Pre Exam Gap Buster Flashcards
(251 cards)
1
Q
Which inflammatory marker is absent in Seronegative Spondyloarthropathy?
A
Rheumatoid Factor
2
Q
Name a Life-Threatening Exacerbation of Rheumatoid Arthritis.
A
Felty’s Syndrome
3
Q
How is the disease progression of rheumatoid arthritis monitored?
A
Through ESR and CRP
4
Q
What is the pathophysiology of a Sub-Dural Haemorrhage?
A
Trauma/Deceleration causes shearing of the dural venous sinuses.
5
Q
Why must you wait 12 hours after a SAH to perform a lumbar puncture?
A
Xanthochromia is most likely to be observed at this point.
6
Q
What results would you see on lumbar puncture is Gullain Barre Syndrome?
A
Normal WCC and Raised Protein
7
Q
What must always be monitored in patients with Gullain Barre?
A
Respiratory Rate - These patients are at high risk of respiratory distress. (Forced Expiratory Volume)
8
Q
What is the treatment for an acute migraine attack?
A
Oral/Nasal Triptan, NSAIDs (Aspirin 900mg).
9
Q
What is the pathophysiology of Parkinson’s Disease?
A
There is a loss of dopaminergic neurons in the Substantia nigra which impairs the Nigrostriatal pathway leading to problems initiating movement.
10
Q
What is the main drawback of the standard treatment for Parkinson’s disease?
A
Levodopa loses its effectiveness over time.
11
Q
What is used to decolourise and counterstain in a gram stain after crystal violet and iodine have been applied?
A
Acetate is used to decolourise and Safranin is used to counterstain.
12
Q
What is the mechanism of action for trimethoprim?
A
These are folate inhibitors.
13
Q
How long are the Tuberculosis antibiotics given for?
A
Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months
14
Q
Why does meningitis present with a non-blanching petechial rash?
A
Due to DIC
15
Q
What is the long-term side effect of Chemotherapy?
A
Tumour Lysis Syndrome
16
Q
Why can iron studies be unreliable?
A
Ferritin is an acute-phase protein which also increases in times of inflammation.
17
Q
What does ferrous sulphate do?
A
Turns stools black
18
Q
Name a Tyrosine Kinase Inhibitor.
A
Imatinib
19
Q
What is the inheritance pattern of Haemophilia A & B
A
X-Linked Recessive
20
Q
Why is Desmopressin given in haemophiliacs
A
It releases factor 8 which is trapped in the endothelium.
21
Q
What can happen if the treatment of CML is not successful?
A
It can progress to AML
22
Q
What is the Tensilon Test?
A
IV Endrophonium bromide (Anticholinesterase) - Acetylcholine in the synapse increases leading to transient improvement in weakness (Myasthenia Gravis)
23
Q
What is the target INR for Atrial Fibrillation?
A
2-3
24
Q
What is the Scoring System used in AF (Anticoagulation)?
A
CHA2DS2-VASC
Congestive Heart Disease - 1
Hypertension - 1
Age > 75 - 2
Diabetes Mellitus - 1
Stroke/TIA/Thrombo-embolus - 2
Vascular Disease - 1
Age 65-75 - 1
Sex Category (Female) - 1
25
Acute Pancreatitis - What is the name for bruising around the belly button?
Cullen's Sign
26
What treatments are patients with heart failure started on to slow progression?
ACE inhibitors & Beta Blockers
27
What are the ECG changes associated with Acute Pericarditis?
Concave ST-Elevation in all leads + PR depression.
28
What is Beck's Triad
Triad of Cardiac Tamponade
Low Blood Pressure
Distended Jugular Veins
Muffled Heart Sounds
29
What is seen Histologically in Parkinsons' disease?
Loss of dopaminergic neurons in the substantia nigra, presence of Lewy bodies.
30
What is the single greatest risk factor for developing atherosclerosis?
HYPERTENSION
31
Where are MHC-1 Proteins Found?
On all nucleated cells.
32
What is the treatment for SIADH?
Tolvaptan - ADH receptor antagonist.
33
What is the treatment for severe hypocalcemia?
IV Calcium Gluconate
34
What is a prominent side effect of calcium channel blockers?
Ankle Swelling
35
Why is Verapamil contraindicated in Heart Failure?
It has negatively inotropic effects
36
Which coronary artery infarction would cause 3rd Degree heart block?
AVN is supplied by RCA in 90% of hearts so an infarct in this region is likely to cause bradycardia and 3rd Degree heart block.
37
What part of the GI tract is most likely to perforate due to obstruction?
Caecum
38
What part of the GI tract is most often affected by Crohn's Disease?
Ileum
39
What is the most common causative organism in Ascending Cholangitis?
E.Coli
40
What are Kayser-Fleischer rings?
Dark rings which encircle the cornea of the eye due to deposition of copper in Wilson's Disease.
41
What is the 1st line treatment for Reactive Arthritis?
NSAIDs
42
How can Osteomalacia be differentiated from Osteoporosis/penia?
In Osteomalacia there are abnormal blood test findings.
43
Give a side effect of SGLT2 inhibitors
Increased risk of Candida + UTI.
44
What is the most common cause of Guillan Barre syndrome?
Campylobacter infection.
45
Would acidosis or alkalosis be seen in an Asthma Attack?
Alkalosis due to hyperventilation.
46
What are the constituents of Co-Amoxiclav?
Amoxicillin + Clavulanic Acid (Beta Lactamase inhibitor which increases the spectrum).
47
How do you manage acute AF in an unstable or recently presenting patient?
DC Cardioversion + Amiodarone if unsuccessful (Unstable) / Flecainide (Stable
48
What is the anion gap?
Estimates unmeasured plasma anions. It is the difference between plasma cations (Na+, K+) and anions (Cl-, HCO3-). It is helpful in determining the cause of metabolic acidosis.
49
What causes of metabolic acidosis also increase the anion gap?
Lactic Acid (Shock, Infection, Ischemia)
Renal Failure
Diabetic Ketoacidosissis
Drugs/Toxins
50
Blood Film Finding: Acute Lymphoblastic Leukemia
Blast Cells
51
What differentiates Acute Myeloid Leukemia from ALL?
Auer Rods on BM biopsy - Crystalline Cytoplasmic inclusion bodies.
52
Characteristic Finding for CML?
Philadelphia Chromosome t(9;22)
53
Blood Film Finding: Chronic Lymphoblastic Leukemia
Smudge Cells - cells damaged in preparation
54
What are the Characteristic cells in Hodgkin's Lymphoma?
Reed-Sternberg Cells
55
Blood Film Finding: Multiple Myeloma
Rouleaux Formation
56
What are Heinz Bodies and when are they seen?
Structures formed due to the breakdown of haemoglobin in cells. Due to oxidative damage from toxins, or due to thalassemia and G6PD deficiency.
57
What is CREST Syndrome?
Limited Scleroderma:
Calcinosis
Raynaud's Phenomenon
Oesophagal Dysfunction
Sclerodactyly
Telangiectasias - dilatation of capillaries leading to red marks on the skin surface.
58
What is Phaeochromocytoma?
Catecholamine-secreting tumours are usually chromaffin cells in the adrenal medulla.
59
What are the symptoms of Phaeochromocytoma?
Episodic headaches, sweating, tachycardia, Anxiety, Chest pain.
Blood Pressure may or may not increase.
60
Testing/Treatment of Phaeochromocytoma
Test - 24hr Urine Metanephrines & Abdominal CT.
Treat - Alpha Blockade before surgery, Beta Blockers.
61
Which T2DM treatments can cause hypoglycemia?
Pioglitazone (increases insulin sensitivity).
Sulfonylurea (increases insulin secretion).
62
What is the characteristic sign of extravascular haemolytic anaemia?
Splenomegaly
63
By what mechanisms can Microangiopathic Haemolytic anaemia occur?
DIC & Prosthetic Valves
64
Name an infective cause of Haemolytic Anaemia.
Malaria P.Falciparum
65
What is the clinical presentation of Beta Thalassemia Major?
Presentation within the first year of life with a failure to thrive.
66
What is the treatment for Immune Thrombocytopenia?
Steroids (Prednisolone)
67
What Hepatobiliary Condition is Sjorgens Syndrome most associated with?
Primary Biliary Cirrhosis
68
Which Blood Marker is Markedly Raised in Paget's Disease of Bone?
ALP (Alkaline Phosphatase)
69
Name three TNF-alpha Inhibitors.
Etanercept, Infliximab, Adalimumab.
70
What hormone is elevated in testicular cancer?
HCG - Human Chorionic Gonadotrophin
71
What is the treatment for UC?
Mesalazine
72
Outline the stepwise treatment pathway for asthma.
Initially: SABA
2: SABA + ICS (low dose)
3: SABA + ICS + LTRA
4: SABA + LABA + ICS + LTRA
5 - Refer for Specialist Input
73
Name a Leukotriene Receptor Antagonist
Montelukast
74
Which UTI antibiotic is teratogenic in the first trimester?
Trimethoprim
75
In which inflammatory bowel disease are skip lesions seen?
Crohn's Disease
76
What is Shober's Test
A test used to diagnose the restriction of lumbar spine flexion, it is particularly useful in ankylosing spondylitis. A line is drawn with the patient standing upright than bent forwards to assess the degree of flexion.
77
Name a Triptan
Sumatriptan
78
Which adrenergic receptor is responsible for smooth muscle relaxation?
Beta-Adrenergic
79
What scoring system is used to assess a patient's risk of stroke in the next 7 days?
ABCD2 Score:
Age >60 - 1
Blood Pressure (High) - 1
Clinical Features of TIA - 2 if weak + dysphasic.
Duration - >1hr = 2 , <1hr = 1
Diabetes - 1
>=4 High risks of stroke, >=6 35.5% in 7 days.
Patients who have had a TIA must receive Aspirin 300mg.
80
Treatment for Acute Severe Asthma
5mg Salbutamol nebulised with oxygen.
PO Prednisolone or IV hydrocortisone.
If PEF remains <75% Repeat prednisolone then give ipratropium.
81
Test for Hepatitis A
Rise in AST/ALT, IgM signifies recent infection, IgG is present for life.
82
What does HBsAg ALONE imply
Vaccination, if within 30 days of HepB vaccination.
HBsAg is the antigen used in the HepB vaccine.
83
What might prompt a HIV test?
A patient with an unexpected condition with no clear underlying cause or recurring infection.
84
What is the most common AIDs opportunistic infection?
Pneumocystis Pneumonia
85
Microbiology: Types of Haemolysis
Alpha (Partial Green) Haemolysis:
Strep. Viridans + Strep. Pneumonia (Optochin Sensitive).
Beta Haemolysis (Complete Clearance):
Lancefield Test - A (Pyogenes), B (Agalacticae)
Gamma Haemolysis:
Streptococcus Bovis
86
What is the first-line antibiotic for Streptococcus Pneumoniae?
Amoxicillin
87
What is the CURB65 Score?
The score used to make a decision on where to treat a patient with Pneumonia:
Confusion - 1
Urea > 7 - 1
Resp Rate > 30 - 1
Blood Pressure <90Sys <60Dias
0 - Treat at Home.
1, 2 - Consider Hospital Treatment.
3, 4 - ITU treatment.
88
First-line antibiotic for Staph. Aureus
Flucloxacillin - Ciprofloxacin
89
What antibiotic is given for atypical pneumonia?
Erythromycin
90
Treatment for Pneumocystis Pneumonia
Co-Trimoxazole + Prednisolone
91
Treatment for Pseudomonas Auriginosa
Piperacillin
92
Why is IV dexamethasone given sometimes in meningitis?
To protect Neurological function.
93
What drug is given for Meningitis prophylaxis?
Oral Ciprofloxacin Meningitis prophylaxis.
94
What is Charcoal Cefazolin Sodium Deoxycholate Agar used for?
Growing Campylobacter
95
What five antibiotics can cause C.Diff and which antibiotic can be given to treat it?
Co-Amoxiclav, Clarithromycin, Ciprofloxacin, Clindamycin, Cephalosporins.
Vancomycin can be used to treat.
96
AKI Criteria
Rise in Creatinine - >26 umol/L within 48 hours.
Rise in Creatinine - >1.5 x Baseline within 7 Days
Urine Output - <0.5mL/Kg/h for >6 consecutive hours.
97
What are Transudative Pleural Effusions?
Caused by factors which alter hydrostatic pressure, pleural permeability and oncotic pressure. HF, Liver Cirrhosis, Hypoalbuminemia. <30g/L
98
What are Exudative Pleural Effusions?
Changes to the Local Factors which influence the formation and absorption of pleural fluid.
Malignancy, Infection, Trauma. >30g/L
99
What does purulent sputum suggest?
Empyema
100
What are Light's Criteria?
Light’s criteria are more accurate for the diagnosis of exudative effusions.
The fluid is considered an exudate if any of the following are present:
The ratio of pleural fluid to serum protein is greater than 0.5
The ratio of pleural fluid to serum LDH is greater than 0.6
The pleural fluid LDH value is greater than two-thirds of the upper limit of the normal serum value
101
What are the diagnosis for Acute Severe Asthma?
Unable to complete sentences in one breath.
Resp Rate >25/min
Pulse Rate >110bpm
PEF 33%-50% of predicted or best.
102
What is the Well's Score?
Clinical Probability of PE:
Signs of DVT - 3
HR > 100 - 1.5
Bed-Ridden/Major Surgery - 1.5
Previous DVT/PE - 1.5
Haemoptysis - 1
Cancer Treatment - 1
Most Likely Diagnosis - 3
>4 = PE Likely
103
What may a CXR in COPD show?
Flat Hemidiaphragm, Barrel Chest, Hypertension, Bullae
104
Rheumatoid Arthritis: Hand Deformities
Ulnar Deviation, Swan-Neck Deformity, Boutonierre's Nodes
105
Blood Cultures Protocol: Infective Endocarditis
3 Cultures from 3 Different Sites at 3 different times.
106
3 Anatomical Areas where Urothiliases are likely to become lodged.
Ureteropelvic junction, the Ureteral crossing of Iliac Vessels, Ureterovesical Junction.
107
Side Effects of Bisphosphonates
Oesophagitis, Oesophageal Ulcers, Osteonecrosis of Jaw.
108
How should be Bisphonates be taken?
Take first thing in a morning on an empty stomach, sit upright for 30 minutes after taking them.
109
Risk Factors for Osteoporosis
S- Steroid Use
H- Hyper(para)thyroidism
A- Alcohol + Tobacco
T- Thin BMI >18.5
T- Testosterone Low
E- Early menopause <40
R- Renal Failure
110
Physical Examination Test - Meningitis
Kernig's Test - Severe knee stiffness.
Brudzinski's Test - Knees rise with neck (Stiffness).
111
Primary Care Treatment for Meningitis
IM Benzylpenicillin
112
Which LFT is suggestive of Alcohol abuse?
GGT - Gamma-glutamyl Transferase
113
Causes of Microcytic Anaemia
Iron Deficiency, Thalassemia, Lead Poisoning
114
Which Valve is most likely to be affected in patients who are IVDU?
Tricuspid Valve
115
What layer of the skin is affected by Cellulits?
Subcutaneous Layer
116
Which Swab is used for suspected bacterial infections?
Black (charcoal) Swab
117
What is the PHQ-9 score used for?
Assessing the severity of depression.
118
What diseases are screened for with the Heel-Prick Test?
Sickle Cell, Cystic Fibrosis, Congenital Hypothyroidism, Inherited Metabolic Diseases.
119
What Vaccines are given at 8 Weeks?
Diptheria, Tetanus, Pertussis, Polio, Haemophilus influenzae, Hepatitis B.
120
Name two side effects of Metformin.
Lactic Acidosis, GI Upset.
121
HbA1c Levels for Healthy Individuals, Pre-Diabetics & Diabetics
Healthy <42mmol/mol
Pre-Diabetic 4247mmol/mol
Diabetic >47
122
What is the main cause of AF in the developed world and developing world?
Developed World = Heart Failure
Developing World = Rheumatic Fever
123
What is the ORBIT Score?
Predicts bleeding in patients on anticoagulation for atrial fibrillation:
O - Older than 75 - 1
R - Reduced Haemoglobin - 2
B - Bleeding History - 2
I - Insufficient Kidney Function - 1
T - Treatment with an antiplatelet agent - 1
3 - Medium Risk (Anything Higher is High Risk)
124
What is used to treat Crohn's Disease to maintain remission?
Azathioprine
125
What is the biliary association of UC?
Primary Sclerosing Cholangitis
126
What does the U Wave on an ECG represent?
Purkinje Fibre depolarisation
127
What can Falsely Increase PSA?
Intense Physical Activity, Sexual Activity
128
Name 5 Factors that contribute to the Glasgow-Blatchford Score.
(Upper GI bleeding Severity)
Urea, Haemoglobin, Blood Pressure, Heart Rate, Melena.
129
What is Pharmacokinetics?
What the body does to the drug - How the plasma concentration changes over time?
130
What is Pharmacodynamics?
What the drug does to the body - the events after binding to the receptor and drug interactions.
131
Pharmacokinetic Concepts
ADME
Absorption (IV vs PO).
Distribution (Bloodstream to Tissues).
Metabolism (CYP450 + Renal).
Excretion (Speed that drugs leave the system)
132
What is Virchow's Triad?
Three broad categories are thought to increase the risk of thrombosis:
Venous Stasis
Hypercoagulability
Venous Damage
133
Heparin Mechanism of Action
Glycosaminoglycan binds to antithrombin and increases its activity - also indirectly downregulates thrombin.
134
What is Cushing's Reflex?
ICP > mAP leads to increased difficulty to provide vascular perfusion - BP increases to accommodate and HR falls due to baroreceptor activation.
HTN -> presses on brainstem resp. centre -> irregular breathing
135
What is the difference in the presentation of Gastric Ulcers/Duodenal Ulcers?
The abdominal pain associated with Gastric tends to get worse upon eating whereas Duodenal ulcers tend to be relieved.
136
What do ECG J waves indicate?
Hypothermia
137
Treatment for Diabetic Neuropathy
Amitryptiline, Duloxetine, Pregabalin, Gabapentin
138
ECG: Short PR + Slurred Upstroke QRS
Wolff-Parkinson White - Requires accessory pathway ablation. DELTA WAVES
139
What is the Tumour Marker for HCC?
Alpha-Fetoprotein (AFP)
140
What is Ramsay Hunt Syndrome?
Varicella Zoster infection of the facial nerve.
141
Treatment of Acute Gout
NSAIDs + Colchicine
142
Prevention of Gout
Allopurinol + Febuxostat
143
What is Gilbert's syndrome?
Genetic disease where the body is unable to process bilirubin.
144
COPD treatment
1-SABA
2-LAMA (Tiotropium)
3-LABA (salmeterol) /ICS
145
What is Sarcoidosis?
Inflammatory disease where granulomas form.
(NON—CASEATING)
146
Which electrolyte disturbance can Spironolactone cause?
Hyperkalemia as Spironolactone - Potassium Sparing
147
What electrolyte disturbance does Conn's Syndrome cause?
Hypokalemia
148
What CD4+ Level is AIDS defining?
<200
149
Which transaminase is most specific for acute liver damage?
ALT
150
How can C-Peptide differentiate between Type 1 and Type 2 Diabetes Mellitus?
It decreases in Type 1 diabetes, it persists in Type 2.
151
Name a Sulfonylurea
Gliclazide
152
What is HHS?
Hyperosmolar Hyperglycemic State - it mainly occurs in Type 2 diabetics where blood glucose rises and results in polyuria, this reduces the circulatory volume and increases the Osmolarity of the blood - this dehydrates the tissues (i.e the brain) which leads to a reduction in the level of consciousness.
153
What is De Quervain's Thyroiditis?
Subacute thyroiditis - self-limited inflammation of the thyroid gland due to viral infection. There is transient thyrotoxicosis due to the destruction of thyroid follicles (raised ESR/CRP), hypothyroidism then euthyroidism.
154
What is Thyroid Storm?
Severe Hyperthyroidism causes severe symptoms such as a loss of consciousness. Precipitated by thyroid surgery, radioiodine or infection/trauma.
155
Name two Cortisol Synthesis inhibitors.
Metyrapone, Ketoconazole
156
Name a Somatostatin analogue
Octreotide
157
Angina Treatment
GTN Spray for Symptom Relief
Beta Blocker or CCB
Isosorbide Mononitrate
Revascularisation
158
Post-MI Discharge Treatment
Aspirin and Clopidogrel for a year.
159
What is the most common cause of Pericarditis?
Coxsackie Virus
160
Mitral Stenosis Murmur
Mid-diastolic Murmur
161
Mitral Regurgitation Murmur
Pansystolic Murmur
162
Aortic Stenosis Murmur
Ejection Systolic Murmur
163
Aortic Regurgitation Murmur
Early Diastolic Murmur
164
What Does Leukemia Cause?
Leads to pancytopenia - anaemia, thrombocytopenia, and leukopenia.
165
What do Mature Cells on Blood Film suggest?
Chronic Leukemia
166
Richter's Transformation
CLL to Lymphoma
167
Treatment for Lymphoma
For Low stage (I, II) - Radiotherapy, Short course ABVD Chemotherapy.
For High Stage (III+) - Radiotherapy + Longer course of Chemotherapy
168
What are Cannonball Metastases?
Large Well-Circumscribed pulmonary metastates which commonly occur secondary to RCC, Choriocarcinoma, Prostate, Endometrial and adrenal carcinoma.
169
What is the triple therapy for H.Pylori for patients with penicillin allergy?
Clarithromycin, Omeprazole, Metronidazole
170
Test for H.Pylori?
Test for antigen in stool or use the urea breath test to see if urease is present (breakdown).
171
Name an H2Receptor Antagonist
Ranitidine
172
Coeliac Pathophysiology
Alpha-Gliadin is immunogenic - it is broken down by tissue transglutaminase leading to an inflammatory response when anti-TTG is present. HLA DQ2 and DQ8 associated.
173
3 Main Causes of Pancreatitis
Gallstones, Ethanol, Trauma
174
Why does acute pancreatitis lead to hypocalcemia?
There is an excess release of pancreatic enzymes such as lipase which leads to breakdown of triglycerides into free fatty acids which bind to calcium and decrease its free levels in the plasma.
175
Why is Oral Vancomycin given before IV in C.Diff Infection?
Vancomycin cannot cross the blood-gut barrier so is most effective when given orally.
176
What is Uhthoff phenomenon?
A transient worsening of neurological symptoms related to a demyelinating disorder, such as multiple sclerosis, when the body becomes overheated in hot weather, exercise, fever, saunas, or hot tubs.
177
Why is nitrofuratoin contraindicated in pregnancy?
In the third trimester, it is linked with haemolytic anaemia of the newborn
178
Treatment for Sarcoidosis
Oral Steroids (Prednisolone)
179
Most common infective exacerbation in COPD?
Haemophilus Influenzae
180
Which Inflammatory Bowel Disease causes Gallstones?
Crohn's Disease - terminal ileitis impairs bile salt reabsorption.
181
What is the most common cause of septic arthritis in sexually active young adults?
Neisseria Gonorrhoea
182
Definition of CKD
Abnormal Kidney Structure/Function >3months
eGFR <60ml/min/1.73m2
eGFR <90ml/min/1.73m2 + Signs of Renal Damage or Albuminemia.
183
What’s the mechanism of action of N-acetyl cysteine?
Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds
184
What receptors are affected in myasthenia gravis?
Nicotinic acetylcholine receptors
185
What is the pathophysiology of hereditary spherocytosis?
It is caused by defects in the red cell membrane, resulting in them having an increased permeability to sodium
186
What is the Triad of Symptoms for Pyelonephritis?
Flank Pain, Fever, Pyuria
187
What is Phren's Sign?
Testicular pain relief on elevation.
Positive = Epididymitis
188
What two drugs are given in BPH?
Tamsulosin (Alpha blocker) - smooth muscle relaxation.
Finasteride (5-alpha-Reductase Inhibitor) - lowers the level of testosterone.
189
Which drug can be given in Prostate cancer to remove the androgenic drive?
Zoladex
190
When are Hypersegmented Neutrophils seen?
In Macrocytic (B12/Folate Deficiency) Anaemia
191
Which Conditions are Polyarteritis Nodosa associated with?
HepB, HepC, HIV
192
In which condition is Saddle-Shaped Noses seen?
Granulomatosis with Polyangiitis
193
Which Antibodies are raised in Sjogren's Syndrome?
Anti-RO, Anti-La
194
What is Epistaxis?
Nosebleed
195
What is Achalasia?
A swallowing disorder where the oesophagus muscles do not contract properly and do not help propel food down toward the stomach
196
How long after onset of symptoms can IV Alteplase be given in Ischemic Strokes?
4.5hrs
197
Pathophysiology and CT appearance of SAH
Rupture of Berry Aneurysm at bifurcation of Circle of Willis - Star Shape
198
Pathophysiology and CT appearance of SDH
Rupture of Bridging Veins - Crescent Shape
199
Pathophysiology and CT appearance of EDH
Fractured Temporal Bone - Convex CT
200
What is Myasthenia Gravis associated with?
Thymic Hyperplasia - 50% will have Thymoma
201
Huntington's Mechanism of Inheritance
Autosomal Dominant (Anticipation)
202
Huntington's Pathophysiology
Expansion of CAG repeats on Chromosome 4 leads to loss of striatum which causes a prodromic illness of irritability, depression and loss of coordination. This progresses to chorea, fits, dementia and death.
203
Horner's Syndrome Triad
Miosis (Pupil Constriction), Partial Ptosis + Enopthalmos (Sunken eye), Anhydrosis (Loss of sweating ipsilaterally).
204
Cystic Fibrosis Mutation
CF transmembrane conductance regulator (CFTR) - Chromosome 7
205
Types of Motor Neurone Disease
Amyotrophic Lateral Sclerosis - Loss of motor neurons in both the motor cortex and the anterior horn of the spinal cord.
Progressive Bulbar Palsy - Affects cranial nerves IX to XII.
Progressive Muscular Atrophy - anterior horn cell lesion, lower motor neuron only.
Primary Lateral Sclerosis - loss of Betz cells in the motor cortex.
206
MND Drug
Riluzole - inhibits the release of glutamic acid.
207
What is caput medusa?
The appearance of distended and engorged superficial epigastric veins
It signifies portal hypertension
208
What can be given to prevent tumour lysis syndrome?
Allopurinol
209
What type of hypersensitivity reaction is coeliac diease
Type IV
210
What is NOT diagnostic for Wilsons disease?
High serum copper
211
What is considered a 'reduced ejection fraction'?
<40%
212
How can IgA be differentiated from Post-Streptococcal Glomerulonephritis?
IgA nephropathy presents within a shorter time period of infection than SGN.
213
Ankylosing Spondylitis X-Ray Findings
Squaring of Vertebrae, Bamboo Spine, Syndesmophytes.
214
Which Blood Marker is Monitored in Anaphylaxis?
Serum Mast Cell Tryptase
215
Teratology of Fallot Defects
Ventricular Septal Defects, Pulmonary Stenosis, Overriding Aorta, Right Ventricular Hypertrophy
216
What is Addison's Disease and how do you test and treat it?
Adrenal insufficiency - the synacthen test is used and treatment is to replace hormones.
217
Tests for Cushing's
Late Night Salivary Cortisol
Urinary Free Cortisol
48hr Dexamethasone Suppression Test
218
Why does Warfarin cause drug interactions?
It is a CYP450 drug inducer.
219
What medication is contraindicated in patients with migraine?
Combined oral contraceptive pill as it increases the risk of stroke in patients with migraine
220
What is the first step in investigating a suspected PE?
Calculate the patient's Wells score.
221
In a patient with a suspected PE, what would be the first step in their management with a Wells score of <4?
Offer a D-Dimer test, with results available within 4 hours.
222
What is D-Dimer and what is its significance in the the investigations of a DVT/PE?
A fibrin breakdown product.
A negative DD effectively excludes a DVT/PE in those with a low or intermediate clinical probability.
It rules out the need for further imaging if negative.
223
In a patient with a suspected PE, what would be the first step in their management with a Wells score of >4?
Admit the patient and arrange an urgent CTPA to rule out a PE!
224
If a CTPA is not immediately available/the results of a DD test are not available within 4 hours, how should you manage a patient with a suspected PE whilst you wait?
Start interim anticoagulation therapy, such as heparin.
225
If a patient with a suspected PE has a positive DD result, what is the next step in their management?
Admit the patient and arrange an urgent CTPA to rule out a PE!
226
If the DD or CTPA return negative, what is the next step in their management?
Stop any interim anticoagulants started.
Consider alternate diagnoses.
227
In a confirmed PE, what is the treatment pathway?
Warfarin and heparin until INR >2.
Stop heparin and continue warfarin for a minimum of 3 months, with an aimed INR of 2-3.
228
What may be considered in patients who develop emboli despite adequate anticoagulation?
A vena caval filter (with concomitant anticoagulation).
229
What is the treatment for a massive PE?
Thrombolysis with a 50mg bolus of alteplase.
230
What is the benefit of tiotropium vs ipratropium bromide?
Tiotropium only has to be inhaled once a day, due to its longer half-life, unlike ipratropium which must be taken multiple times a day.
231
What is a potential cause of Horner's Syndrome?
A Pancoast Tumour
232
What is a Pancoast Tumour?
A tumour of the apex of the lung.
233
How can a Pancoast tumour cause Horner's syndrome?
Compression and disruption of the sympathetic chain as the tumour grows.
234
Hyperkalemia ECG Changes
Flat P, Tall Tented T, Wide QRS
235
Hypokalemia ECG Changes
Small/Inverted T Waves, U Waves, Long PR
236
Hypercalcemia ECG Changes
Short QT
237
Hypocalcemia ECG Changes
Long QT
238
Sulfonylurea Name
Gliclazide
239
SGLT2 Name
Dapagliflozin
240
What is the Name of the flank bruising in Pancreatitis?
Grey Turners Sign
241
What is the Synacthen test?
Short ACTH stimulation test.
Check cortisol levels before and 30mins after 250ug IM tetracosactide (synacthen).
Addisons is excluded if the second cortisol is >550nmol/L
242
What are superantigens?
Antigens which bind to MHC without matching a specific epitope, therefore leading to nonspecific activation of T-cells.
They can activate up to 20% of the body's T-cells, compared to a normal antigen which can activate up to 0.001% of the body's T-cells.
243
Give an example of a condition associated with superantigens.
Rheumatic fever.
244
'Molecules that mimic human proteins, eliciting an immune response' best describes what?
Molecular mimicry method of disease.
245
Give an example of molecular mimicry method of disease.
Campylobacter involvement in Guillain Barre.
246
What is the inheritance pattern of G6PD?
X linked recessive.
247
What do APTT and PT Measure the Effectiveness of?
APTT - Intrinsic Pathway (Haemophilia + VWf)
PT - Extrinsic Pathway (Liver Disease + Warfarin)
248
IBS Symptoms
Abdominal Pain relieved by Defecation, can also present with tenesmus.
249
What Benzodiazepam can be used to treat alcohol withdrawal?
Chlorodiazepam
250
Which Scoring System is used for UC Flares?
True-Love Witts
251
How is Metformin Excreted?
By the Kidneys
