PTS Reading Week 2 Flashcards
(230 cards)
1
Q
Which TLRs are intracellular?
A
TLR 3,7,8 and 9
2
Q
What is the mechanism of action of Beta Lactams antibiotics?
A
Inhibit the synthesis of the peptidoglycan layer of bacterial cell walls by binding irreversibly to Penicillin Binding Proteins
3
Q
Name 4 categories of beta lactam antibiotics
A
- Penicillins
- Cephalosporins
- Carbapenems
- Monobactams
4
Q
Name some penicillins
A
- Penicillin
- Amoxacillin
- Flucloxacillin
5
Q
Name some cephalosporins
A
- Cefotaxime
- Ceftriaxone
- Cefuroxime
6
Q
Name some carbapenems
A
- Meropenem
7
Q
What sorts of bacteria are more susceptible to beta lactam antibiotics?
A
Gram positive
Staph & Strep
8
Q
What is responsible for differences in the spectrum and activity of beta lactams?
A
Their relative affinities for different Penicillin Binding Proteins
9
Q
What can beta lactams not be used in?
A
Intracellular pathogens
10
Q
What is the mechanism of action of glyopeptides?
A
Block bacterial cell wall synthesis
11
Q
Name 2 glyopeptide antibiotics
A
- Vancomycin
- Teicoplanin
12
Q
What is the mechanism of action of quinolones?
A
Block DNA replication by inhibiting DNA gyrase
13
Q
Name some quinolones
A
- Ciprofloxacin
- Levofloxacin
14
Q
What is the mechanism of action of Metronidazole?
A
Causes a loss of helical DNA structure and strand breakage, and disrupts protein synthesis
15
Q
What is the mechanism of action of Rifampicin?
A
Inhibits RNA polymerase
16
Q
What is the mechanism of action of macrolides?
A
Bind to the 50S subunit of the ribosome and inhibit protein transcription
17
Q
Name some macrolides
A
- Clarithromycin
- Azithromycin
- Erythromycin
18
Q
What is the mechanism of action of aminoglycosides?
A
Bind to the 30S subunit of the ribosome and inhibit protein transcription
19
Q
Name an aminoglycoside
A
- Gentamicin
20
Q
What is the mechanism of action of lincosamides?
A
Bind to the 50S subunit of the ribosome and inhibit protein transcription
21
Q
Name a lincosamide
A
- Clindamycin
22
Q
What is the mechanism of action of tetracyclines?
A
Bind to the 30S subunit of the ribosome and inhibit protein transcription
23
Q
Name a tetracycline
A
Doxycycline
24
Q
What is the mechanism of action of streptogramins?
A
Bind to the 50S subunit of the ribosome and inhibit protein transcription
25
Name a streptogramin
1. Virginiamycin
26
What is the mechanism of action of sulphonamides?
Bind to the DHPS enzyme and inhibit folate synthesis
27
Name a sulphonamide
Sulfasalazine
28
What is the mechanism of Trimethoprim?
Inhibits folate synthesis
29
What is the purpose of clavulanic acid in Co-Amoxiclav?
Makes it harder for the bacteria to break down the amoxicillin
30
What is a key finding in the blood or CSF during bacterial infection?
Neutrophils!!
31
What is type 1 hypersensitivity?
Mass cell degranulation (basophils and mast cells) mediated by IgE linkage
32
What is type 2 hypersensitivity?
IgM and IgG linkage to surface cell antigens or tissue components
33
What is type 3 hypersensitivity?
Antibody-antigen complexes deposit into tissues
34
What is type 4 hypersensitivity?
T cell mediated response
35
What is type 5 hypersensitivity?
Stimulatory autoantibodies
36
Give examples of a type 1 hypersensitivity reaction
1. Anaphylaxis
2. Atopy
37
Give examples of a type 2 hypersensitivity reaction
1. Goodpasture syndrome
2. Autoimmune haemolytic anaemia
38
Give examples of a type 3 hypersensitivity reaction
1. Systemic Lupus Erythematosus
39
Give examples of a type 4 hypersensitivity reaction
1. Tuberculosis
40
Give examples of a type 5 hypersensitivity reaction
1. Grave's Disease
41
What is the test for delayed type 4 hypersensitivity reactions
Patch test
42
Which antibody is first released in the humoral response?
IgM
43
What is the most efficient and powerful antigen presenting cell?
Dendritic cells
44
What is the most common opportunistic infection and presentation of AIDS?
Pneumocystis Pneumonia
(caused by the pneumocystis jirovecii fungus)
45
What bacteria is the most common cause of UTI?
Escherichia Coli
46
What bacteria is the most common cause of Pyelonephritis?
Escherichia Coli
47
What pathogen is most commonly isolated in cases of chronic diarrhoea associated with HIV
Cryptosporidium
48
What is the mechanism of action of rivaroxaban (and other DOACs)
Directly inhibits activated clotting factor X to prevent conversion of prothrombin to thrombin
49
What is the mechanism of bisphosphonates?
Inhibit osteoclastic activity to decrease bone resorption, which reduces bone turnover and improves bone mass
50
What sort of drug is Diclofenac?
NSAID
51
What medicines can cause constipation?
Opiates! eg, Codeine
52
What can decrease the effects of warfarin?
Leafy green vegetables
53
What can increase the effects of warfarin?
Alcohol
54
What anti-emetic is contraindicated in Parkinson's?
Metoclopramide - because it is a dopamine blocker
55
What are the diagnostic criteria for DKA?
1. Blood glucose > 11mmol/L
2. Plasma ketones > 3mmol/L
3. Blood pH < 7.3
4. Bicarbonate < 15mmol/L
56
What is the most common subtype of thyroid cancer?
Papillary
57
What is the gold standard investigation for carcinoid syndrome?
Chromagranin-A + octreoscan
58
What are typical EKG findings in hyperkalaemia?
1. Tall tented T waves
2. Wide QRS
3. Prolonged PR
4. Absent P waves
59
What are some symptoms of polycystic ovarian syndrome?
1. Oligomenorrhea
2. Hirsutism
3. Acne
4. Ovarian cysts
60
What is the difference between Gigantism and Acromegaly?
Gigantism is the over secretion of GH PRIOR to the fusion of the epiphyses
61
What is the management for diabetic ketoacidosis?
IV Fluids immediately
Then insulin and potassium (as insulin can cause hypokalaemia_
62
What is the epithelium of the Vas Deferens?
Pseudostratified columnar epithelium with stereocilia
63
Where in the female reproductive tract does fertilisation usually occur?
Ampulla
64
What is cardiac tamponade?
The accumulation of fluid in the pericardial cavity that compresses the heart and reduce cardiac function
65
What are the four main features of Tetralogy of Fallot?
1. Ventricular septal defect
2. Pulmonary artery stenosis
3. Right ventricular hypertrophy
4. Overriding aorta
66
What is orthopnoea?
Difficulty breathing when lying down
67
What is a Mobitz type 1 second degree heart block?
Increasingly long PR intervals followed by a drop in a QRS complex
68
What is a Mobitz type 2 second degree heart block?
Constant length PR intervals but drops in QRS complexes (eg, 2 or 3 PRs for every QRS)
69
What are roth spots?
Retinal haemorrhage with pale centers
70
What are the signs of left sided heart failure on Xray?
1. Alveolar oedema
2. Kerley B lines
3. Cardiomegaly
4. Dilated upper lobe vessels
5. Pleural effusion
71
What are the signs of right sided heart failure?
1. Increased JVP
2. Hepatomegaly
3. Ascites
4. Pitting oedema
72
What is primary prevention?
Methods taken to prevent the onset of disease
73
What is secondary prevention?
Methods to detect and address an existing disease prior to the appearance of symptoms
74
What is the most appropriate 1st line test in patients with symptoms for stable angina?
CT coronary angiography
75
What is taken for the prevention of angina attacks?
1st line treatment is beta blocker or a cardioselective CCB (eg, Verapamil)
2. After that, combine beta blockers with a non-cardioselective CCB such as Nifedipine
76
What is the most appropriate initial treatment for STEMI?
1. Dual antiplatelets (Aspirin + Clopidogrel & Ticagrelor)
2. Anticoagulation (Heparin)
3. Percutaneous Coronary Intervention
77
What is the 1st line treatment for hypertension in people aged 55+ or Afro Caribbeans?
Calcium Channel Blocker, eg. Amlodipine
78
What is the 1st line treatment for hypertension in people aged < 55 or ANY AGE with T2DM?
Ace-i
79
What is the treatment given in atrial fibrillation to prevent strokes?
Warfarin or DOAC
80
When is Warfarin more effective than a DOAC?
In a patient with metal heart valves
81
What is the treatment for pericarditis?
NSAIDs & Colchicine
82
What is the mechanism of action of colchicine
Tubulin disruption which reduces inflammatory pathways
83
What is the 1st line treatment for iron deficiency anaemia?
Ferrous sulphate
84
What is G6PD deficiency?
A deficiency in Glucose-6-phosphate-dehydrogenase which causes haemolytic anaemia
85
What drug is contra-indicated in G6PD deficiency?
Nitrofurantoin - as it can cause a drug induced oxidative crisis
86
What is a diagnostic test for DVT?
Doppler ultrasound
87
What are some causes of thrombocytopenia?
1. HIV
2. Myeloma
3. Heparin
4. Alcohol abuse
88
What leukaemia is most common in children?
Acute lymphoblastic leukaemia
89
What is the diagnostic test for sickle cell anaemia?
Hb electrophoresis
90
What is the treatment for chronic myeloid leukaemia?
Chemotherapy and a tyrosine kinase inhibitor, eg. Imatinib
91
What is the pathology of hereditary spherocytosis?
Defects in the red cell membrane, resulting in them having increased permeability to sodium
92
What is the infective stage of the malaria parasite?
Sporozites
93
What are some hallmarks of Acute Myeloid Leukaemia?
Auer rods
94
What are some hallmarks of Acute Lymphoblastic Leukaemia?
Most common type in children
Blast cells
95
What are some hallmarks of Chronic Myeloid Leukaemia?
Association with the Philadelphia chromosome
96
What are some hallmarks of Chronic Lymphoblastic Leukaemia?
Smudge cells
97
What are some hallmarks of Multiple Myeloma?
RBCs in Rouleaux formation
Bence jones proteins
98
How long would a patient be initially put on a DOAC for as a result of a provoked DVT?
3 months
99
How long would a patient be initially put on a DOAC for as a result of an unprovoked DVT?
6 months
100
What indicates a poor prognosis in a diagnosis of Acute Lymphoblastic Leukaemia?
1. WCC of >20 at time of diagnosis
2. Age < 2 or > 10
3. Being male
101
What are some of the long term complications of ABVD chemotherapy used to treat Hodgkin's lymphoma?
1. Infertility
2. Lung damage
3. Cardiomyopathy
4. Peripheral neuropathy
5. Hair loss
102
What gene is associated with a proportion of myeloma cases?
MGUS
103
What is sideroblastic anaemia?
A type of anaemia where the body has enough iron, but is unable to turn it into haemoglobin
104
What are some clinical features of sideroblastic anaemia?
Iron accumulates in the mitochondria of blood cells, causing "ringed sideroblasts"
105
What foods are rich in B12
Meat, dairy and eggs
106
What is beta-thalassaemia major?
Blood disorder that reduces the production of haemoglobin due to a lack of production of beta-globin
107
What are reticulocytes?
Immature red blood cells
108
What genetic mutation is associated with polycythaemia rubra vera?
JAK2
109
What are some risk factors for DVT?
1. Overweight
2. Long haul travel
3. Oral contraceptive
4. Pregnancy
5. Immobility
110
What virus is associated with Hodgkin's lymphoma?
Epstein-Barr virus
111
What is Haemolytic Uraemic Syndrome?
A potential complication of E.Coli infection - endothelial damage to blood vessels that leads to thrombocytopenia and haemolytic anaemia
112
What is the 1st line test for suspected coeliac?
Serology for IgA tTg antibodies
113
What is the appropriate 1st line management of IBS?
Dietary advice
Then, anti-motility agents to help with diarrhoea (eg. Loperamide) / mild laxatives for help with constipation (eg. Lactulose)
114
What is the 2nd line treatment for IBS?
Tri-cyclic antidepressant - amitriptyline
115
What is Zenker's diverticulum / Pharyngeal pouch?
A herniation of the upper oesophagus. Zenker's is posteromedial.
116
What are some symptoms of pharyngeal pouch?
1. Dysphagia
2. Chronic cough
3. Bad breath
4. Throat lymp that gurgles on palpatation
117
What is the treatment for H.pylori?
7 day of triple therapy (2 antibiotics and a PPI)
eg, Omeprazole, Amoxicillin, Clarithromycin
118
What is the difference between anal fissures and haemorrhoids?
1. Anal fissures are associated with intense pain post defecation
2. With haemorrhoids you may feel an outpouching
119
Where is Virchow's node located?
The left supraclavicular area
120
What is a hallmark of IBS?
Symptoms improve upon opening bowels
121
Where is iron absorbed?
Duodenum
122
Where is vit B12 absorbed?
Terminal ileum
123
Where is folate absorbed?
Duodenum and jejunum
124
How do NSAIDS cause peptic ulcers?
NSAIDS inhibit COX enzymes which are needed to produce prostaglandins that stimulate mucus secretion
Less mucus > reduced mucosal defense > ulcer
125
How does H.pylori cause peptic ulcers?
Secretes urease which splits urea in the stomach into CO2 and ammonia.
Ammonia combines with H+ in the stomach to make ammonium.
Ammonium causes an inflammatory response and reduces the mucosal defense
126
How does bile regurgitation cause peptic ulcers?
Strips away the mucus layer in the stomach, reducing muscosal defense
127
How does ischaemia cause peptic ulcers?
Reduced blood flow means gastric cells die off and don't produce mucin, reducing mucosal defense
128
Where is the most common place for colorectal cancers to develop in the large intestine?
Rectum
129
What are main sources of ALP in the body?
1. Bone
2. Liver
130
What is the diagnostic test for primary biliary cholangitis?
Blood test for Anti mitochondrial antibodies
131
In the context of GI pathology, what would a raised ALP indicate?
Cholestasis
132
What is the mechanism of action of N-acetyl cysteine in paracetamol overdose treatment?
Replenishes the supply of glutathione that conjugates NAPQI to non toxic compounds
133
What is the best investigation to confirm a suggested diagnosis of ascending cholangitis?
ERCP
134
What are some causes of chronic pancreatitis?
1. Iatrogenic - ERCP
2. Hypercalcaemia
135
What hepatitis virus is a DNA virus?
Hepatitis B
136
What are some symptoms of iron excess / haemochromatosis?
1. Fatigue
2. Weakness
3. Abdominal problems
4. Bronzing of skin
5. Hepatomegaly
137
What is the 1st line investigation for suspected haemochromatosis
Blood test for ferritin levels
138
What is the 1st line antibiotic for uncomplicated UTI?
Nitrofurantoin
139
What drug can also be used in UTI?
Trimethoprim - but it is teratogenic
140
What is the gold standard investigation for kidney stones?
Non contrast CT - Kidney ureter bladder
141
What are some symptoms of bladder cancer?
1. Painless haematuria
2. Polyuria
3. Increased urgency
4. Nocturia
142
What are the treatments for chlamydia?
Doxycycline or Azithromycin
143
What are some risk factors for testicular torsion?
1. Young age, often just before puberty
2. Cryptorchidism
3. Trauma or exercise
144
What are some signs of Wegener's granulomatosis / granulomatosis with polyangiitis
1. Nasopharynx symptoms
2. Saddle nose
3. Hypertension
145
What is Henoch-Schoenlein purpura?
A disease where capillaries become inflamed and damaged
146
What are the 4 main symptoms for Henoch-Schoenlein purpura?
1. Non blanching purpura ash
2. Abdominal pain
3. Glomerulonephritis
4. Arthralgia
147
When does Henoch-Schoenlein purpura tend to occur?
Males age 3-15 after an upper respiratory tract infection
148
What is Alport syndrome?
A defect in type IV collagen that causes problems in the kidneys, eyes and ears
149
What is the most appropriate 1st line treatment for frequency and urgency?
Oxybutynin with bladder training
150
What are the side effects of anticholinergics such as oxybutynin?
1. Dizziness
2. Dry mouth
3. Constipation
151
What are some symptoms of acute pyelonephritis?
1. Fever
2. Flank pain
3. Frequency and urgency
4. Pain on urination
152
What is the 1st line antibiotic for pyelonephritis?
Ciprofloxacin
Cefalexin
Co-amoxiclav
153
What are most renal calculi made of?
Calcium oxalate
154
What is another cause of renal calculi?
Magnesium ammonium phosphate
155
What is Chvostek's sign?
Associated by hypocalcaemia - elicited by tapping CN7 resulting in momentary facial contraction
156
What is Prehn's sign positive?
Pain relief upon lifting the affected testicle
157
What does a positive Prehn's sign indicate?
Epididymitis
158
What does a negative Prehn's sign indicate?
Testicular torsion
159
What is the most common cause of epididymitis?
STIs
160
What does new onset proteinuria on a background of diabetes mellitus suggest?
Diabetic nephropathy
161
What is the treatment for diabetic nephropathy?
Hypertensive control - Ace-i
162
Where does the left testicular vein drain to?
The left renal vein
163
Where does the right testicular vein drain into?
The IVC
164
What drugs must be stopped in AKI?
1. NSAIDs
2. ACE-i & ARB
3. Aminoglycosides
165
What dietary advice should be followed in patients with chronic kidney disease?
Low protein, phosphate, potassium and sodium
166
What genetic component is most associated with spondyloarthropathies?
HLA-B27
167
What would the blood profile look like in a patient with Paget's disease of bone?
Elevated ALP
Normal PTH, phosphate, calcium, vitD
168
What medicines can cause gout?
Bendroflumethiazide
169
What nerve covers the knee jerk reflex?
L4
170
What STI is a common causative agent of reactive arthritis?
Chlamydia
171
What STI can cause septic arthritis?
Gonorrhoea
172
What is a risk for contracting a Pseudomonas aeruginosa infection?
IVDU
173
What sort of bacteria is Haemophilus Influenzae
A gram negative coccobaccilus
174
What forms of arthritis has distal interphalangeal joint (DIPJ) involvement?
Osteoarthritis and Psoriatic arthritis
175
What is the 1st line medication for osteoarthritis?
Topical NSAIDs
176
What is the 2nd line medication for osteoarthritis?
Oral NSAIDs & PPI
177
What is the 3rd line medication for osteoarthritis?
Weak opioids eg. Codeine
178
What is reserved for very severe osteoarthritis?
Intra articular steroid injection
179
What antibodies are found in Sjogrens?
Anti-Ro (SS-A) and Anti-La (SS-B)
180
What is the most specific antibody in Sjogrens?
Anti-La (SS-B)
181
What is methotrexate?
A disease modifying anti-rheumatic (DMARD)
182
Why must methotrexate be avoided in pregnancy?
It is a folic acid inhibitor
Folic acid is crucial in the neurodevelopment of the foetus
183
What is severe osteoporosis?
A score of < -2.5 and a known pathological fracture
184
What is the name of the descending painless loss of vision that can occur in patients with Giant Cell Arteritis?
Amaurosis Fugax
185
What part of the brain is most affected in complex partial seizures?
Temporal lobe
186
What is Wernicke encephalopathy?
Degenerative brain disorder that can present with changes in metal status, gait and oculomotor dysfunction
187
What is Korsakoff syndrome?
A memory disorder
188
What causes Wernicke encephalopathy and Korsakoff syndrome?
Vitamin B1 deficiency (associated with alcohol abuse)
189
What is Myasthenia Gravis?
An autoimmune disorder where autoantibodies attack post synaptic nicotinic ACh receptors at the neuromuscular junction of skeletal muscles
190
What is Guillain-Barre syndrome?
An autoimmune demyelination of the PNS
191
Early on in GBS, Schwann cells can remyelinate nerves, but what happens as the disease progresses?
The Schwann cells fail to remyelinate properly leading to irreversible damage to the PNS
192
What are some symptoms of Guillain Barre?
1. Parasthesia
2. Loss of ankle and arm reflexes
3. Double vision and difficulty speaking
193
What tests can be done to help confirm a diagnosis of Guillain Barre?
1. Lumbar puncture, increased protein in CSF but not increased leukocytes
2. Nerve conduction tests
194
What is the treatment for Guillain Barre
Intravenous immunoglobulin
195
What are the complications of Guillain Barre?
Respiratory failure
Pulmonary emboli
196
What is Motor Neurone disease?
A neurodegenerative disease that causes destruction of the upper and lower motor neurones
197
What are the symptoms of MND?
1. Muscle weakness (with visible wasting)
2. Spasticity & Fasciculations
3. Problems swallowing
198
What drug can be used in MND?
Riluzole
199
What is Cauda Equina syndrome?
Compression of the cauda equina
200
What are the symptoms of Cauda Equina?
1. Lower back pain
2. Loss of bowel or bladder control
3. Pain that radiates bilaterally down the leg
201
What is the difference in the CSF between viral and bacterial hepatitis?
Viral: Normal glucose, higher protein, lymphocytes
Bacteria: Lower glucose, higher protein, neutrophils
202
What is Horner's syndrome?
Disruption to the sympathetic nerve supply that presents with ptosis, facial anhydrosis, miosis
203
What can cause Horner's syndrome?
A Pancoast tumour in the upper part of lung can interfere with the sympathetic chain
204
What is Brown Sequard syndrome?
Lesion to one half of the spinal cord
205
What are the symptoms of Brown Sequard syndrome?
1. Ipsilateral loss of position, vibration, sensation and motor control at the level of the lesion
2. Contralateral pain and temperature loss 2 levels below the lesion
206
What artery is commonly implicated in an extradural haematoma?
Middle meningeal artery
207
What drug can be used to lower intercranial pressure?
Mannitol
208
What drug should be given as soon as possible after sub arachnoid haemorrhage is confirmed?
Nimodipine
CCB to prevent vasospasm
209
What bacteria is the most common cause of Guillain Barre?
Campylobacter jejuni
210
What is the most common cause of bacterial gastroenteritis?
E.Coli
Salmonella
Campylobacter jejuni
211
What are some symptoms of cluster headaches?
1. Unilateral around the eye
2. Bad pain
212
What is the most appropriate 1st line investigation for suspected MS?
MRI head
213
What can be used with an MRI to help confirm a diagnosis of MS?
Lumbar puncture
214
What would a lumbar puncture show in MS?
Oligoclonal IgG bands
215
What characterises an extradural haematoma?
A lucid interval
216
If a patient is getting farily regular moderate level migraines, what treatment is appropriate?
Triptans eg. Sumatriptan
217
What is the mechanism of action of Triptans?
A serotonin 5-HT1 receptor agonist, causes vasoconstriction
218
What is Lambert Eaton Myasthenic syndrome?
A pre synaptic neuromuscular junction disorder
219
What is the main difference between Lambert Eaton Myasthenic syndrome and Myasthenia Gravis symptoms?
LEMS improves after exercise but Myasthenia Gravis gets worse
220
What are some characteristics of Frontotemporal dementia?
Can cause early personality changes, eg. aggression and disinhibition
221
What are some non-motor symptoms of Parkinson's?
1. Depression
2. Constipation
3. REM sleep disorder
4. Postural hypotension
222
What is the only life prolonging medication in MND?
Riluzole
223
How does Guillain Barre tend to present?
Weakness in the toes to nose fashion
224
What is Charcot Marie Tooth?
Inherited condition that causes nerve damage
225
What are some symptoms of Charcot Marie Tooth?
1. Weakness / Numbness in the legs and arms
2. Usually presents in children under 10
226
What is 1st line treatment for tonic-clonic seizures?
Sodium Valproate
227
What is the 1st line treatment for women of child bearing age for tonic-clonic seizures?
Lamotrigine
228
What causes Alzheimer's disease?
Beta amyloid plaques and Tau neurofibrillary tangles in the brain that disrupt the neural network and lead to memory issues
229
What sort of dementia is Parkinson's linked to?
Lewy-body
230
What test can be used to test for Carpal Tunnel?
Phalen's test
