PASSMED 4 Flashcards
(107 cards)
1
Q
what is loefflers endocarditis?
A
a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis.
2
Q
classic causes of restrictive cardiomyopathy?
A
amyoloidos
post-radiotherapy
loefflers endocarditis
3
Q
does paracetamol give a hepatic or cholestastic liver disease picture?
A
hepatic
4
Q
does COCP give a hepatic or cholestastic liver disease picture?
A
cholestatic
5
Q
does sodium valproate give a hepatic or cholestastic liver disease picture?
A
hepatic
6
Q
does phenytoin give a hepatic or cholestastic liver disease picture?
A
hepatic
7
Q
do antibiotics such as flucloxacillin/co-amox give a hepatic or cholestastic liver disease picture?
A
cholestatic
8
Q
do MAOIs give a hepatic or cholestastic liver disease picture?
A
hepatic
9
Q
do sulphonylureas give a hepatic or cholestastic liver disease picture?
A
cholestatic
10
Q
do statins give a hepatic or cholestastic liver disease picture?
A
hepatic
11
Q
does anti-TB drugs give a hepatic or cholestastic liver disease picture?
A
hepatic
12
Q
do anabolic steroids give a hepatic or cholestastic liver disease picture?
A
cholestatic
13
Q
does amiodarone give a hepatic or cholestastic liver disease picture?
A
hepatic
14
Q
does methyldopa give a hepatic or cholestastic liver disease picture?
A
hepatic
15
Q
do phenothiazines e.g. chlorpromazine give a hepatic or cholestastic liver disease picture?
A
cholestatic
16
Q
does nitrofurantoin give a hepatic or cholestastic liver disease picture?
A
hepatic
17
Q
do fibrates give a hepatic or cholestastic liver disease picture?
A
cholestatic
18
Q
which groups of patients are at increased risk of developing hepatotoxicity following paracetamol OD?
A
patients taking liver enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St John’s Wort)
malnourished patients (e.g. anorexia nervosa) or patients who have not eaten for a few days
19
Q
what scoring tool is used to determine if a pt with paracetamol liver failure requires a liver transplantation?
A
kings college hospital criteria for liver transplantation
arterial ph <7.3 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
20
Q
LFT results in ischaemic hepatitis?
A
ALT is >1000 or 50x the upper limit of normal
21
Q
AST:ALT in acute alcoolic hepatitis?
A
> 2:1
22
Q
ALP rise with normal GGT indicates….?
A
bone disease
if GGT rise too then cholestasis is more likely
23
Q
antibodies in autoimmune hepatitis type 1? what age does it affect?
A
ANA
anti-SMA
adults & children
24
Q
antibodies in autoimmune hepatitis type 2? what age does it affect?
A
anti-liver/kidney microsomal type 1 antibodies (LKM1)
children
25
antibodies in autoimmune hepatitis type 3? what age does it affect?
soluble liver-kidney antigen
middle-aged adults
26
diagnostic investigation for PSC?
ERCP or MRCP showing multiple biliary strictures giving a beaded appearance
27
how can carcinoid syndrome affect the heart?
it can affect the right side
tricuspid insuffcnecy and pulmonary stenosis
28
which Parkinson's drugs provide the most improvement in motor symptoms?
levodopa
29
which Parkinson's drugs provide the most improvement in ADLs?
levodopa
30
which Parkinson's drugs causes the most motor compilations?
levodopa
31
which Parkinson's drugs causes more adverse events?
dopamine agonists and COMTi
32
what are the main adverse effects of dopamine agonists?
excessive sleepiness
hallucinations
impulse control disorders
nasal congestion and postural hypotension are sometimes seen
33
inducer or inhibitor of the P450 system: AEDs?
inducer
34
inducer or inhibitor of the P450 system: barbiturates?
inducer
35
inducer or inhibitor of the P450 system: ciprofloxacin ?
inhibitor
36
inducer or inhibitor of the P450 system: rifampicin ?
inducer
37
inducer or inhibitor of the P450 system: erythromycin?
inhibitor
38
inducer or inhibitor of the P450 system: st johns wort?
inducer
39
inducer or inhibitor of the P450 system: isioniazid?
inhibitor
40
inducer or inhibitor of the P450 system: amiodarone?
inhibitor
41
inducer or inhibitor of the P450 system: allopurinol?
inhibitor
42
inducer or inhibitor of the P450 system: SSRIs?
inhibitor
43
inducer or inhibitor of the P450 system: chronic alcohol intake?
inducer
44
inducer or inhibitor of the P450 system: amiodarone?
inhibitor
45
inducer or inhibitor of the P450 system: griseofulvin?
inducer
46
inducer or inhibitor of the P450 system: smoking?
inducer
47
inducer or inhibitor of the P450 system: allopurinol?
inhibitor
48
inducer or inhibitor of the P450 system: imidazole e.g. ketoconazole?
inhibitor
49
inducer or inhibitor of the P450 system: acute alcohol intake?
inhibitor
50
inducer or inhibitor of the P450 system: sodium valproate?
inhibitor
51
inducer or inhibitor of the P450 system: steroids?
inducers
52
inducer or inhibitor of the P450 system: grapefruit?
inhibitor
53
features of thyroid storm
fever > 38.5ºC
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
abnormal liver function test - jaundice may be seen clinically
54
precipitating events of thyroid storm?
thyroid or non-thyroidal surgery
trauma
infection
acute iodine load e.g. CT contrast media
55
features of giardiasis?
prolonged non-bloody diarrhoea
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur
56
features of campylobacter?
A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
57
most common cause of primary hyperparathyroidism/
solitary parathyroid adenoma
58
blood results for Ca, phos and PTH in primary hyperparathyroidism?
raised Ca2+
low phos
low or normal vit D
PTH raised or inappropriately normal
59
blood results for Ca, phos, vit D and PTH in secondary hyperparathyroidism?
Ca normal or low
Phos raised
vit D low
PTH raised
60
blood results for Ca, phos, vit D and PTH in tertiary hyperparathyroidism?
Ca normal or high
phos low or normal
vit D normal or low
PTH raised
61
urine osmolality, serum osmolality and urine sodium conc in SIADH?
urine osmolality high
serum osmolality low
urine sodium high
62
causes of nephrogenic DI?
genetic
hypercalcaemia
hypokalaemia
lithium
demeclocyline
tubful-interstitial disease e.g. sickle cell or pyelonephritis
63
urine osmolality, serum osmolality and water deprivation test results in nephrogenic diabetes insipidus?
high plasma osmolality
low urine osmolality
after water deprivation urine osmolality is still low <300
64
urine osmolality, serum osmolality and water deprivation test results in cranial diabetes insipidus?
high plasma osmolality
low urine osmolality
after water deprivation urine osmolality increases >600
65
urine osmolality, serum osmolality and water deprivation test results in psychogenic diabetes insipidus?
low plasma osmolality
high urine osmolality
after water deprivation urine osmolality is still high and no change really occurs
66
mm for ST elevation in leads V2-3?
men:
if under 40 - >=2.5mm
if over 40 - >=2.0
women:
1.5mm
67
mm for ST elevation in all leads except for V2-3?
>=1.0mm
68
cause of a scrotal swelling that you cannot get above on examination?
inguinal herna
69
scrotal swolling cause that you can get above and lies above and behind the testicle?
epididymal cyst
70
MOA of digoxin?
increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump
decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
also stimulates the vagus nerve
71
features of digoxin toxicity?
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
72
examples of class 1 antiarrhythmic drugs? MOA?
quinidine
procainamide
disopyramide
inhibit sodium channels
73
examples of class 2 antiarrhythmic drugs? MOA?
propanolol and bisoprolol
act on AV node to reduce conduction and have variable selective action on beta-1 and -2 receptors
74
examples of class 3 antiarrhythmic drugs? MOA?
amiodarone and sotalol
block K+ channels to extend the refractory period and prolong the cardiac action potential
75
examples of class 4 antiarrhythmic drugs? MOA?
verapamil and diltiazem
non-dihydropyridine CCB which block L-type Ca2+ channels and cause spontaneous depolarisation
negative inotropes and chronotropes
76
MOA of adenosine?
Agonism of adenosine receptors A1 and A2 = induces K+ efflux and inhibiting Ca2+ influx through channels in nerve cells =hyperpolarization = reduces conduction time in AVN
77
ECG features of digoxin?
down-sloping ST depression ('reverse tick', 'scooped out')
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia
78
features of organophosphate insecticide poisoning?
SLUD:
Salivation
Lacrimation
Urination increased
Diarroea and diaphoresis
hypotension, bardcardia, miosis and muscle fasciculations
79
blood film findings in G6PD deficiency?
Heinz bodies
bite cells
blister cells
80
what drugs can cause haemolysis in G6PD deficiency?
anti-malarials: primaquine
ciprofloxacin
sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas
81
inheritance pattern of G6PD deficiency?
x-linked recessive
82
typical ethnicity of G6P deficiency?
african
mediterranean
83
inheritance pattern of hereditary spherocytosis?
AD
84
typical ethnicity of hereditary sperocytosis?
northern european
85
in BV there is an overgrowth of....
Grdnerella vaginalis (this leads to a fall in lactic acid producing aerobic lactobacilli resulting in raised vaginal PH)
86
what criteria is used for BV diagnosis?
Amsel's criteria
3 of the following 4 points should be present:
thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)
87
is low or high calcium a poor prognostic sign for pancreatitis?
low
88
difference between Glasgow-Imrie and Ranson score for pancreatitis?
Ranson score uses a smaller range of clinical and biochemical markers; first at admission then again at 48 hours, to generate a predictive score of mortality.
Glasgow-Imrie score assesses the severity
89
pre-renal, intra-renal and post-renal urinary Na+ findings?
pre-renal <20
intra and post-renal >40
90
metabolic abnormalities in refeeding syndrome?
low phosphate, magnesium and potassium
91
microscopic findings in crohns?
increased goblet cells
granulomas
rose-thorn ulcers
92
microscopic findings in UC?
crypt abscess
decreased goblet cells
pseudopolyps
93
how does H.pylori affect risk of barretts oesophagus and why?
decreases the risk as the gastric atrophy leads to decreased secretion of gastric acid, reducing reflux
94
outline Duke's staging for bowel cancer?
A - limited to the mucos
B - in bowel wall
C - lymph node mets +/- through bowel wall
D - distant mets
95
inducing remission and maintenance Tx in crohns?
steroids
azathioprine or mercaptopurine
96
inducing remission and maintenance Tx in UC?
topical aminosalicylates (unless severe then steroids)
aminosalicylates for maintenance too
97
how common are DVTs associated with PICC lines?
incidence is about 5%
98
consequences of prolonged PPI use?
osteoporosis
hypomagnesium
hyponatraemia
microscopic colitis
increased risk of c.diff
99
why may allopurinol given with azathioprine in some cases of IBD?
allopurinol inhivits xanthine oxidase
xanthine oxidase usually cleaves 6MP which is azathioprine's metabolite. reducing xanthine oxidase means more 6MP is converted to azathioprine's active metabolite of 6TGNs. this can be useful for patients who are non-responders!
however increased plasma concentrations of the active metabolites may lead to life-threatening leukopenia, thrombocytopenia or pancytopenia!!
100
what is budd-chiari syndrome? what is it associated with?
hepatic vein thrombosis - obstruction to the outflow of blood from the liver
associated with hpercoagulable states e.g. plycythemia, thrombophilia, pregnancy and COCP
101
triad of budd-chiari syndrome?
abdominal pain
tender hepatomegaly
ascites
102
diagnostic investigation for budd-chiari syndrome?
doppler USS
103
what is mirizzi syndrome?
when a gallstone is located I Hartmanns pouch of the gallbladder, or in the cystic duct and causes compression on the adjacent common hepatic duct resting in obstructive jaundice
its one of the rare times when acute cholecystitis can present with jaundice
104
what does this barium swallow show?
oesophageal cancer
105
what does this barium swallow show?
achalasia - birds beak appearance
106
what does this barium swallow show?
pharyngeal pouch - out pouching of posterior hypo pharyngeal wall at C5-C6
107
what's the most sensitive test for hiatus hernia?
barium swallow (although most pt will have endoscopy and find hiatus hernia incidentally)
