare chronic granulomatous disease resulting in a non-functioning kidney. Chronic/subacute infection by organisms such as Proteus mirabilis predispose to renal stones including staghorn calculi. Foamy (lipid laden) macrophages are typically seen.

Question 39

What is p value

Answer 39

P value - is the probability of obtaining a result by chance at least as extreme as the one that was actually observed assuming that the null hypothesis is true

Question 40

Indications for a temporary pacemaker

Answer 40

symptomatic/haemodynamically unstable bradycardia, not responding to atropine post-ANTERIOR MI: type 2 or complete heart block post-INFERIOR MI complete heart block is common and can be managed conservatively if asymptomatic and haemodynamically stable trifascicular block prior to surgery

Question 41

Li Fraumeni syndrome vs Lynch syndrome

Answer 41

Li-Fraumeni syndrome is an autosomal dominant condition caused by germline mutations of the p53 gene, which encodes a transcription factor that normally regulates the cell cycle and acts as a tumour suppressor. particularly early-onset breast cancer, sarcoma, brain tumours (particularly glioblastoma), leukaemia and adrenocortical carcinoma. Lynch syndrome (also known as hereditary non-polyposis colorectal cancer) is an autosomal dominant condition that is associated with colorectal cancer, along with malignancies of the endometrium, ovary, stomach, small intestine, hepatobiliary tract, brain and skin.

Question 42

Wiskott Aldrich syndrome

Answer 42

Wiskott-Aldrich syndrome causes primary immunodeficiency due to a combined B- and T-cell dysfunction. It is inherited in a X-linked recessive fashion and is thought to be caused by mutation in the WASP gene. Features recurrent bacterial infections (e.g. Chest) eczema thrombocytopaenia low IgM levels

Question 43

# Lithium toxicity Name 6 main features

Answer 43

Features of lithium toxicity coarse tremor (a fine tremor is seen in therapeutic levels) hyperreflexia acute confusion polyuria seizure coma

Question 44

Precipitants of lithium toxicity

Answer 44

Toxicity may be precipitated by: dehydration renal failure drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

Question 45

Management of lithium toxicity

Answer 45

Management mild-moderate toxicity may respond to volume resuscitation with normal saline haemodialysis may be needed in severe toxicity

Question 46

# Myasthenia gravis exacerbating factors

Answer 46

The most common exacerbating factor is exertion resulting in fatigability, which is the hallmark feature of myasthenia gravis.. Symptoms become more marked during the day The following drugs may exacerbate myasthenia: penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Question 47

# HLA associations HLA-A3 HLA-B51

Answer 47

HLA-A3 haemochromatosis HLA-B51 Behcet's disease

Question 48

# HLA associations HLA B27 HLA DQ2/DQ8

Answer 48

HLA-B27 ankylosing spondylitis reactive arthritis acute anterior uveitis psoriatic arthritis HLA-DQ2/DQ8 coeliac disease

Question 49

# HLA associations HLA DR2

Answer 49

HLA-DR2 narcolepsy Goodpasture's

Question 50

HLA DR3 HLA DR4

Answer 50

HLA-DR3 dermatitis herpetiformis Sjogren's syndrome primary biliary cirrhosis HLA-DR4 type 1 diabetes mellitus* rheumatoid arthritis - in particular the DRB1 gene (DRB1*04:01 and DRB1*04:04 hence the association with DR4)

Question 51

Pathological findings on blood film Howell joly bodies + siderocytes Basophilic stippling and cabot rings Rouleaux formation Schistocytes Toxic granulation Dohle bodies

Answer 51

Hyposplenism is a feature of coeliac disease. Blood film findings include Howell-Jolly bodies and siderocytes. Basophilic stippling and cabot rings are features of lead poisoning. Rouleaux formation are chronic inflammation and myeloma. Schistocytes are a feature of haemolytic anaemia. Toxic granulation and Döhle bodies are a neutrophil response to infection.

Question 52

Drug-induced thrombocytopenia (probable immune-mediated)

Answer 52

Drug-induced thrombocytopenia (probable immune-mediated) quinine abciximab NSAIDs diuretics: furosemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate heparin

Question 53

Polyarteritis nodosa is associated with c-anca or panca

Answer 53

pANCA 20% positive