Old Medicine stuff Flashcards
(135 cards)
1
Q
Treatment options for moderate/severe obstructive sleep apnoea
A
Weight loss
CPAP - First line
Intra-oral devices (eg mandibular advancement)
2
Q
Test for sleep quality for obstructive sleep apnoea
A
Epworth Sleepiness Scale- questionnaire completed by patient +/- partner
Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)
3
Q
Diseases that require DVLA to be informed
A
OSA that causes daytime sleepness
4
Q
Name all of the stages of Severity of asthma attack & PEF,RR, pulse, sats correlation
A
Moderate - 50-75%, RR<25, HR<110
Acute severe - 33-50%, RR>25, HR >110, sats >=92%
Life threatening - <33%, RR?, HR drops, sats <92%
Near fatal
5
Q
Adult management of asthma
A
SABA
SABA + ICS
SABA + ICS + Leukotriene antagonist (LTRA)
SABA + ICS + LABA +/- LTRA
MART (ICS + LABA) +/- LTRA
6
Q
Paediatric asthma tx
A
SABA (throughout all stages)
Low dose ICS
LTRA
Low dose ICS +/- LABA or LTRA (>= 5y/o)
Low dose ICS + LTRA (<5y/o)
Increasing ICS
(IF no response to LABA, stop it)
Refer to specialist
7
Q
What is the dose for low, moderate or high dose inhaled steroid (for asthma)?
A
definitions of what constitutes a low, moderate or high-dose ICS have also changed. For adults:
<= 400 micrograms budesonide or equivalent = low dose
400 micrograms - 800 micrograms budesonide or equivalent = moderate dose
> 800 micrograms budesonide or equivalent= high dose.
8
Q
Examples of obstructive lung disease (on spirometry)
A
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
9
Q
Examples of restrictive lung disease (on spirometry)
A
Pulmonary fibrosis
ARDS
kyphoscoliosis
Neuromuscular disorders
Severe obesity
Asbestosis
Sarcoidosis
10
Q
What respiratory condition would you give ramipril?
A
Pulmonary HTN (secondary to COPD)
NOT for cor pulmonale
11
Q
What are the yearly/long term management of COPD?
A
Annual influenza vaccination
One off pneumococcal vaccination
Pulmonary rehab (MRC grade 3 or above)
Smoking cessation
12
Q
Patients with COPD, what features would you check to see if they have asthmatic/steroid responsiveness?
A
Previous diagnosis of asthma or atopy
Higher eosinophilic count
Substantial variation of FEV1 over time (at least 400ml)
Substantial diurnal variation of PEFR (at least 20%)
13
Q
How to treat COPD?
A
https://www.google.com/search?client=ms-android-google&sxsrf=AB5stBi-Y5Qno5x8KCJ0FbZnXbL4Pvr_Vg:1690138544777&q=nice+guidelines+copd&tbm=isch&sa=X&ved=2ahUKEwihl9TcwKWAAxVaUEEAHZ6ZCZIQ0pQJegQICBAB&biw=393&bih=708&dpr=2.75#imgrc=pJAtn0GDIqPrLM
14
Q
What is the prophylactic antibiotics therapy for COPD patient (who doesn’t smoke and have optimised standard treatments and still getting exacerbations)?
A
Azithromycin
Need to exclude bronchiectasis (CT chest), atypical infection/TB (solution sputum culture), prolonged QT (LFTs and ECG)
15
Q
Treatment for cor pulmonale
A
Loop diuretic
NOT ace-i, CCB, alpha blockers
16
Q
Improve survival of COPD
A
Smoking cessation
LTOT
Lung volume reduction surgery on selected patients
17
Q
What is acute bronchitis?
What is the cause?
How to treat?
A
Lower resp tract infection causing inflammation of bronchial airways.
Due to virus: rhino, entero, influenza, parainfluenza, Corona, RSV, adeno, human metapneumovirus. Not common to have bacteria.
Only treat if high risk of complications (due to comorbidities) or systemically unwell or CRP>100 (immediate tx) or 20-100 (delayed prescription)
18y/o or older: Doxycycline first line. If not, amoxicillin, clarothromycin or erythromycin.
12-18y/o: amoxicillin first line. If not, clarothromycin, erythromycin, Doxycycline.
Don’t offer saba/LABA/ICS or mucolytic.
18
Q
Causes of bronchiectasis
Tx that is most important long term control of symptoms.
A
H. Influenza
P. Aeruginosa
Klebsiella
S. Pneumonia
Inspiratory muscle training and postural drainage
19
Q
How to categorise COPD based on spirometry (FEV1) results?
A
Stage 1(mild) >80%
Stage 2 (moderate) 50-79%
Stage 3 (severe) 30-49%
Stage 4 (very severe) <30%
20
Q
Treatment of CAP
A
Low severity : amoxicillin
Moderate/high severity: dual abx (amoxicillin and macrolide) for 7/7.
High severity : stable penicillin like co-amox, ceftriaxone or piperacillin with tazobactam + macrolide
Repeat cxr in 6 weeks
21
Q
Bacteria causing cavitating pneumonia
A
Klebsiella pneumonia (Gram negative rod) affects upper lobes for diabetics or alcoholics
Staph aureus - common in patients with underlying chronic and/or debilitating disease.
22
Q
Features of legionnaire’s disease
A
Hyponatremia
Bilateral lung changes
Hepatitis
Myalgia
23
Q
Features of mycoplasma pneumoniae (atypical) cause of pneumonia
A
Haemolytic anaemia
Erythema multiforme
24
Q
Correlation of Venturi masks (&colour) to oxygen flow from wall
A
Blue - 24% - 2l/min
White - 28% - 4l/min
Orange - 31% - 6l/min
Yellow - 35% - 8l/min
Red - 40% - 10l/min
Green - 60% - 15l/min
25
What are pleural plaques?
Benign asbestos related drug disease
It indicates that patient has been exposed to asbestos in the past. This could mean higher risk of mesothelioma (BUT due to ongoing exposure to asbestos rather than malignant degeneration).
They are not premalignant.
26
Asbestosis Vs mesothelioma
Asbestosis - lower lobe fibrosis. Severity is related to length of exposure. Features: clubbing, SOB, bilateral end inspiratory crackles, restrictive lung disease and reduced gas transfer
Mesothelioma - malignant pleura. Crocidolite blue asbestos is most dangerous form. Features: progressive SOB, chest pain, pleural effusion. Tx : palliative chemo. Poor prognosis 8-14months.
27
What is catamenial pneumothorax?
Pneumothorax that occurs in association with mensuration. Secondary to thoracic endometriosis.
28
Light's criteria
Exudate : protein >30g/L
Transudate : protein <30g/l
If protein level is between 25-35g/l. Exudate is likely if at least one of the criteria are met:
- pleural fluid protein / serum protein >0.5
- pleural fluid LDH / serum LDH >0.6
- pleural fluid LDH >2/3 the upper limits of normal serum LDH
29
Treatment of pneumothorax.
- primary Vs secondary
- rim of air space
Primary
- <2cm & not SOB, discharge
- <2cm & SOB, aspirate
- >2cm +/- sob - aspirate
- if aspirate fail, chest drain
Secondary (>50y/o, significant smoking history, evidence of underlying lung disease on examination or cxr)
- >2cm +/- SOB -> chest drain
- 1-2cm & SOB -> chest drain
- 1-2cm & not SOB -> aspirate.
---->If fails (still >1cm) chest drain. All patients must be admitted at least 24 hours.
----> <1cm, give oxygen & admit.
30
Treatment of idiopathic pulmonary fibrosis.
Pulmonary rehab
Supportive care
Nintedanib : if FVC is between 50-80%
Pirfenidone : same as above
Lung transplant
Mechanical ventilation
31
Risk factor that increases risk of lung cancer THE MOST!
Smoking (10x)
Asbestos (5x)
Others: arsenic, radon, nickel, chromate, aromatic hydrocarbon, cryptogenic fibrosing alveolotis
Not related: coal dust
32
Common organisms for infective exac of COPD
Haemophilus influenza - MOST COMMON
Strep pneumonia
Moraxella catarrhalis
Respiratory viruses (30%)
33
Anterior mediastinum mass - 4Ts
Thymoma
Teratoma
Terrible lymphadenopathy
Thyroid mass
34
Typical bacteria for lung abscess
Staph aureus
Klebsiella pneumonia
Pseudomonad aeruginosa
35
Alpha 1 antitrypsin phenotype
M for normal, S for slow, Z for very slow
Normal : PiMM
heterozygous: PiMZ
Homozygous PiSS (50% A1AT levels)
Homozygous PiZZ (10% normal A1AT levels) - disease
36
Causes of bilateral hilar lymphadenopathy
Sarcoidosis
TB
Lymphoma/other malignancy
Pneumoconiosis (eg berrylliosis)
Fungi (eg histoplasmosis, coccidioidomycosis)
37
Indications for Bipap for COPD patient
pH 7.25-7.35
Type 2 resp failure secondary to chest wall deformity, neuromuscular disease or OSA
cardiogenic pulmonary oedema unresponsive to CPAP
38
Berylliosis - common cause?
Beryllium dust
Workers of electronics, metal extraction industries, aerospace, nuclear, telecommunications, semi-conductor industries
39
Tumour markers.
Monoclonal antibodies for:
Ovarian cancer
Pancreatic cancer
Breast cancer
Tumour antigen for:
Prostate ca
Hepatocellular cancer, teratoma
Colorectal cancer
Melanoma, schwannoma
Small cell lung ca, gastric ca, neuroblastoma
CA125
CA19-9
ÇÀ15-3
PSA
AFP
CEA
S-100
Bombesin
40
Common side effects of chemo drugs
Toxicity bear!
41
Thyroid cancers - which type cause increased calcitonin levels?
Medullary (as it derives from parafollicular cells)
42
What is the MMSE score for dementia?
Less than 24/30
43
What are the cognitive assessment tools that can be used for GP/non-specialist setting?
10-CS, 6CIT
10 point cognitive screen, 6 item cognitive impairment test
NOT Recommended by NICE (for non specialist setting): AMT, GPCOG, MMSE
44
What is the pathological finding found in lewy body dementia?
Lewy body - alpha-synuclein cytoplasmic inclusions
45
Difference in presentation between dementia with lewy body & Parkinson's disease
PD - the triad occur BEFORE the general
DLB - the opposite occur. Can also have REM-sleeping disorder.
46
Treatment of acute stroke (with target time)
Thombolysis (within 4.5 hours)
Aspirin needs to be given rectally once haemorrhagic stroke has been excluded.
Thrombectomy (within 6 hours of symptom onset) & thrombolysis (within 4.5) for acute ischemic stroke AND confirmed proximal anterior cirulation occlusion on MRA/CTA.
Thrombectomy (been 6-24 hours) (including wake up strokes) for:
- finding proximal anterior circulation occlusion from MRA/CTA
- if there is potential for salvage brain tissue as per CT-Perfusion/diffusion weighted MRI sequences showing limited intact core volume.
CONSIDER thrombectomy & IV thrombolysis (within 4.5 hours) for people last known you be well up to 24 hours perviously (& wake up strokes:,:
- acute ischaemic stroke & confirmed proximal posterior occluding as per MRA/CTA
- if there is potential to salvage brain tissue
Clopidogrel is used for secondary prevention of stroke. (Other options: aspirin or dipyridamole)
Carotid endarterectomy recommended of patients suffered stroke or tia in carotid territory and she not severely disabled. Should be used if carotid stenosis >70% (ECST criteria) or >50% (NASCET criteria)
47
Cluster headache - treatment options
Acute tx: sumatriptan
Prophylaxis: verapamil
48
Tx of trigeminal neuralgia
Carbamezepine
49
Brain lobes corresponding to Broca area and Wernicke area.
Broca - frontal
Wernicke- temporal
50
What gyrus and cerebral artery affects wenicke area and Broca area?
Wernicke- - superior temporal gyrus, inferior division of left MCA
Broca - inferior frontal gyrus, superior division of left MCA
51
Causes of Dupuytren's contracture
Manual labour
Phenytoin
Alcoholic liver disease
Diabetes mellitus
Trauma
52
Location of bursa for
-housemaid knee
-clergyman knee
Housemaid - prepatellar
Clergyman - infrapatellar
53
What is the classification system for hip fracture?
Garden system
54
What is the difference between intracapsular and extracapsular fracture?
Intra: from edge of femoral head to insertion of capsule of the hip joint
Extra: either trochanteric or subtrochanteric (the lesser trochanter is the dividing line)
55
Tx of intracapsular hip fracture
Undisplaced - internal fixation or hemi (if unfit)
Displaced- arthroplastic (either total or hemi).
Total is favoured if: patient can walk independently with no more than a stick, no cognitive impairment, medically fit for anaesthesia and procedure.
56
Tx for extracapsular hop fracture
Stable intertrochanteric fracture: DHS
if reverse oblique/transverse/subtrochanteric fracture: intramedullary device
57
Main sign present for adhesive capsulitis
Impaired external rotation of shoulder (both active and passive movement)
58
Another name for adhesive capsulitis
Frozen shoulder
59
What is the Finkelstein test?
If positive, what does it mean?
Pain over the radial styloid on forced abduction/flexion of the thumb
Tenosynovitis (de quervain's)
60
which antibiotic increase risk of Achilles tendon rupture?
ciprofloxacin (quinolone)
61
MRI finding of sciatica (to show cause)
Tx of this
Prolapse disc causing compression of nerve root.
Nsaids & physiotherapy.
If not improved in 4-6weeks, refer to orthopaedic
62
Golfer elbow Vs tennis elbow
Golfer: medial epicondylitis
Tennis: lateral epicondylitis
63
Bacterial cause of osteomyelitis
Staph aureus
If sickle patients, salmonella (non typhoid type)
64
What is the frax tool?
estimates the 10-year risk of fragility fracture
valid for patients aged 40-90 years
based on international data so use not limited to UK patients
assesses the following factors: age, sex, weight, height, previous fracture, parental fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol intake
bone mineral density (BMD) is optional, but clearly improves the accuracy of the results. NICE recommend arranging a DEXA scan if FRAX (without BMD) shows an intermediate result
65
When would you use dexa scan instead of clinical fragility tool?
before starting treatments that may have a rapid adverse effect on bone density (for example, sex hormone deprivation for treatment for breast or prostate cancer).
in people aged under 40 years who have a major risk factor, such as history of multiple fragility fracture, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer).
66
When would you recalculate the fracture risk?
if the original calculated risk was in the region of the intervention threshold for a proposed treatment and only after a minimum of 2 years, or
when there has been a change in the person's risk factors
67
How long does perforated eardrum heal?
6-8 weeks
68
What is samter's triad?
Asthma, aspirin sensitivity, nasal polyp
69
Give 2 normal/physiological causes of haematuria
Strenuous exercise(around 3days)
Sex
Menstruation
Beetroot
70
eGFR variables for calculation
CAGE - Creatinine, Age, Gender, Ethnicity
71
Metabolic acidosis
- causes for normal anion gap/hyperchloraemic
- causes for raided gap
Normal anion gap: GI bicarb loss (diarrhoea)
72
Patients with CKD are advised to have what type of diet?
Low phosphate
Low sodium
Low potassium
Low protein
73
Drugs causes of gout
Drug causes
diuretics: thiazides, furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin: it was previously thought that only high-dose aspirin could precipitate gout. However, a systematic review (see link) showed that low-dose (e.g. 75mg) also increases the risk of gout attacks. This obviously needs to be balanced against the cardiovascular benefits of aspirin and the study showed patients coprescribed allopurinol were not at an increased risk
74
pneumothorax and hypermobility & upward lens dislocation. Aortic root dilatation. diagnosis?
Marfan's
Beta blocker may slow down dilatation of aortic root
75
Tx for polymyalgia rheumatica.
Tx for psoriasis.
Polymyalgia: Pred
Psoriasis: Sulphasalazine
76
other markers of bone turnover are...?
procollagen type I N-terminal propeptide (PINP)
serum C-telopeptide (CTx)
urinary N-telopeptide (NTx)
urinary hydroxyproline
77
antibodies checked in anti-phsopholipid syndrome
anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
lupus anticoagulant
78
treatment for osteoarthritis causing pain at hands
Paracetamol
Topical NSAIDs
79
treatment of gout
1. NSAIDs with PPI (not aspirin)/Colchicine
2. Urate Lowering Drugs - allopurinol/febuxostat
3. Urate oxidase - uricase (catalyzes the conversion of urate to the degradation product allantoin.)
4. Polyethylene glycol modified mammalian uricase - pegloticase (used for patients who have persistent symptomatic and severe gout despite the adequate use of urate-lowering therapy)
80
6 'A's for ankylosing spondylitis
Amyloidosis
Anterior uveitis
AV nodal block
Aortic regurgitation
Apical fibrosis
Achilles tendonitis
Peripheral arthritis (25% and more common in females)
Cauda equina syndrome
81
treatment for psoriatic arthritis
mild peripheral arthritis/mild axial disease may be treated with 'just' an NSAID, rather than all patients being on disease-modifying therapy as with RA
if more moderate/severe disease then methotrexate is typically used as in RA
use of monoclonal antibodies such as ustekinumab (targets both IL-12 and IL-23) and secukinumab (targets IL-17)
apremilast: phosphodiesterase type-4 (PDE4) inhibitor → suppression of pro-inflammatory mediator synthesis and promotion of anti-inflammatory mediators
has a better prognosis than RA
82
Difference in presentation/symptoms/signs between radial tunnel syndrome and lateral epicondylitis
Radial tunnel
- pain is typically distal to the epicondyle
- pain worse on elbow extension/forearm pronation
Lateral epicondylitis
- pain over the common extensor origin
- pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
83
Treatment for RA
1 DMARD (with steroid as bridging)
(option of DMARD: 1st line methotrexate OR sulfasalazine. 2nd line: azathioprine, cyclophosphamide, ciclosporin. Not sure about leflunomide, hydroxychloroquine)
TNF-inhibitors (etanercept, infliximab, adalinumab)
Rituximab
Abatacept (fusion protein that modulates a key signal required for activation of T lymphocytes -> leads to decreased T-cell proliferation and cytokine production)
84
treatment of Raynaud's disease
Non-drugs: staying warm, stopping smoking, wearing gloves and avoiding the cold.
Drugs: dihydropyridine calcium channel blocker such as nifedipine.
IV prostacyclin (epoprostenol) infusions:
85
In pregnancy, you can find these 2 diseases but what are the differences in presentation for: pubic symphysis dysfunction and transient idiopathic osteoporosis?
Pubic symphysis dysfunction
- Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs.
- A waddling gait may be seen
Transient idiopathic osteoporosis
- Groin pain associated with a limited range of movement in the hip
- Patients may be unable to weight bear
- ESR elevated
86
treatment for SLE
hydroxychloroquine (continue all the time)
Mild SLE: oral/IM glucocorticosteroids
Moderate SLE: IV glucocorticosteroids + immunosuppresants (eg calcineurin inhibitors and mycophenolate). If not responding -> biological agents such as belimumab.
Severe SLE: as mentioned above. Also consider cyclophosphamide or rituximab.
87
Early X-ray findings of RA
loss of joint space
juxta-articular osteoporosis
soft tissue swelling
88
Late X-ray findings of RA
periarticular erosions
subluxations
89
What are the 4 types of systemic sclerosis?
Pre-scleroderma
Limited cutaneous (ie CREST)
Diffuse cutaneous
Scleroderma (no internal organ involvement)
90
Give a subtype of limited cutaneous systemic sclerosis?
CREST
91
Antibodies for
- diffuse cutaneous systemic sclerosis
- limited cutaneous systemic scleorosis
- systemic scleroderma
Diffuse: Anti-Scl 70 antibodies
Limited: Anti-centromere antibodies, Anti-nuclear antibodies
Systemic Scleroderma: anti-topoisomerase antibodies such as anti-Scl70
92
Complications of diffuse cutaneous systemic sclerosis
Lung (interstitial lung disease, pulmonary arterial HTN)
Renal disease
HTN
93
Examples of seronegative arthritis
Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis
Reactive arthritis
94
antibodies for dermatomyositis
ANA
around 30% of patients have antibodies to aminoacyl-tRNA synthetases (anti-synthetase antibodies), including: antibodies against histidine-tRNA ligase (also called Jo-1), antibodies to signal recognition particle (SRP), anti-Mi-2 antibodies
95
There are 2 types of primary osteoporosis - what are they?
Type 1 (post-menopausal)
Type 2 (age-related)
96
What are the causes of secondary osteoporosis?
Hyperthyroidism
Hyperparathyroidism
Alcohol abuse
Immobilisation
97
Treatment of osteoporosis
Oral bisphosphonates (reserved for those with a 10-year probability of osteoporotic fragility fracture > 1%, or : A hip or vertebral fracture OR T-score <2.5 or less at the femoral neck ORT-score between -1.0 and -2.5 and a 10-year probability of a hip fracture >3% using FRAX).
Oral Alendronate (first line) and if not tolerated well, risedronate are given as 1-weekly doses, or etidronate or zoledronic acid as a 1-yearly infusion. Don't use bisphosphonates with eGFR <35 mL/minute/1.73m(2).
THINK ABOUT THE T-SCORES for these:
Strontium ranelate
Raloxifene
Denosumab (monoclonal antibody)
98
What are the high risk criteria when assessing for fracture risk? (And therefore, will be advised for lifelong bisphosphonates until the criteria no longer apply)
Age >75
Glucocorticoid therapy
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score <-2.5 after treatment
99
Food containing high purines (increase risk of gout)
Sardines
Mackerel
Other oily fish
Liver
Kidneys
Yeast products
Seafood
100
Risk factors of osteoporosis
history of glucocorticoid use
history of parental hip fracture
premature menopause
endocrine disorders: hyperthyroidism, hypogonadism (e.g. Turner's, testosterone deficiency), growth hormone deficiency, hyperparathyroidism, diabetes mellitus
multiple myeloma, lymphoma
gastrointestinal disorders: inflammatory bowel disease, malabsorption (e.g. coeliac's), gastrectomy, liver disease
chronic kidney disease
osteogenesis imperfecta, homocystinuria, rheumatoid arthritis
current smoking
alcohol excess
low body mass index
sedentary lifestyle
Caucasians and Asians
101
Give examples of drugs that can cause drug-induced lupus.
Most common:
Hydralazine
Procainamide
Less common:
Isoniazid
Minocycline
Phenytoin
102
Antibodies for drug-induced lupus
ANA positive in 100%
dsDNA negative
anti-histone antibodies are found in 80-90%
anti-Ro and anti-Smith positive in 5%
103
What is femeroacetabular impingement syndrome?
one of the most common causes of persistent hip pain in active young adults.
commonly presents with hip/groin pain worse on prolonged sitting and associated with snapping, clicking or locking of the hip.
There is an association between FAI and prior hip pathology eg Perthes in childhood. It is caused by a variant in hip anatomy leading to abnormal contact between the femur and acetabulum rim. Over time this can lead to soft tissue damage including labral tears.
104
Treatment of ankylosing spondylitis
Exercise + NSAIDS
Physiotherapy
DMARDS (eg sulfasalazine)
the 2010 EULAR guidelines suggest: 'Anti-TNF therapy should be given to patients with persistently high disease activity despite conventional treatments'
research is ongoing to see whether anti-TNF therapies such as etanercep and adalimumab should be used earlier in the course of the disease
105
X-ray changes of osteoarthritis
X-ray changes of osteoarthritis (LOSS)
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts
106
treatment for Sjogren syndrome
artificial tears and saliva
pilocarpine to stimulate saliva production
107
anti-RNP antibodies seen in what disease?
mixed connective tissue disease (MCTD)
108
anti-smooth muscle antibody is seen in what disease?
autoimmune hepatitis
109
anti-centromere antibody is seen in what disease?
limited cutaneous systemic sclerosis (CREST)
110
antibodies for Sjogren's syndrome
anti-Ro (SSA) (70%)
anti-La (SSB) (30%)
111
which antibiotic should not be prescribed with methotrexate?
Co-trimoxazole & Trimethoprim
(this is classically used for P.jirovecii pneumonia but can be used for HAP). It contains trimethoprim that inhibits dihydrofolate reductase that can cause myelosuppression!
Aspirin
It reduces excretion of methotrexate - therefore, increase toxicity.
112
What is presenting complaint of 'greater trochanteric pain' (aka trochanteric bursitis)?
pain and tenderness over the lateral side of thigh
due to repeated movement of the fibroelastic iliotibial band
most common women age 50-70years old
113
Normal calcium and phosphate level
Raised ALP
?diagnosis
Paget's disease
(there is increased turnover of bone - ie osteoclast and osteoblasts - but kidneys working hard to remove calcium)
114
Low calcium and phosphate.
Raised ALP and PTH.
?diagnosis
Osteomalacia
(question can be made easy with low vit D in qs stem)
115
what are the 6 types of Gell and Coobs classification of hypersensitivity reactions?
1: Anaphylactic (IgE)
2: Cell Bound (IgG or IgM binds to antigen on cell surface) Eg Goodpasture's, ITP, autoimmune haemolytic anaemia, rheumatic fever, pernicious anaemia, acute haemolytic transfusion reactions, bullous pemphigoid.
3: Immune-complex (free antigen and antibody combine). Eg SLE, post-strep GN, extrinsic allergic alveolitis
4: Delayed hypersensitivity (T-cell mediated) Eg TB, graft vs host disease, allergic contact dermatitis, scabies, tuberculin test
5: Antibodies that recognise and bind to cell surface receptors (IgG) Eg Myasthenia gravis, Grave's disease, neonatal hyperthyroidism
6: killer cells (lyse target cells that have been coated by antibody). Eg tumour rejection, defence against parasites
116
what is the presenting complaint of drug-induced lupus
arthralgia
myalgia
skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%
117
Prolonged APTT
Low platelet
?diagnosis
Anti-phospholipid syndrome
118
treatment of anti-phospholipid syndrome
primary thromboprophylaxis
aspiring (low dose)
secondary thromboprophylaxis
-warfarin (INR 2-3) initially
- if recurrent, INR 3-4
- arterial thrombosis: INR 2-3
119
When giving alendronic acid, what blood test should you check for before starting this tx?
Vitamin D and calcium levels
(as it can cause hypocalcaemia due to underlying vitamin D or calcium deficiency)
120
What is the minimum age of patient on long-term steroid that must be prescribed bisphosphonate?
65
(if less than 65, then DEXA scan will be done and if T-score less than -1.5, then offer bone protection, 0- -1.5, repeat in 1-3 years).
121
How much steroid must be taken to be labelled as 'long-term steroid causing side effect such as osteoporosis'?
75mg a day for >= 3 months
122
How long must the fatigue last for before making a diagnosis of chronic fatigue syndrome?
3 months
123
difference in location between
Heberden & Bouchard nodes
Heberden: distal IP joint
Bouchard: proximal IP joint
124
Marfan Vs ehlers danlos
Marfan : upward lens dislocation, aortic dilatation, spontaneous pneumothorax
ED: fragile blood vessels, recurrent spontaneous haemorrhages, mitral valve prolapse, hyperplastic skin, aneurysm
125
BRCA 1 positive can be seen in what type of cancers?
Breast
Ovarian
Prostate
Pancreatic
Colorectal
BRCA1 is tumour suppressor gene at chromosome 17
126
BRCA2 positive is found in which type of cancer?
Breast
Ovarian
Prostate
Fanconi anaemia
127
Downward dislocation of lens & marfanoid symptoms
Homocystinuria
128
Management of aortic aneurysm
screening for men >65yo
If <3cm -> discharged
3-4.4cm -> yearly surveillance
4.5-5.4cm -> USS 3 monthly
>5.5cm -> vascular surgeon for consideration of repair
129
Gaucher's disease - what is it?
deposition of glucocerebroside in cells of macrophage-monocyte system. deficient in enzyme glucocerebrosidase
130
test for latex-specific wheals/reaction
RAST test (radioallergosorbent test) to look for IgE.
Skin patch is used to test for delayed type 4 hypersensitivity to latex - therefore, not used as first line
Skin prick is not used as can cause anaphylaxis
131
Lymph nodes draining rectal cancer
- superior to pectinate line
- inferior to pectinate line
- Internal iliac
- Inguinal (superficial)
132
Autosomal dominant disease
achonndroplasia
polycystic kidney disease
ehler's danlos
familial adenomatous polyposis
hereditary spherocytosis
huntington's disease
malignant hyperthermia
marfan syndromes
myotonic dystrophy
neurofibromatosis
myotonic dystrophy
noonan syndrome
osteogenesis imperfecta
retinoblastoma
peutz-jeghers syndrome
retinoblastoma
tuberous sclerosis
von hippel lindau syndrome
von willebrand disease
133
autosomal recesssive examples
albinism
ataxia telangiectasia
cystic fibrosis
congenital adrenal hyperplasia
cystinuria
friederich;s ataxia
gilbert syndrom
glycogen storage disease
haemochromatosis
homocysinurua
PHU
sickle cell disease
thalassemia
wilson's disease
134
X-linked recessive diseases
androgen insensitivity syndrome
becker's muscular dystrophy
colour blindness
duchenne muscular dystrophy
fabry's disease
G6PD deficiency
haemophilia A & B
nephrogenic diabetes insipidus
retinitis pigmentosa
wiskott aldrich syndrome
135
X-linked recessive disease
