Quick facts Flashcards
(268 cards)
1
Q
Which area of the bowel is most commonly affected by ischaemic colitis
A
Splenic flexure (watershed area)
2
Q
XR signs of ischaemic colitis
A
Thumbprinting
3
Q
Which malignancy are patients with Sjogren’s syndrome at greater risk of?
A
Lymphoma / lymphoid malignancies
4
Q
Aetiology of pemphigus vulgaris
A
Antibodies against desmoglein 3
5
Q
Clotting screen abnormality in Von Willebrands disease
A
Mildy elevated APTT
6
Q
Most aggressive type of melanoma
A
nodular
7
Q
Cells responsible for hyperacute organ rejection
A
B cells
induce a reaction normally within minutes or hours of the transplant
8
Q
How long before a patient with a resolved pneumothorax should fly?
A
2 weeks
9
Q
Which marker raises first after a myocardial infarction
A
myoglobin
10
Q
Which type of pneumonia causes red blood cell agglutination
A
Mycoplasma pneumoniae
Promotes production of IgM antibodies (cold agglutinins)
11
Q
Translocation associated with Burkitt’s lymphoma
A
c-myc gene translocation, usually t(8:14).
12
Q
Disease with ‘starry sky’ appearance on microscopy
A
Burkitt’s lymphoma
13
Q
Translocation and disease associated with Philadelphia chromosome
A
t(9:22)
chronic myeloid leukaemia
14
Q
What is the ABG picture in hypoventilation
A
Respiratory acidosis
15
Q
What kind of skin cancer has keratin pearls on histopathology
A
SCC
SCCs arising in a chronic scar are typically more aggressive and carry an increased risk of metastasis
16
Q
Most common non-iatrogenic cause of Cushing’s syndrome?
A
Pituitary tumour = Cushing’s disease (80%)
Adrenal adenoma (10%)
17
Q
What conditions are pyoderma gangrenosum linked to?
A
IBD (UC, Crohn’s)
RA, SLE
PBC
18
Q
Other features of ulcerative colitis
A
Large joint arthritis
Sacroilitis
Pyoderma gangrenosum
19
Q
Which TCA is most dangerous in overdose
A
Dosulepin
20
Q
What might cause a false negative Coeliac’s serology test?
A
IgA deficiency as TTG is an IgA antibody
21
Q
Endoscopic biopsy findings in Coeliac’s
A
Gold standard Ix
Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes
22
Q
Which antibiotics might have a crossover with a Penicillin allergy
A
Cephalosporins e.g. cefalexin, Ceftriaxone
Carbapenems
All beta-lactam antibiotics
23
Q
Which infections are patients with a splenectomy particularly at risk of?
A
Pneumococcus
Haemophilus
Meningococcus
24
Q
Prophylaxis and vaccines for patients undergoing splenectomy
A
Hib, meningitis A&C
Annual influenza
Pneumococcal every 5 years
Pen V
25
H. Pylori associations
Duodenal and Gastric Ulcers
Gastric cancer
B cell lymphoma of MALT tissue
Atrophic gastritis
26
Management of H. Pylori
PPI
Amox
Clari or Metro (or both if pen allergic)
27
Tx of scabies
5% Permethrin
All skin including scalp
Leave on for 12 hours
Repeat in 7 days
28
Signs of Wilson Disease
Neuropsychiatric Sx
Kayser-Fleischer rings
Liver disease - hepatitis, cirrhosis
Ix - reduced serum caeruloplasmin, reduced serum copper, increased urinary excretion
29
Inheritance pattern of Wilson's disease
Autosomal recessive
Increased copper absorption
Reduced hepatic copper excretion
ATP7B, chromosome 13
30
Mx of Wilson's disease
Penicillamine / Trientine hydrochloride +/- tetrathiomolybdate
Chelates copper
31
Causes of foot drop
Most commonly - common peroneal nerve lesion
32
Tx of cerebral oedema in patients with brain tumours
Dex
33
Presentation of mercury poisoning
Visual field defects
Hearing loss
Paraesthesia
High chloride
Metabolic acidosis
34
Presentation of lead poisoning
Abdo pain
Constipation
Neuropsych Sx
Blue gum margin
35
How does St John's Wort affect P450 system?
Inducer (decreasing levels of drugs such as warfarin, COCP etc.)
36
Onset of Sx in alcohol withdrawal
Sx from 6-12 hours
Seizures from 36 hours
Delirium tremens from 48-72 hours
37
Conversion of PO to SC/IV morphine
2:1 (half PO dose)
38
Treatment of ITP
Oral pred
IV Ig is 2nd line / given in severe bleeding
39
Drug causes of liver cirrhosis
Methotrexate
Methyldopa
Amiodarone
40
Management of genital warts
Multiple, non-keratinised --> topical podophyllum
Single, keratinised --> cryotherapy
41
Mx of Myaethenic crisis
Plasmapheresis or IV Ig
42
Presentation of myaethenia gravis
Muscle fatiguability
Insufficient functioning acetylcholine receptors
43
Mx of Myasthenia Gravis
Long acting acetylcholinesterase inhibitors e.g. pyridostigmine
+/- pred
44
Cause of CLL
Monoclonal proliferation of B-cell lymphocytes
45
Ix for CLL
Lymphocytosis, anaemia, thrombocytopenia
Smudge cells on blood film
Immunophenotyping is key
46
Tx of essential tremor
Propanolol
Primidone if asthmatic
47
Presentation of acoustic neuroma / vestibular schwannomas
Vertigo
Hearing loss
Tinnitus
Absent corneal reflex
--> MRI of cerebellopontine angle
48
Mx of Meniere's disease
Acute - prochlorperazine
Prevention - betahistine
49
Ix findings in dermatomyositis
Elevated CK
ANA +ive 60%
Anti-Mi-2 (highly specific, 20%)
Tx - pred
50
Test prior to starting Azithromycin
ECG - to rule out prolonged QT
LFTs
51
Secondary prevention of MI
Dual anti-platelet
ACE-I
BB
Statin
52
What causes amiodarone to have a long half life
Extensive lipid binding resulting in extensive tissue distribution
53
Endocarditis pathogen associated with poor dental hygiene
Strep mitis (subtype of strep viridans)
54
Mx of stable angina
Bisoprolol (BB) or Amlodipine (CCB) for prevention
(Aspirin and statin)
GTN
55
ECG changes in hypokalaemia
In hypokalaemia, U have no Pot and no T, but a long PR and a long QT
56
Measure of QT interval
Start of Q to end of T
57
MOA of loop diuretics
Inhibits Na-K-CL co-transporter in the thick ascending limb of the loop of Henle
58
What does troponin T bind to?
Tropomyosin
59
main constituent of Pulmonary surfactant
main constituent is dipalmitoyl phosphatidylcholine (DPPC)
60
What condition is adenomatous polyposis coli gene (APC) associated with?
FAP
Autosomal dominant
Hundreds of polyps in the large intestine
Increased risk of CRC
61
Which condition is DNA mismatch repair protein linked to?
Lynch syndrome
Autosomal dominant
Increased risk of CRC in proximal colon
62
Genotype of sickle cell disease
HbAS - trait. asymptomatic
HbSC - moderate
HbSS - severe disease
63
Presentation of methanol poisoning
Metabolic acidosis
Reduced vision
Poorly reactive pupils
64
Features of otosclerosis
Autosomal dominant
Young adults
Conductive deafness
65
Complications of polycythaemia rubra vera
Myelofibrosis, AML
Tx with aspirin, venesection and hydroxyurea
66
Cause of slow-rising pulse
Aortic stenosis
67
Cause of collapsing pulse
aortic regurg
PDA
68
Cause of pulsus alternans
Severe LVF
69
Causes of jerky pulses
HOCM
70
Which CCBs should not be used with betablockers
Verapamil or Diltiazam
(Non-dihydropyridine CCBs)
71
Treatment of Patent ductus arteriosus in newborns
Ibuprofen
Indomethacin
72
ECG changes seen in hypercalcaemia
Shortening of QT interval
Prolonged PR
Widened QRS
ST elevation
73
Define cardiac syndrome X
Microvascular angina
Normal ECG, normal coronary angiogram
ST depression on exercise stress testing
74
How to determine 4th line management of HTN
K <4.5 --> spiro
K >4.5 --> beta-blocker / alpha-blocker
75
Other cause of ejection systolic murmur
Atrial septal defects (louder on inspiration, fixed split S2)
76
Initial blind therapy in infective endocarditis
Amox +/- Gent
Pen allergic --> Vanc + Gent
Prosthetic valve --> Vanc, Rifampicin + Gent
77
Abx in IE due to staph (native vs prosthetic valve)
Native - Fluclox
(Vanc + Rifampicin if pen allergic)
Prosthetic - Fluclox + Rifampicin + Gent
(Vanc + Rifampicin + Gent if pen allergic)
78
Abx Tx in fully sensitive strep
Benpen - add Gent if partially sensitive
(Vanc + Gent if pen allergic)
79
Cause of bisferiens pulse
Mixed aortic valve disease
80
Recent MI + Persistent ST elevation + No CP
Left ventricular aneurysm
- High risk of thrombus formation
- Should receive anti-coag
81
Triad of cardiac tamponade
Falling BP
Rising JVP
Muffled heart sounds
Beck's triad
recognised complication of PCI
82
Causes of 'a' wave on JVP
Large due to raised atrial pressure e.g. tricuspid stenosis, pulmonary stenosis, pulmonary HTN
83
Causes of cannon 'a' waves on JVP
Atrial contractions against a closed tricuspid
Complete heart block, ventricular tachycardias/ectopics, nodal rhythm, single chamber ventricular pacing
84
Features of severe aortic stenosis
Narrow pulse pressure
Slow rising pulse
Soft S2
Present S4
85
Cause of U waves
Hypokalaemia
Due to delayed ventricular repolarisation
86
Cause of delta waves
WPW
87
ECG changes in pericarditis
PR depression - most specific for percarditis
Saddle-shaped ST elevation
88
Which meds should be avoided in HOCM
ACE-inhibitors
Nitrates
Nifedipine/ Dihydropyridine CCB
89
Which blistering skin condition involves the mucosa
Pemphigus vulgaris
90
Tx of fungal nail infection
Mild - topical treatment (6 months fingernails, 9-12 months for toenails)
Extensive - oral terbinafine (3-6 months)
91
What can exacerbate plaque psoriasis
Alcohol
Ace-inhibitors, Beta-blockers and NSAIDs
Lithium
Anti-malarials
92
What is urticaria pigmentosa and what disease is it caused by
affected skin undergoes whealing upon rubbing
due to systemic mastocystosis
Diagnosis made by urinary histamine
93
Causes of eczema herpeticum
HSV 1 or 2
Coxsackie virus
94
Tx of lichen planus
Potent topical steroids
95
Which cancer and conditions are associated with Acanthosis nigricans
Gastric cancer
T2DM, PCOS, Acromegaly, Cushing's, Hypothyroidism
COCP
96
Tx of rosacea
Topical ivermectin
Oral Doxy
97
Presentation of hereditary haemorrhagic telangiectasia
Autosomal dominant
Epistaxis, Telangiectasia, AV malformations
98
Why does severe hyponatraemia cause confusion
Cerebral oedema
99
What happens if hyponatraemia is correctly too rapidly
Central pontine myelinolysis
100
Differentiating MODY vs LADA
Maturity onset diabetes of the young - autosomal dominant, slim individuals, polyuria, polydispia, recurrent balanitis --> Mx Sulphonylrureas
Latent autoimmune diabetes of adults - overweight individuals
101
MOA mirabegron
Beta-3 agonist
Used in urge incontinence
102
Tx of stress incontinence
Pelvic floor exercises
Duloxetine
+/- surgery
103
Tx of urge incontinence
Bladder retraining
Oxybutynin 1st line
Mirabegron
Tolerodine
104
Liddle's syndrome
Rare autosomal dominant condition
HTN + hypokalaemic alkalosis
Tx - amiloride or triamterene
105
Which conditions cause hypercholesterolaemia (as opposed to hypertriglyceridaemia)
Nephrotic syndrome
Cholestasis
Hypothyroidism
106
Tx of infertility in PCOS
Clomifenere (or Metformin)
107
Sick euthyroid syndrome
Reversible state
Abnormal thyroid function tests due to non-thyroidal illness
No pre-existing thyroid issues
TSH - normal, T4 and T3 - low
108
Most common cause of primary hyperaldosteronism (Con's)
Bilateral idiopathic adrenal hyperplasia (60-70% of cases)
Adrenal adenoma (20-30% of cases)
HTN + Hypokalaemia
Mx - surgery or aldosterone antagonist e.g. spironolactone
109
Signs of congenital adrenal hyperplasia
Irregular menses, acne, hirsutism, early breast and pubic hair development, clitoromegaly and male-pattern baldness
Due to 21-hydroxylase deficiency
110
Tx of gestational diabetes
Dx with FG >5.6 and 2hr >7.8
Fasting Glucose:
< 7 - diet and exercise trial
>7 - insulin
6-6.9 + foetal complication - insulin
If after a couple of weeks of trial, FG remains >5.3 --> add metformin --> add insulin
111
Indications for hyperparathyroidism surgery
<50yrs old
adj Calcium >0.25 above upper range
eGFR <60
Renal stones
Osteoporosis or #
Symptomatic disease
112
Safe thyroid medications in pregnancy
1st trimester - propylthiouracil
2nd trimester - switch to carbimazole
113
Cancer assocaited with Hashimoto's thyroiditis
MALT (mucosa-assocaited lymphoid tissue) lymphoma
Malignancy arises due to chronic inflammation of thyroid
Presents as thyroid lump - USS and FNA
114
Presentation of anaplastic thyroid carcinoma
Rapidly enlarging neck mass + compression associated symptoms
115
Riedel's thyroiditis
Normal thyroid tissue is replaced with dense fibrotic tissue that extends beyond the thyroid capsule
results in a hard woody thyroid gland and compression sx
116
Tx of diabetic neuropathy
Amitriptyline (avoid in BPH --> retention)
Duloxetine
Gabapentin
Pregabalin
117
Which cardiac medication can cause gynaecomastia
Digoxin
118
Signs of pseudohypoparathyroidism
target cells insensitive to PTH
Ass. w/ low IQ, short stature, shortened 4th and 5th metacarpals
Low calcium, high phosphate, high PTH
119
Addison's disease
Primary hypoadrenalism
Reduced cortisol and aldosterone
120
Side effects of radioiodine treatment
Worsening of thyroid eye disease
121
Bartter's syndrome
Polyuria and polydipsia
Hypokalaemia
Normotension
Weakness
Autosomal recessive - defect in Na-K-SCL co-transporter
122
Primary Ix for Con's
Plasma renin:aldosterone ratio
(Results can be interfered with by any meds that involved RAAS e.g. ACE-i, ARBs, spiro)
Causes include adrenal adenoma or bilateral adrenal hyperplasia
123
Mx of hypercalcaemia
IVF first to correct any dehydration
Can use bisphosphonates once adequately hydrated
Furosemide can sometimes play a role
124
Causes of Pseudohyperkalaemia
Haemolysis
Myeloproliferative disorders e.g. thrombocytosis
125
Inheritance of familial hypercholesterolaemia
Heterozygous
Autosomal dominant
126
Which type of thyroid cancer is associated with RET Oncogene
Medullary - associated with MEN2
Encodes a tyrosine kinase receptor
127
Define Impaired fasting glucose
Due to hepatic insulin resistance
Fasting glucose 6-7
128
Define impaired glucose tolerance
Due to muscle insulin resistance
Fasting glucose <7 + OGTT 2hr >7.8
129
Presentation of subacute thyroiditis
tender goitre
hyperthyroidism
raised ESR
Technetium thyroid scan - globally reduced uptake (due to inflammation/destruction of thyroid tissue)
130
Kallman's syndrome
Pubertal delay and poor secondary sexual development
Anosmia, cleft palate
Low FSH, LH and testosterone --> hypogonadotropic hypogonadism
X-linked inheritance
131
Klinefelter syndrome
Delayed pubertal development and small testes
Raised FSH and LH but low testosterone --> Hypergonadotropic hypogonadism
132
Nuclear scintigraphy scan for toxic multinodular goitre
Patchy uptake
133
Causes of HTN + Hypokalaemia
Conn's syndrome (high aldosterone, low renin)
Cushing's syndrome (high aldosterone, low renin)
Liddle's syndrome (low aldosterone, low renin)
11-beta hydroxylase deficiency
134
Commonest types of inherited colon cancer
Hereditary non-polyposis CRC (5%)
Familial adenomatous polyposis (<1%)
135
RF for eosinophilic oesophagitis
Dysphagia
Young males
Hx of allergies/eczema/asthma
Initial Mx - dietary changes and steroids, if Sx not improving then dilatation
136
What deficiency causes haemochromotosis
HFE (the protein that regulates iron absorption) - autosomal recessive, chromosome 6
Presents with multi-system dysfunction e.g. DM, ED, HF, liver disease, arthritis, hypogonadism + TAN
137
Which deficiency causes Wilson's disease
ATP7B, autosomal recessive, chromosome 13
Usually presents with neurological disease, liver disease, Kayser-Fleischer rings, blue nails
Tx - Penicillamine
138
Which deficiency causes Gilbert's disease
Glucuronyl transferase deficiency
139
Presentation of re-feeding syndrome
Symptoms mainly due to low phosphate (although low magnesium and potassium are often also present)
Feeding causes reactive hyperinsulinaemia
Results in low phosphate
Leads to heart failure and skeletal muscle weakness
140
Associated conditions with PBC
Sjogrens (80%)
RA
Systemic sclerosis
Thyroid disease
141
Treatment of recurrent C. Diff infections
Bezlotoxumab
142
Mx of SBP
IV Cefotaximine
143
Presentation of Peutz-Jegher's syndrome
Autosomal dominant
Numerous hamartomatous polyps in the GI tract
Pigmented freckles on the lips, face, palms and soles
High risk of CRC
144
Vitamin supplementation required in gastric bypass patients
Iron
Calcium
(Absorbed in the duodenum)
145
Which vaccination should Coeliac disease patients receive?
Pneumococoal every 5 years
Influenza every year
Repeat Hep B vaccine once on a gluten free diet
Coeliacs --> hyposplenism
146
Prophylaxis of variceal haemorrhage
Propanolol
Endoscopic variceal band ligation
Transjugular Intrahepatic Portosystemic Shunt
147
Indicators of severe pancreatitis
Age > 55
WCC >15
Calcium <2
Urea >16
LDH >600
Albumin <32
Glucose >10
148
Budd-Chiari syndrome
Hepatic vein thrombosis
Causes: pregnancy, COCP, malignancy, polycythaemia
Sx - sudden onset abdo pain, ascites and tender hepatomegaly
Bloods - sig. raised ALT
Dx - doppler US liver
149
Most common complication of ERCP
Acute pancreatitis
150
Presentation of Primary Biliary Cholangitis
Fatigue amd pruritus
Cholestatic LFTs (ALP, GGT)
Anti-mitochondrial antibody positive (M2)
IgM
Middle aged females
Tx - ursodeoxycholic acid
151
Test/Signs of chronic pancreatitis
CT pancreas
Shows calcification
152
How does C. Diff spread
Faecal-oral route
Ingestion of spores
153
Signs of Whipples Disease
Chronic curable systemic bacterial infection
Chronic diarrhoea +/- steatorrhoea
Weight loss
Arthralgia
Lymphadenopathy
Ophthalmoplegia - supranuclear gaze palsy
154
Sx of Still's disease
Fever
Joint pain
Salmon-coloured bumpy rash
155
Zollinger-Ellison Syndrome
Excessive gastrin secretion from tumour in duodenum or pancreas (increased hydrogen secretion from gastric parietal cells)
Sx - multiple gastro/duodenal ulcers, diarrhoea and malabsorption
Dx - fasting gastrin levels
30% of cases occur as part of MEN1
156
Carcinoid syndrome
Flushing
Diarrhoea
Bronchospasm
Hypotension
Right heart valvular stenosis
Pellagra
Ix - urinary 5-HIAA
Mx - somatostatin analogue e.g. octreotide
157
Commonest bacteria in SBP
E. Coli
158
How is haemochromatosis monitored
Transferrin saturation and serum ferritin
159
Grading severity of UC
mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
160
Abx for liver abscess
Amox + Cipro + Metro
(Cipro and Clinda if pen allergic)
161
BMI cut off for referral for bariatric surgery
BMI 35 + as well as RF (T2DM, HTN)
BMI 40 + (if no RF)
162
Mx of ascites 2ndary to liver cirrhosis
Aldosterone antagonist e.g. spironolactone
163
Presentation of Cholangiocarcinoma
Palpable gallbladder + painless jaundice
Raised CA 19-9
Anorexia and weight loss
PSC is the main RF
164
Microscopic colitis
Chronic diarrhoea, mildly elevated faecal calprotectin and ESR
Causes: PPIs
Ix - colonoscopy and biopsy
165
Osteoarthritic and skin changes in haemochromatosis
Hook like osteophytes at the 2nd and 3rd digits of MCP joints
Slate-grey appearance
Monitor with transferrin saturation (and can test ferritin)
166
What need to be check with TTG levels
IgA
167
Presentation of schistosomiasis/ Katayama fever
fever
myalgia
cough
diarrhoea
urticarial rash
hepatosplenomegaly
Bloods - eosinophilia
CXR - B/L pulmonary infiltrates
Tx - Praziquantel
168
Presentation of leptospirosis
Transmitted through rat urine
Sewage workers at risk
Lower back pain, fever, myalgia, fatigue, jaundice and subconjunctival haemorrhage
169
Causes of bloody diarrhoea
Shigella
Amoebic dysentery
Enterohaemorrhagic E. Coli
Possibly Campylobacter
170
Which HPV causes genital warts
HPV 6 and 11
171
Tx of Amoebiasis
7 days oral metronidazole or tinidazole (for invasive stage)
Followed by 10 days Diloxanide (for cystic stage)
172
HIV
RNA retrovirus
HIV 1 is more severe than HIV 2
Leads to depletion of T Cells
Enters the cell via CD4 receptor
173
Tx for animal or human bites
Co-Amox
174
Jarisch-Herxheimer reaction
Seen following treatment of syphilis
Thought to occur due to release of endotoxins
Fever, rash, tachycardia
Can give paracetamol if needed
175
Tuberculoid leprosy
Limited number of skin lesions
Hyperaesthesia
Hair loss
176
Most common organism found in central line infections
Staph epidermidis
177
Chest infection common in HIV patients
Pneumocystis jiroveci
Pneumothorax is a common complications
178
Common causes of UTI in young SA women
E. Coli (gram-negative)
Staphylococcus saprophyticus (gram positive, coagulase-negative)
179
Most common organism in animal bites
Generally polymicrobial
Pasteurella mutocida
180
Tx of trichomonas vaginalis
Oral Metronidazole
181
Tx of gonorrhoea
IV Ceftriaxone
182
Presentation of yellow fever
Flu-like illness
Brief remission
Development of jaundice and haematemesis
183
Live attenuated vaccines
MMR
BCG
Yellow fever
Oral - typhoid, polio, rotavirus
184
Mx of viral meningitis
Self-limiting
Supportive care
185
Cause of rocky mountain spotted fever
Rickettsia ricketsii
186
Cause of endemic vs epidemic typhus
Endemic - Rickettsia typhi
Epidemic - Rickettsia prowazekii
187
Hookworm presentation
Iron deficient anaemia
Eosinophilia
Rash
Ix - stool sample for ova, cysts and parasites
188
Tx of severe campylobacter
Clarithromycin or azithromycin
189
Tx of toxoplasmosis
Only indicated in severe infections or immunocompromised patients
6 weeks of pyrimethamine and sulphadiazide
190
Common organism in human bites
Eikenella corrodens
Strep spp.
Staph aureus
Fusobacterium
Prevotella
191
Types of schistosomiasis infections
Schistosoma haematobium - bladder ca, calcification
Schistosoma mansoni and japonicum - inhabit protal system --> hepatosplenomegaly, liver cirrhosis, cor pulmonale
192
Tx of gonorrhoea
IM Ceftriaxone
193
SE of tetracyclines
Photosensitivity
194
UTI in pregnancy
Oral Nitro (Trimethoprim CI)
195
Most severe complication of Chagas disease
Cardiomyopathy
196
Tx of aspergilloma
Surgical resection
197
What are the 4 variable use to calculate eGFR
Creatinine
Age
Gender
Ethnicity
198
Nephropathy associated with malignancy
Membranous nephropathy
199
Indications for renal replacement therapy
Hyperkalaemia
Metabolic acidosis
Complications of uraemia e.g. pericarditis, encephalopathy
Severe pulmonary oedema
AND refractory to medical management of these conditions
200
Cause of nephrotic syndrome in HIV
Focal segmental glomerulosclerosis (FSGS)
201
Defect in Alport's syndrome
Type IV collagen
202
Causes of nephrogenic DI
Hypercalcaemia
Hypokalaemia
Lithium
Demeclocycline
Tubulo-interstitial disease - obstruction, sickle-cell, pyelonephritis
203
Sx of Haemolytic uraemic syndrome
Microangiopathic haemolytic anaemia
Thrombocytopenia
Renal impairment
Typically 2ndary to GI infection
Tx - eculizumab
204
Most common bacteria in peritonitis secondary to peritoneal dialysis
Coagulase negative staph
Tx - Ceftazidime + Vanc added to dialysis fluid
205
Valve disease associated with ADPKD
Mitral valve prolapse
206
Extra-renal manifestations of ADPKD
Liver cysts
Berry aneurysms
Mitral valve prolapse/incompetence
Aortic root dilation
Aortic dissection
207
Anti-GBM disease
Small vessel vasculitis
Pulmonary haemorrhage
Rapidly progressive glomerulonephritis
Anti-GBM antibodies against type IV collagen
IgG deposit along basement membrane
Raised transfer factor
Mx - plasma exchange, steroids, cyclophosphamide
208
Differentiating Conn's from renal artery stenosis
Both low potassium and high aldosterone
Conn's - low renin
RAS - high renin
(Bartter's is the same as RAS but pt is normotensive)
209
Most common cause of nephrotic syndrome in children
Minimal change disease
210
Tumour markers in testicular cancer
Seminomas - hCG
Non-seminomas - AFP +/- hCG
LDH is raised in approx. 40%
211
Features of fibromuscular dysplasia
Young female
HTN
Asymmetrical kidneys
212
Which glomerulonephritis is associated with SLE?
Diffuse proliferative GN
213
Why are patients will nephrotic syndrome predisposed to clots
Loss of anti-thrombin-III, protein C and S
Rise in fibrinogen levels
214
Chromosome affected in ADPKD Type 1 vs 2
Type 1 - chromosome 16 (85% of cases)
Type 2 - chromosome 4 (15% of cases)
215
Most common causes of nephrotic syndrome in adults
focal segmental glomerulosclerosis
Membranous glomerulopathy
216
How to calculate anion-gap
(sodium + potassium) - (chloride + bicarb)
Normal is 10-18
217
Causes of normal anion gap
prolonged diarrhoea
uterosigmoidostomy
fistula
renal tubular acidosis
acetazolamide
addison's
218
causes of raised anion gap
lactate e.g. shock, sepsis and hypoxia
ketones e.g. DKA, alcohol
urate e.g. renal failure
acid poisoning e.g. salicylates, methanol
219
Conditions associated with IgA nephropathy
Alcoholic cirrhosis
Coeliac disease
HSP
220
Presentation of IgA nephropathy
Macroscopic haematuria
Young person
Usually after an URTI
221
Antibodies present in idiopathic membranous GN
Anti-phospholipase A2
222
How does lithium cause Diabetes Insipidus
Desensitises the kidneys ability to respond to ADH
223
Which glomerulonephritis is associated with heroin use
FSGN
224
Prevention of stones (calcium, uric acid, oxalate)
Calcium stones - thiazide diuretics
Uric acid stones - allopurinol, oral bicarb
Oxalate - cholestyramine, pyridoxine
225
Factors that may affect eGFR
Pregnancy
Muscle mass
Eating red meat prior to sample
226
What is a staghorn calculus made of?
Struvite - magnesium ammonium phosphate
227
Calciphylaxis
Complication of end-stage renal disease
Necrotic, progressive skin ulcer, reticular pattern
Painful
228
Treatment of minimal change disease
Steroids
229
Henoch-Schonlein purpura
IgA mediated
Purpuric rash, abdo pain, polyarthritis
Features of IgA nephropathy - haematuria, renal failure
Biopsy - mesangial hypercellularity
230
Signs of CMV infection
Often in immunocompromised patients
Fever, deranged LFTs, leukopenia, thrombocytopenia
Tx - ganciclovir
231
Nephritic syndrome + URT signs
Granulomatous with polyangiitis
Crescents on renal biopsy
Ass. w/ cANCA
(Anti-GBM presents with pulmonary haemorrhage)
232
Which med is CI in absence seizures
Carbamazepine
Ethosuximide is gold standard
233
Which area of the brain causes expressive aphasia
Broca's area - inferior frontal gyrus, posterior/lateral frontal lobe
234
Positive Rinnes test
air cond. > bone cond.
normal or indicates SNHL
235
Negative Rinnes test
air cond. < bone cond.
Conductive HL
236
Tx of Ramsay-Hunt
Oral aciclovir and corticosteroids
237
Myotonic dystrophy
Ptosis, cataracts
Dysarthria
Distal weakness
DM
Heart block or caridomyopathy
Dysphagia
Autosomal dominant - presents around 20-30 years old
238
Neurofibromatosis Type 1
Neurofibromas of the skin
Cafe au lait spots
Lisch nodules
Optic gliomas
239
Neurofibromatosis Tpye 2
Schwannomas
Meningioma
Acoustic neuromas - SNHL
240
Sturge-Weber Syndrome
Developmental delay
Port-wine stains
Glaucoma
Seizures
241
Tuberous sclerosis
Angiofibromas and moles
Development delay
Epilepsy
242
Von Hippel Lindau Syndrome
Patients develop multiple cysts and tumours
Subarachnoid haemorrahge (2ndary to haemangiomas)
Vitreous haemorrhage
Phaeochromocytoma
RCC
Cysts in pancreas, liver and epididymis
243
Which migraine med can cause acute angle closure glaucoma
Topiramate
244
Stroke prophylaxis
Clopi +/- statin if appropriate
245
Conjugate gaze palsy
Ipsilateral loss of adduction
Contralateral abduction nystagmus
Medial longitudinal fasciculus affected
In paramedian area of midbrain and pons
246
First line Tx of myoclonic seizures
Sodium valproate
247
Miller-Fisher variant
Type of GBS
Starts by affecting cranial nerves --> eye signs
Usually preceded by an infection
248
Normal pressure hydrocephalus
Urinary incontinence + Gait abnormality + Dementia
'Magnetic gait'
249
Most common subtype of Motor Neuron Disease
Amyotrophic lateral sclerosis (50% of patients)
250
Tx. of restless leg syndrome
Ropinorole - dopamine agonist
251
Causes of raised lymphocytes in CFS
Viral/TB/Bacterial meningitis/encephalitis
Lyme disease
Behcet's disease
SLE
Lymphoma or leukaemia
252
Lambert-Eaton Syndrome
Muscle weakness
Improves with repetition
Hyporeflexia
Dry mouth, impotence and difficulty PU
Antibodies against voltage gated calcium channels
253
Ix for suspected SAH
CTH
If NAD <6hrs - consider other Dx
If NAD >6 - perform LP 12hrs after onset of Sx
254
Von Hippel-Lindau Syndrome
Episodic HTN
Sweating
++HTN
Phaeochromocytoma
RCC
255
Myasthenia Gravis
Autoimmune - antibodies to Acetylcholine receptors
Progressive weakening of muscles
Diplopia
Ptosis
Dysphagia
Mx - pyridostigmine
256
Causes of gingival hyperplasia
Phenytoin
Ciclosporin
Calcium channel blockers
AML
257
Vessel damaged in extra-dural haemorrhage
Middle meningeal artery
258
cluster headaches tx
Acute - SC sumatriptan + O2
Prevention - verapamil
259
Eye sign in raised ICP
Down and out eye - CNIII palsy
Occurs due to herniation
260
Abx Mx of brain abscess
Cephalosporin
Metronidazole
261
Sx of GBS
Flaccid paralysis
Hyporeflexia
Tachycardia
Urinary retention
Nerve conduction studies - reduced velocity
262
Cause of chorea
Damage to basal ganglia inc. caudate nucleus
263
Sx of Creutzfeldt-Jakob disease
Rapid onset dementia
Myoclonus
264
Sign of HSV encephalitis
Temporal lobe changes on CTH
265
Columns affected in subacute combined degeneration of the cord
Dorsal and lateral
Dorsal - impaired proprioception and vibration sense
Lateral - motor impairment
(Anterior - pain, temp, coarse touch and pressure)
266
Syringomyelia
collection of CSF within the spinal cord
- cape-like loss of sensation to temp
267
Weakness of intrinsic muscles of the hands
T1 lesion
268
MRI signs of Wernicke's
Enhancement of the mamillary bodies
