Random Flashcards
1
Q
what is type 1 hypersensitivity?
A
short onset
ige
allergy etc
2
Q
what is type 2 hypersensitivity?
A
igG/igM
hours - days
haemolytic anaemia
3
Q
what is type 3 hypersensitivity?
A
weeks
immune complex
SLE
4
Q
what is type 4 hypersensitivity?
A
T cells
weeks
rash
stevens johnson
5
Q
how does ADH affect portal blood pressure?
A
decreases portal blood flow
6
Q
blood supply to foregut eg stomach is provided by ___
A
coeliac artery
7
Q
Humeral neck fracture = damage to what?
A
axillary nerve / artery / vein
8
Q
midshaft humeral neck fracture = damage to what?
A
radial nerve
9
Q
suprachondular humeral fracture = damage to what?
A
median nerve
brachial artery
maybe ulnar
10
Q
what is odansetron?
A
5HT3 antagonist
antiemetic
11
Q
what is cyclizine?
A
H1 antagonist
antiemetic
12
Q
what is metoclopramide?
A
D2 antagonist
anti emetic
13
Q
metaplasia vs dyspasia?
A
metaplasia = transformation into another cell type dysplasia = dodgy change
14
Q
what biomarker for ovarian cancer?
A
ca125
15
Q
what is cea a biomarker for?
A
colon/bowel
16
Q
what is epithelium in oesophagus made from?
A
stratified squamous
non keratinised
17
Q
where is transitional epithelium?
A
bladder
called transitional because it looks different when bladder is bigger
18
Q
what is the most important IMMEDIATE treatment for sepsis?
A
fluids
19
Q
what does hyperparathyroidism look like on ECG?
A
high PTH = high calcium
tall T and short QT
20
Q
drugs ending in -azole are?
A
antifungals
21
Q
definition of sensitivity and specificity?
A
sensitivity = number of true positives specificity = number of true negatives
22
Q
define prevalence and incidence?
A
prevalence = number of cases today incidence = number of new cases today
23
Q
how to calculate the amount of units in alcohol?
A
% x ml / 1000
24
Q
autonomy is..
A
allowing patients with capacity to have an input in their care
(must have capacity to have autonomy)
25
diadepesis is?
when neutrophils attract other inflammatory cells
26
treatment for hypercalcaemia?
fluids
if severe / symptoms you can use bisphosphonates & calcitonin
(calcitonin is released from C cells in the thyroid and lowers blood calcium)
27
cold peripheries are associated with what thyroid pathology?
hypothyroid (cold intolerance)
28
the MRC score is for..
breathlessness
| 1 is fine, 5 is cannot leave house
29
what is Felty's syndrome?
rheumatoid arthritis
splenomegaly
neutropenia
30
what does a claw hand / unable to cross fingers / forearm flexor wasting / poor grip indicate damage to?
ulnar nerve
31
what does unable to open jam jar / poor grip / thenar muscle wasting indicate damage to?
median nerve
32
what is the usual 1st line SSRI for depression?
| & a side effect?
fluoxetine
| sleep disturbance / random dreams / ulcers
33
what is citalopram? what is a side effect?
SSRI for depression/anxiety
arrythmias
34
what are venlafaxine and duloxetine?
SNRI - serotonin noradrenaline reuptake inhibitors
primarily use for depression
raised BP
35
what class is amytriptilline?
TCA - tricyclic antidepressant
36
which antidepressants cannot be taken with lots of cheese etc?
MAOI - monoamine oxidase inhibitors eg phenelzine
37
what should you do before prescribing antidepressants?
- warn the patient they can cause increased anxiety/suicide for first few weeks
- warn patient they take 3-4 weeks to work
- make sure pt knows where to find help if they suicidal
- consider other treatment eg CBT
- tell patient not to stop them abruptly, they need to be tapered
38
what is sertraline?
SSRI
39
presentation of depression?
```
Low mood
Anhedonia, a lack of pleasure in activities
Low energy
Anxiety and worry
Irritability
Avoiding social situations
Hopelessness about the future
Poor sleep, particularly early morning waking
Poor appetite or over eating
Poor concentration
Physical symptoms such as abdominal pain
```
40
risk factors for depression?
stressful life events eg loss of a partner
family history
living alone
chronic disease
parental drug/alcohol abuse / childhood neglect
alcohol
Cushing's / overuse of steroids
41
what 2 questionnaires can be used to assess depression?
PHQ 9
| GAD 7
42
what 2 questionnaires can be used to assess depression?
PHQ 9
| GAD 7
43
how are BRCA 1 and BRCA 2 inherited?
autosomal dominant
44
BRCA1 and BRCA 2 increase the risk of which cancers?
```
breast
ovarian
prostate
skin
digestive tract
```
45
what is the function of BRCA 1 and BRCA2 proteins?
repair double stranded breaks in DNA
46
a 'triple negative' breast cancer does not express receptors for:
progesterone
oestrogen
her 2
triple neg usually BRCA 1
47
5 risk factors for breast cancer?
```
alcohol
smoking
obesity
BRCA1/2, TP53 etc
family history
radiation (eg several CXR)
chemotherapy eg for Hodgkins
diabetes
female
dense/glandular breasts
gynaecomastia
ashkenazi jew
```
48
what are the signs of breast cancer?
```
nipple inversion
dimples
palpable lump
nipple/areolar exczema
unilateral nipple discharge
axillary lump
change in breast size
```
49
T classification for breast cancer?
1 - less than 2cm
2 - 2-5cm
3 - 5cm +
4 - metastasised
50
treatment for oestrogen receptor positive breast cancer?
tamoxifen - for pre menopausal (selective oestrogen receptor antagonist/SERT)
letrozole/aromatase inhibitor for post menopausal (after menopause aromatase is the main source of oestrogen)
51
treatment of HER-2 receptor positive breast cancer?
herceptin (trastuzumab)
| side affect - affects heart function
52
what is goosrhelin?
GnRH agonist
| can be used in oestrogen receptor pos breast cancer
53
what 4 main things do they look for at the 8 week baby check?
hip dysplasia
congenital cataract
undescended testes
congenital heart disease eg VSD
54
what contraception can you use immediately after giving birth?
implant
injection
progesterone only pill
condoms
55
what contraception can you not use in the weeks following giving birth?
```
vaginal ring
combined pill
patch
diaphragm/cap
coil - unless you put it in within 48hrs
```
56
what are caspases?
enzymes that destroy the organelles in apoptosis
57
what type of necrosis is there in MI and tubular necrosis?
coagulative
| denatured
58
what happens in caseous necrosis?
eg TB
| macrophage form giant mutlinucleated cells
59
define 'neoplasm'?
autonomous abnormal growth of cells
persists when stimulus removed
benign or malignant
60
what is the stroma around a neoplasm?
supportive tissue
| eg fibroblasts, blood vessels
61
what is the difference between the way benign and malignant tumours grow on mucosa?
benign - exophytic - grow up and out
| malignant - endophytic - grow down into and ulcerate
62
what is a papilloma?
benign
| not glandular
63
carcinogenesis vs oncogenesis?
carcin - only for malignant
| onco - benign or malignant
64
what specifically increases the risk of seminoma?
undescended testes
65
how do sulphamethoxazole and trimethoprim work?
stop the production of folic acid
66
how does metronidazole work?
stops the production of nucleic acid
| only works in anaerobes
67
how do macrolides such as erythromycin, clarithromycin, azithromycin work?
target ribosome - inhibit protein synthesis
68
what kind of drug is doxycycline and what does it do?
tetracycline
| targets the ribosome to stop protein synthesis
69
what abx do you need to be careful of in penicillin allergy?
cephalosporin
| carbopenems
70
amoxicillin covers __
gram pos
strep
listeria
enterococcus
71
by changing from amoxicllin -- co amoxiclav what are you now covering for?
staph
haemophilus
e coli
72
what kind of bacteria does doxycycline cover?
very broad spec
| gram pos and neg and atypical
73
define sepsis?
body launches a large immune response against a pathogen
= systemic vasodilation
affects organ function
74
what makes up the triad of haemolytic uraemic syndrome?
haemolytic anaemia
AKI
thrombocytopenia
75
how does haemolytic uraemic syndrome develop?
following infection with ecoli 0157 or shigella
-- caused by the shiga toxin
more likely if they have abx or loperamide, this is why gastroenteritis not routinely treated like that
76
presentation of haemolytic uraemic syndrome?
```
oliguria
Haematuria
Abdominal pain
Lethargy
Confusion
Hypertension
Bruising
following a period of blood diarrhoea
```
77
what is the treatment for haemolytic uraemic syndrome?
antihypertensives
blood products (to combat haemolysis)
dialysis
78
what blood product would you give in anaemia?
packed red cells
| used to restore the oxygen carrying capacity
79
what is cryoprecipitate for?
anticoagulation reversal
80
when is whole blood usually given?
generally only in acute/prehospital
81
causes of erectile dysfunction?
```
antidepressants
trauma eg pelvis fracture
MI
hypertension
diabetes
prostatectomy
alcohol
```
82
what is the investigation for thyroid cancer?
fine needle aspiration for cytology
| this is sensitive for all thyroid cancers except follicular
83
what happens in hyperthyroid crisis?
```
tachycardia
extreme pyrexia
abdo symptoms
confusion/agitation
associated with graves
immediate treatment is carbimazole
```
84
immediate treatment for type II heart block?
atropine
85
Graves is associated with pretibial myxoedema but what is that?
discoloured, non-pitting swelling of the lower legs, usually found bilaterally and can be sore or itchy
86
8 risk factors for angina?
biologically male
fam history
genetic hyperlipidaemia
age
```
HTN
type 2 diabetes mellitus
smoking
cholesterol
obesity
```
87
Systemic features of ankylosing spondylitis?
| 5As
```
anterior uveitis
autoimmune bowel disease
apical lung fibrosis
aortic fibrosis
amyloidosis
```
88
what is prophylaxis for migraine?
propanolol
topiramate
amitryptilline
89
how is adrenaline administered in anaphylaxis?
1 in 1000 IM
90
3 risk factors for Crohn's?
```
family history
HLA b27
caucasian
ashkenazi Jewish
smoking
NSAIDs
```
91
non malignant causes of lymphadenopathy?
```
infection
sarcoidosis
SLE
phenytoin
EBV associated lymphoproliferative disease
```
92
3 symptoms of leukaemia?
```
lymphadenopathy
weight loss
anorexia
fatigue
bleeding
infections
abdo pain
```
93
As well as the blood film what can you use to confirm the diagnosis of leukaemia?
immunophenotyping
94
3 risk factors for TB?
```
IVDU
homeless
immunosupressed
close contact with infected people
alcoholic
from a country of high incidence
```
95
what kind of diuretic is furosemide and how does it work?
loop diuretic
| inhibits the sodium potassium transporter in the ascending loop of henle
96
what kind of diuretic is bendroflumethiazide and how does it work?
thiazide
| inhibits sodium potassium pump in the Distal convoluted tubule
97
what is acetazolamide and how does it work?
carbonic anhydrase inhibitor diuretic
| works at proximal distal tubule
98
what is amiloride and how does it work?
diuretic
| inhibits ENaC on apical membrane at distal tubule
99
what is a good antibiotic for skin infections eg cellulitis?
flucloxacillin
100
what is the most important part of the U&E to monitor in AKI?
potassium
101
what infection do owls eye bodies indicate?
CMV
102
what is:
| paraprotein in urine, racoon eyes, macroglossia?
amyloidosis
103
What is the name of the test for sjorens?
| dry mucous membranes
schirmers test
104
which of the coeliac antibodies are most specific & sensitive?
TTG - sensitive
EMA - specific
105
in vWF deficiency how does the clotting tests change?
Like haemophilia, high APTT as vWF deficiency affects the intrinsic pathway
106
a posterior duodenal ulcer can lead to bleeding from which artery?
gastroduodenal
107
why does isoniazid cause peripheral neuropathy?
because it depletes vit B6
108
at what Well's score do you do a CTPA or USS not a D dimer?
2 or more
109
in tension pneumothorax where do you put your wide bore cannula?
2nd intercostal space on the midclavicular line just above the rib
(left or right is fine)
110
what kind of hypersensitivity is asthma?
type I
111
what drug for Raynauds?
nimodipine
112
in tertiary hyperPTH what is high/low?
high PTH
high Ca
high phosphate
caused by chronic secondary hyperPTH, usually needs surgery
113
how is G6PD deficiency inherited?
x linked recessive
114
what is the treatment for vWF deficiency?
1 - packing
2 - TXA
3 - vasopressin analogue
4 - vWF
115
where do you hear the aortic valve/a murmur radiating to the carotids?
2nd intercostal space
| left sternal border
116
what mutation is most common in CF?
f508 deletion
| chromosome 7
117
what diet should people with CF follow?
high calorie high fat
118
what 4 bones does pagets commonly affect?
vertebrae
pelvis
skull
femur
119
what investigations (3) in pagets?
X ray to see bone lesions
calcium and phosphate - normal
ALP - high
120
what about driving after a TIA?
you dont need to tell the DVLA, but don't drive for 1 month
121
what is first and second line treatment for chlamydia?
first - doxycycline 1 week
| second - azithromycin 3 days
122
prophylaxis for a. migraine and b. cluster headache?
migraine : amitriptyline, propanolol, topiramate (amy, poppy and tally get migraines)
cluster: verapamil, lithium and prednisolone (vere, leo and fred)
123
what chromosome is CF on?
7
124
what chromosome is wilson's on?
13
125
what chromosome is alpha 1 antitrypsin on?
14
126
what chromosome is haemachromotosis on?
6
127
what is the best imaging for bowel obstruction?
CT
128
What hypersensitivity is hypersensitivity pneumonitis?
3
129
define positive predictive value?
proportion of positive results that are true positives
130
who gets osteosarcoma?
young people/children
131
who gets ITP & when?
children get it acutely following an illness
adults with SLE etc get it chronically
presents with purpura/rash
132
4 typical presenting features of TTP?
purpura
fever
fluctuating cerebral function
haemolytic anaemia
133
what are the clotting tests like in DIC?
high PT, APTT, TT
134
how does aplastic anaemia present?
bleeding, especially from gums and blisters in mouth
| increased susceptibility to infections
135
when you test for DI how is the desmopressin given?
IM
136
what cardiac related drugs can you not give in heart failure?
verapamil, other calcium channel blockers
| amlodipine is fine
137
at what QFracture score or FRAX score do you need a DEXA scan?
10% or more
| or over 50 with a frailty fracture
138
3 times when it's appropriate to break confidentiality?
risk to public safety
patient has given consent
required by law (eg notifiable disease)
139
what does the ABCD2 score mean about TIA?
everyone with TIA or ?TIA needs to be seen within 7 days
score of 4 -- seen within 24hrs
score of 6 -- seen immediately
140
how is spontaneous pneumothorax managed?
needle aspiration
141
what is de quervains thyroiditis, when does it develop, what are the symptoms, how is it managed?
```
hyperthyroidism
after infection
large painful asymmetrical neck lump
lid lag, tremour, sweating, etc
supportive management - analgaesia, anti inflammatories, beta blockers
```
142
in anterior artery stroke which limbs are affected?
legs
there can also be sensory impairment
face, speech, vision etc should be fine
143
If there is high unconjugated bilirubin, nomal/low conjugated, what kind of jaundice is this, and what will the urine/stools be like?
pre hepatic jaundice
eg haemolytic anaemia, gibsons
urine is pale bc urine has conjugated bilirubin in it (makes it water not fat sol)
144
if both conjugated and unconjugated bilirubin is high what kind of jaundice is this? what might cause it?
intrahepatic
| liver damage/cirrhosis/PBC
145
what part of the lung is affected in idiopathic pulmonary fibrosis?
lower
| this is different from most other problems, eg silicon, ankylosing spondylitis, hypersensitivity affect the top
146
at what CD4 do you diagnose AIDS?
200 or less
147
what drug do you give for pneumonia, based on the CURB score?
mild (CURB of 0-1): amoxicillin
moderate (CURB 2): amoxicillin + clarithromycin
severe (CURB3): co-amoxiclav + clarithromycin
PCP: cotrimoxazole (really you only see this in AIDs)
148
what is ABPI?
ankle brachial pressure index
an index of vessel competency
measure ratio of systolic BP in arm vs ankle
ratio less than 0.8 indicates arterial disease
149
what is the lump like in testicular cancer?
hard and painless
doesnt transluminate
part of the testicle (different from a hernia)
heavy/dragging sensation
150
what is the most specific blood marker of acute liver damage?
ALT
| albumin is best for chronic
151
in haemophilia what is the INR?
normal
152
what are the 'irritative' LUTs?
related to storage
| nocturia, frequency, urgency, incontinence
153
what is mild UC?
4 or less poos a day
| small amounts of blood
154
what is moderate UC?
4-6 poos
| mild-severe blood
155
what is severe UC?
```
6+ poos
ESR 30+
pyrexia
tachycardia (above 90)
anaemia
```
156
how is aminosalicylate given in UC?
topically in mild-moderate, and orally if no response
157
what are the main differences between arterial and venous ulcers?
arterial -- caused by peripheral vascular disease. on the feet. dry base. 'punched out'. painful
venous -- caused by blood stasis. ragged edges, on the legs, not painful, oozing, superficial
158
give two points from the wilson and jungner criteria for screening tests?
- condition is an important health problem
- there is an accepted treatment for patients with the disease
- there are available facilities for the diagnosis and treatment of the disease
- there is a recognisable latent or early symptomatic stage of the disease
- there must be a suitable test or examination
- and this test must be acceptable to the public
- we should understand the natural history of the condition, including the progression from latent to declared disease
159
what is cullens sign?
bruising around the bellybutton
160
what is fox's sign?
bruising around the inguinal ligament
161
what is grey-turners sign?
discolouration, eccymosis of the flank
