SPM Flashcards
1
Q
What blood test monitoring must occur when prescribing simvastatin?
A
LFTs @ baseline, 3 months, 12 months
2
Q
How does subclavian steal syndrome present?
A
Posterior circulation symptoms e.g. dizziness, vertigo during exertion of an arm
3
Q
How do you calculate an anion gap?
A
(sodium + potassium) - (bicarbonate + chloride
4
Q
What are the causes of a normal anion gap or hyperchloremic metabolic acidosis?
A
- GI bicarbonate loss: diarrhoea, fistula
- Renal tubular necrosis
- Drugs e.g. acetazolamide (carbonic anhydrase inhibitor)
- Ammonium chloride injection
- Addison’s disease
5
Q
What are the causes of a raised anion gap metabolic acidosis?
A
- Lactate: shock, hypoxia
- DKA, alcohol (ketones)
- urate: renal failure
- Acid poisoning: salicylates, methanol
6
Q
When can an intra-aortic balloon pump be used?
A
Cardiogenic shock
7
Q
Which MI region is most likely to cause AV block?
A
Inferior MI
8
Q
What time period would you expect to see pericarditis following a transmural MI?
A
In the first 48 hours
9
Q
When does Dressler’s syndrome tend to occur?
A
2-6 weeks following MI
10
Q
How would dressler’s syndrome present? How would you treat it?
A
fever, pleuritic chest pain, pericardial effusion, raised ESR
NSAIDs
11
Q
When would you expect a left ventricular wall rupture to present after an MI? What is the TX?
A
1-2 weeks after
Urgent pericardiocentesis + thoracotomy
12
Q
What type of MI is acute mitral regurgitation most common with?
A
Infero-posterior infarction
13
Q
How can Takayasu’s arteritis present?
A
Young Asian women
Occlusion of the aorta –> absent limb pulses
Malaise, headache, unequal BP in upper limbs, carotid bruit, intermittent claudication, AR
14
Q
Treatment of orthostatic hypotension?
A
Fludrocortisone - increases renal sodium reabsorption and increases plasma volume
15
Q
What is Tietze’s syndrome?
A
Inflammation of costal cartilages –> chest pain with tenderness
16
Q
When can you hear a ejection systolic murmur?
A
- Children
- Tachycardia
- pregnancy
- AS
- Pulmonary stenosis
- hypertrophic (obstructive) cardiomyopathy
17
Q
When can you hear a pansystolic murmur?
A
Mitral/tricuspid regurgitation or VSD
18
Q
when can you hear a early diastolic murmur?
A
Aortic regurgitation - high pitched
19
Q
What is a Graham Steel murmur?
A
If pulmonary regurgitation is secondary to pulmonary HTN resulting from mitral stenosis
20
Q
When would you hear a mid-diastolic murmur?
A
Mitral stenosis - low and rumbling
21
Q
Describe where some murmurs radiate to
A
AS radiates to carotids, MR radiates to the axilla
22
Q
Describe attenuation movements
A
Leaning forward attenuates aortic regurgitation
Left lateral position attenuates mitral stenosis
23
Q
what does the S1 sound represent?
A
Closure of the mitral and tricuspid valves
24
Q
When would S1 be loud?
A
MS, short PR interval, tachycardia
25
When is S3 loud?
Loud in dilated LV w/ rapid filling (MS, VSD) or poor LV function (post MI, dilated cardiomyopathy)
26
What does S4 represent?
Atrial contraction against a stiff ventricle e.g. AS, HTN
27
When would you see a slowly rising pulse w/ a narrow pulse pressure?
Aortic stenosis
28
When would you see a collapsing (water-hammer) pulse?
Aortic regurgitation
29
What signs are associated with mitral regurgitation?
Corrigan's sign (carotid pulsation)
de Musset's sign (head nodding w/ each heartbeat)
Quincke's sign (capillary pulsations in nail beds)
30
Causes of systolic HF
IHD, MI, Cardiomyopathy
31
Causes of diastolic heart failure?
Ventricular hypertrophy
Constrictive pericarditis
Cardiac tamponade
Obesity
32
New York classification of heart failure
1. Heart disease present but no undue dyspnoea from ordinary activity
2. Comfortable at rest; dyspnoea during ordinary activity
3. Less than ordinary activity causes dyspnoea, which is limiting
4. Dyspnoea present at rest; all activity causes discomfort
33
What are the actions of BNP?
Increases GFR, decreases renal sodium absorption, decreases fluid load and relaxes smooth muscle thus lowering preload
34
What does CHA2DS2-VASc score stand for?
```
C = congestive cardiac failure
H = HTN
A = Age (65-74 = 1 point; over 74 = 2 points)
D = Diabetes
S = previous stroke/TIA/Thromboembolism
V = vascular disease
S = sex (1 point if female)
```
35
What does HASBLED stand for?
```
H = HTN
A = Abnormal renal/liver function
S = Stroke
B = bleeding history/ predisposition
L = Labile (unstable/high) INR
E = Elderly (+65 yrs)
D = drugs/alcohol
```
36
Give examples of 'the pill' used PRN in paroxysmal AF
Sotalol or flecainide
37
Give examples of inherited primary arrhythmias linked with sudden death
Congenital long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia
38
What is the most common atrial septal defect and how does it present?
Ostium secundum --> RBBB with right axis deviation.
| Often asymptomatic until adulthood when L --> R shunt develops. --> dyspnoea/HF around 40-60 y/o
39
How does ostium primum present?
In childhood. RBBB w/ left axis deviation
40
What is Eisenmenger's complex?
Initial L-->R shunt --> pulmonary HTN --> increased right heart pressures until they exceed left heart pressure --> shunt reversal --> cyanosis.
41
What signs will ventricular septal defect present with?
Harsh pansystolic murmur heard best at left sternal edge. Signs of pulmonary HTN. Ventricular hypertrophy.
42
What medications must a patient be on post PCI?
Aspirin and clopidogrel for at least 12 months to reduce stent thrombosis
43
What type of MI may lead to sinus bradycardia?
Inferior MI pts may suffer from atropine-unresponsive bradycardia due to infarction of nodal tissue.
44
What are the 1st, 2nd and 3rd lines treatments for chronic heart failure?
1st line: ACEi + b-blocker
2nd line: Aldosterone antagonist (spironolactone), angiotensin II receptor blocker or hydralazine (vasodilator) WITH a nitrate.
3rd line: cardiac resynchronization/ digoxin/ivabradine
45
What change occurs in Barrett's oesophagus?
Squamous to columnar epithelium
46
Drugs that affect oesophageal motility and predispose to GORD
Nitrates, anticholinergics, calcium channel blockers
47
Drugs that damage oesophageal muscosa and predispose to GORD
NSAIDs, K+ salts, bisphosphonates
48
What follow up is required for patients with gastric ulcers?
endoscopy @ 6-8 weeks to confirm ulcer healing
49
How many weeks off PPIs is needed before testing HP?
2 weeks
50
Which inflammatory bowel condition presents with hyperaemic/haemorrhagic colonic mucosa +/- pseudo-polyps
UC
51
Which inflammatory bowel condition is more common in non-smokers?
UC
52
What changes would you see on an AXR of someone with UC?
Mucosal thickening/islands, colonic dilatation
53
What is the treatment for mild UC?
Mesalazine (5-ASA), topical steroid foams PR
54
What is the treatment for moderate UC? How does one define moderate UC?
Moderate UC = 4-6 motions/day
| Induce remission w/ oral prednisolone for 1 week then taper. Maintain on mesalazine
55
What are the side effects of mesalazine (5-ASA)?
Rash, haemolysis, hepatitis, pancreatitis, paradoxical worsening of colitis.
56
What monitoring is needed for mesalazine?
FBC + U&Es @ start then @ 3 months then annually
57
How does one define severe UC? How does one treat severe UC?
>6 months + unwell
Admit: IV fluids, IV steroids
If no improvement after a few days: Ciclosporin or infliximab, then urgent colectomy.
58
What should be offered to patients with UC who flare on steroid tapering or have over 2 courses of steroids per year?
Immunomodulation (e.g. Azathioprine).
| Monitoring: FBC, U&Es, LFTs weekly for 4 weeks, then every 4 weeks for 3 months, then at least 3 monthly.
59
Primary biliary sclerosis is linked with which inflammatory bowel disease?
Crohn's
60
What are the treatments for mild/moderate Crohn's?
Mild/moderate: Prednisolone for 1 week, then taper.
61
What does a positive Murphy's sign suggest?
Patient had acute cholecystitis - only positive result if same test in LUQ doesn't cause pain!
62
Antibiotic for acute cholecystitis
Co-amoxiclav
63
What is cholangitis? E.g. of Abx to TX it?
Bile duct infection. Tazocin IV.
64
What is Charcot's triad
- RUQ Pain
- Jaundice
- Rigors
Suggest cholangitis
65
What is gallstone ileus?
Gallstone erodes through GB into duodenum; may then obstruct the terminal ileum
66
What would you see on AXR in a pt with gallstone ileus?
Air in CBD (pneumobilia), small bowel fluid levels and a stone.
67
What is Mirizzi's syndrome?
Stone in GB presses on bile duct --> jaundice.
68
Causes of pancreatitis?
```
G: gallstones
E: ethanol
T: trauma
S: steroids
M: mumps
A: autoimmune hepatitis
S: Scorpion venom
H: hyperlipidaemia, hypothermia, hypercalcaemia
E: ERCP and emboli
D: Drugs
```
69
What is Cullen's sign?
What is Grey turner's sign?
What do they indicate?
Cullen's sign = periumbilical bruising
Grey Turner's sign = flank bruising
Suggestive of pancreatitis
70
what is a better marker for pancreatitis and why?
Serum lipase as it rises earlier and falls later
71
What is the modified Glasgow criteria?
Predicts severity of pancreatitis - over 3 factors within 48 hrs of onset means pancreatitis is severe - ITU needed!
72
What type of virus is Hep A
RNA virus
73
What is the incubation period of Hep A
2 - 6 weeks
74
Which enzyme would you see a big increase in in Hep A
ALT
75
What type of virus is Hep B?
DNA virus
76
What is the incubation period for Hep B?
2 - 6 months
77
What type of virus is Hep C?
RNA virus
78
What type of virus is Hep D?
Incomplete RNA virus - needs HBV for its assembly
79
What type of virus is Hep E?
RNA virus
80
Where can you find gluten?
Wheat, barley, rye, oats
81
What would happen to the following in Coeliac disease?
- Hb
- Red cell distribution width
- B12
- Ferritin
decreased Hb
increased red cell distribution width
decreased B12
Decreased ferritin
82
Which antibodies are associated with Coeliac disease?
Anti-transglutaminases Abs
83
What would you see on duodenal biopsy in someone with coeliac disease?
Subtotal villous atrophy, increased intra-epithelial WBCs and crypt hyperplasia.
84
Where would you see diverticula most frequently?
Sigmoid colon
85
How would you diagnose diverticulitis?
CT abdomen (colonoscopy risks perforation!)
86
What is the Rockall scoring system used for?
To predict prognosis in acute GI bleed. Worse prognosis if severe shock; malignancy; renal/liver failure; visible blood.
87
which laxative should you NOT prescribe in IBS
Lactulose as it ferments and aggravates bloating
88
What medication should you recommend to patients with IBS who are suffering from diarrhoea?
Loperamide (AKA Imodium) after each loose stool
89
What treatment options are available to patients with IBS who are suffering from colic/bloating?
Oral antispasmodics (mebeverine or hyoscine butylbromide). Combo probiotics. Low FODMAP diet.
90
When would you see micronodular liver cirrhosis?
Alcoholic liver disease, biliary tract disease
91
When would you see macronodular liver cirrhosis?
Chronic viral hepatitis
92
To diagnose portal HTN, what measure is used?
HVPG > 5mmHg
93
what is budd-chiari syndrome and how does it present?
hepatic venous outflow obstruction. --> abdo pain, ascites, liver enlargement
94
In hepatocellular injury, out of ALT/AST and Alk phos/GGT, which would be raised more?
ALT/AST
95
In cholestatic disease, out of ALT/AST and Alk phos/GGT, which would be raised more?
Alk phos/GGT
96
What is hepatic foetor?
It is seen in portal HTN - systemic shunting allows thiols to pass directly into lungs. Sweet, faecal smell of breath.
97
Which antibodies are associated with autoimmune hepatitis?
IgG, ANA, anti-smooth muscle ab
98
Which antibody is associated with primary biliary cirrhosis?
antimitochondrial ab
99
If Ferritin & transferrin saturations are high (> 45%) when doing a liver screen, what should you do next?
Perform HFE for haemochromatosis
100
Treatment for Wilson's disease
Penicillamine (a copper-binding agent)
101
What screening should be done for all patients with cirrhosis?
Hepatocellular carcinoma screening (abdo US 6 monthly), variceal screening (gastroscopy every 1 -3 years)
102
What blood test results would you expect to see in acute alcoholic hepatitis?
Increased bilirubin with normal tests otherwise, impaired liver function (increased PTT, hypalbuminaemia)
103
What treatment should be offered to patients with large oesophageal varices?
Long-term B blocker
| Variceal banding if intolerant of b-blocker
104
Define hyperacute liver failure
Encephalopathy within 7 days of onset of jaundice
105
Define acute liver failure
Jaundice to encephalopathy from 8 to 28 days
106
Define sub-acute liver failure
Jaundice to encephalopathy from 4 to 12 weeks
107
Aetiology of ALF/SALF:ALT >2000
Paracetamol OD, ischaemic hepatitis, acute Hep B
108
Main medication used in TX of paracetamol OD? How long after a POD is it still effective?
Acetylcysteine: 100mg/kg NAC in 100ml normal saline over 16 hours. NAC effective up to 72 hrs after POD - it decreases cerebral oedema and mortality
109
What are the stages of encephalopathy?
1) Slow mentation (number connection) - mild asterixis
2) Drowsy and inappropriate - asterixis present
3) Agitation and aggression --> increasing somnolence, asterixis present
4) Coma - asterixis may or may not be present
110
Name 2 RFs for bacterial overgrowth
DM + PPIs
111
What treatment should you try for bacterial overgrowth
Metronidazole
112
How do you diagnose bacterial overgrowth?
Breath hydrogen analysis - take samples of end-expired air; give glucose; take more samples every 30 mins; early increase in exhaled hydrogen = overgrowth
113
How low would you expect the viral load to be for oral candidiasis to be present in a patient with HIV
CD4 500 - 200 cells/mm3
114
How low would you expect the viral load to be for oesophageal candidiasis to be present in a patient with HIV
CD4 100-50 cells/mm3
115
How low would you expect the viral load to be for HHV-8 Kaposi sarcoma to be present in a patient with HIV
CD4 500 - 200 cells/mm3
116
How low would you expect the viral load to be for S. Pneumonia to be present in a patient with HIV
CD4 500 -200 cells/mm3
117
How low would you expect the viral load to be for Mycobacterium tuberculosis to be present in a patient with HIV
CD4 500 - 200 cells/mm3
118
How low would you expect the viral load to be for Non-Hodgkin's Lymphoma to be present in a patient with HIV
CD4 500 - 200 cells/mm3
119
How low would you expect the viral load to be for Pneumocystis Jiroveci Pneumonia to be present in a patient with HIV
CD4 200 - 100 cells/mm3
120
How low would you expect the viral load to be for Cryptosporiadiosis/ Microsporidosis to be present in a patient with HIV
CD4 200 - 100 cells/mm3
121
How low would you expect the viral load to be for JC virus to be present in a patient with HIV
CD4 100 - 50 cells/mm3
122
How low would you expect the viral load to be for histoplasmosis to be present in a patient with HIV
CD4 100 - 50 cells/mm3
123
How low would you expect the viral load to be for toxoplasmosis to be present in a patient with HIV
CD4 100 - 50 cells/mm3
124
How low would you expect the viral load to be for Cryptococcal Neoformans Meningitis to be present in a patient with HIV
CD4 <50 cells/mm3
125
How low would you expect the viral load to be for Mycobacterium avium complex to be present in a patient with HIV
CD4 <50 cells/mm3
126
How low would you expect the viral load to be for CMV retinitis to be present in a patient with HIV
CD4 <50 cells/mm3
127
How would you manage a pregnant woman who has a detectable viral load at the time of delivery?
Caesarean section
AZT infusion running prior to and throughout delivery
Baby will require 4 weeks of treatment with 3 antiretroviral drugs
128
If a pregnant woman's viral load is suppressed at time of delivery, how should you manage her baby?
Give the baby 4 weeks of single drug anti-retroviral treatment (zidovudine)
129
When should you test baby whose mother has HIV?
Look for HIV DNA in baby's blood at day 1, 6 weeks and 3 months of age.
Maternal HIV Abs will be detectable in baby's blood for 18 months - loss of these abs after confirms that the patient is HIV negative
130
How can an acute/primary HIV infection present?
Fevers, fatigue, rash. Glandular-fever-like.
131
How does Kaposi's sarcoma look like?
Purple lesions on skin or mucus membranes
132
What is a regimen of HAART like?
Usually a combo of at least 3 antiretroviral drugs E.g. (non)/ nucleoside/tide reverse transcriptase inhibitors/analogues, protease inhibitors, integrase inhibitors, fusion + CCR5 inhibitors
133
Which medications do PEPSE entail?
Truvada (1 a day) + Raltegravir (2 a day) for 28 days
134
What is the treatment for Bacterial Vaginosis
Metronidazole 400mg twice daily for 5 days or 2g stat.
TX only symptomatic patients. Avoid single doses in pregnancy.
135
What is the treatment for Trichomonas Vaginalis
Metronidazole 400mg twice daily for 5 days.
136
What is the treatment for Candida (thrush)
Women: Antifungal pessary +/- cream
Men: Emollient +/- azole cream
137
What is the treatment for Chlamydia
Doxycycline 100mg bd for 7 days OR Azithromycin 1g stat
A test of cure should be done at least 4 weeks after completion of TX (essential in pregnant women!)
138
What is the treatment for Epididymo-orchitis
Doxycycline 100mg bd for 14 days + Ceftriaxone 500 mg IM
Review in 2 weeks and continue therapy for 1 month if not fully recovered.
139
What is the treatment for Gonorrhoea
Ceftriaxone 500mg IM as a stat dose + Azithromycin 1g PO as a stat dose
Return for test of cure in 2-4 weeks
140
What is the treatment for Herpes Simplex Virus (HSV 1/2): Primary/ 1st episode
Aciclovir, Valaciclovir, Famciclovir for 5 days. Analgesia. Laxatives. Bathing in dilute saline solution.
141
What is the treatment for Herpes Simplex Virus (HSV 1/2): Recurrent episode
Saline washes + analgesics
142
What is the treatment for Herpes Simplex Virus (HSV 1/2): Persistent recurrent episodes
Aciclovir for 6 months
143
What is the treatment for a Non-immune contact after potential Hep B infection
Specific Hep B Immunoglobulin – Works best within 48 hours, of no use after 7 days. An accelerated course of recombinant vaccine should be offered to all those given HBIG and all sexual + household contacts.
144
What is the treatment for Pelvic inflammatory disease
Doxycycline 100mg bd for 14 days + Metronidazole 400mg bd for 14 days + Ceftriaxone 500mg IM
145
What is the treatment for Syphilis
Long-acting Penicillin. Follow up for a minimum of 1 year with repeat serology.
146
What is the treatment for urethritis
Doxycycline 100mg bd for 7 days OR azithromycin 1g stat. All sexual contacts in last 3 months should be treated. Avoid sex (even w/ condoms) until both have completed treatment.
147
What is the treatment for
| Simple external warts
Podophyllotoxin cream (avoid in pregnancy + nut allergy), weekly cryotherapy, Imiquimod.
148
Name 2 skin changes you may see in inflammatory bowel disease and say how they would present
```
Pyoderma gangrenosum (deep ulcers, usually on legs)
Erythema nodosum (tender red nodules usually seen on both shins - inflammation of fat cells)
```
149
What changes would you see in mild acne
Mainly comedones
150
How would you treat mild acne?
How long until the treatment becomes effective?
Topical benzoyl peroxide or topical retinoid or topical antibiotic alone.
Takes up to 8 weeks to be effective
151
What would you see with moderate acne?
Inflammatory lesions
152
What treatment options are available for moderate acne?
Topical antibiotic w/ benzoyl peroxide or topical retinoid
Oral antibiotic e.g. tetracycline
COCP
153
What would you see in severe acne?
Nodules, cysts, scars, inflammatory papules and pustules.
154
How would you treat severe acne?
Isoretinoin (teratogenic!)
155
What topical treatment options are available for plaque psoriasis?
Topical corticosteroids + topical vitamin D. Tar is widespread disease. Dithranol in TX resistance
156
What conditions are narrowband UVB phototherapy typically used for?
guttate or plaque psoriasis
157
What conditions are PUVA typically used for?
| What is the extra component in PUVA
Extensive large plaque psoriasis or localised pustular psoriasis
P in PUVA stands for Psoralen
158
What oral drugs can be used in severe psoriasis?
Methotrexate, ciclosporin, acitretin
159
Common causes of cellulitis
B haemolytic streps + staphs
160
Treatment for cellulitis
Elevate affected part
| Benzylpenicillin IV + Flucloxacillin PO
161
Treatment for scabies
Permethrin dermal cream. Oral ivermectin if severe.
| Treat all close contacts!
162
Cause of impetigo
Staph aureus
163
Tx for impetigo
Topical fusidic acid
| Oral flucloxazillin if severe
164
Treatment options for eosinophilic folliculitis
Tacrolimus, topical steroids. UVB therapy, PUVA therapy
165
Treatment for common warts and plantar warts if they are painful, unsightly or persisting
Topical salicylic acid (keratolytic), cryotherapy, duct-tape occlusion
166
Treatment options for genital warts
Podophyllin or imiquimod cream
| Cryotherapy
167
What is herpes zoster?
The varicella-zoster virus lies dormant in dorsal root ganglia after chickenpox. It presents as being dermatomal. Polymorphic red papules, vesicles, pustules.
168
Treatment for herpes zoster
If mild, no TX. Aciclovir PO 1 wk.
169
How do you treat candida on the skin?
Imidazole cream
170
How do you treat candida in the mouth?
Nystatin or miconazole oral gel
171
How do you treat candida in the vagina?
Imidazole cream +/- pessary
172
How does squamous cell carcinoma look like?
Persistently ulcerated/crusted firm irregular lesion
173
2 differential diagnoses of malignant melanoma
Seborrheic keratosis; benign melanocytic lesions
174
Is melanoma responsive to radiotherapy?
NO. Melanoma is not responsive to radiotherapy!
175
What treatment options are available for actinic keratosis?
```
Emollient for mild AK
Diclofenic gel
Fluoracil cream
Imiquimod
Cryotherapy
Photodynamic therapy
Excise if atypical, unresponsive to TX or invasive SCC suspected
```
176
What is Bowen's disease?
SCC in situ
177
How does Bowen's disease look like?
Well-defined slowly enlarging red scaly plaque w/ flat edge (Asymptomatic). Full thickness dysplasia.
178
What are the 3 stages of naevi?
1) Junctional: flat evenly pigmented
2) Compound: raised, evenly pigmented dome-shaped naevi
3) Intradermal: pale brown papules
179
How does lentigo maligna look like and what is the treatment of it?
Brown macules/patches. Irregular, variably pigmented. Excise.
180
How does seborrheic keratosis look like and what is the treatment of it?
Small, rough then thick, wart-like surface. Usually round. Harmless - most need no TX.
181
How do pyogenic granuloma arise and what do they look like?
Vascular, due to minor trauma, usually on fingers. Fleshy moist red lesion, grows rapidly, bleeds easily.
182
Which condition is pretibial myxoedema associated with?
Exophthalmic thyroid eye disease
183
How does necrobiosis lipoidica look like? What condition is it associated with?
Waxy, shiny yellowish areas on shins
| Linked with diabetes
184
How does acanthosis nigricans look like?
| What condition is it associated with?
Pigmented, rough thickening of axillary, neck or groin skin.
Diabetes
185
What condition is localised granuloma annulare linked to?
| What condition is extensive granuloma annulare linked to?
Localised: Autoimmune thyroiditis
Extensive: Diabetes
186
How does pyoderma gangrenosum look like?
| Which condition is it associated with?
Rapidly growing, recurring nodulo-pustular ulcers with tender necrotic edge.
IBD
187
Give a few examples of drugs that can lead to pruritis
Statins, ACEi, opiates, antidepressants
188
How and in who does bullous pemphigoid present in?
| How common is oral involvement?
Over 65y/o, tense blisters on urticated base
| Oral involvement is RARE
189
What is the pathophysiology behind bullous pemphigoid?
IgG autoantibodies to the basement membrane
190
What is the treatment for bullous pemphigoid?
V potent topical steroids; Prednisolone PO
191
How and in who does pemphigus present in?
| How common is oral involvement?
Affects younger people. Flaccid, superficial blisters on normal looking skin - rupture easily, leading to widespread erosions.
Oral ulceration is common.
192
What is the pathophysiology of pemphigus?
Due to IgG autoantibodies against desmosomal components --> acantholysis (keratinocytes separate from each other)
193
What is the treatment of pemphigus?
PO prednisolone with tapering. Rituximab and IV Igs in resistant cases.
194
How can you diagnose both bullous pemphigoid and pemphigus?
Positive immunofluorescence
195
What condition is dermatitis herpetiformis linked to?
Coeliac disease
196
What area is 1 FTP equivalent to?
Palmar surface of 2 adult hands
197
Where does a trichileminal (pilar) cyst derive from?
Who does it occur more commonly in?
Which area does it commonly affect?
Derived from cells @ bottom of hair foliicle
Most common in middle aged women
Scalp most commonly affected
198
Where does an epidermoid cyst derive from?
What size are they typically?
Who does it commonly affect?
Epidermal cells that line the top of the hair follicle (infundibulum)
Pea-sized with a punctum
Young and middle-aged adults
199
What is another name for cherry angioma? What actually are they?
Campbell de Morgan spots.
| Acquired overgrowth of predominantly dilated capillaries
200
What is another name for strawberry naevus?
| How long do they last for?
Capillary haemangioma
| Nearly all resolve over several years.
201
Define a keloid scar
A fibrous tissue overgrowth beyond the site of trauma
202
What is the treatment of keloid scars?
Dressing w/ silicone. Steroid cream/tape/injection
203
In which condition would you see lots of neurofibromas?
What is its inheritance pattern?
What other feature may you see?
Neurofibromatosis type 1
Autosomal dominant
Café au lait macules
204
How does sebaceous gland hyperplasia present?
| How can they be treated?
Soft, yellow-domed papules.
| Usually no TX required but can be gently cauterised to flatten.
205
What condition are sebaceous adenomas linked to?
Muir Torre syndrome (a cancer-prone genetic syndrome)
206
What is the significance of the lamina lucida?
It is the weakness spot of the dermal-epidermal junction and is where most blisters occur after trauma.
207
What is the pathophysiology of bullous impetigo? Which patients does it occur in?
S. aureus toxins can directly cleave desmoglein 1 to form blisters.
Common in paeds.
208
How is staphylococcal scalded skin syndrome diagnosed?
Frozen section
209
What is the pathophysiology behind staphylococcal scalded skin syndrome?
Bacterial toxin cleaves desmoglein 1 --> superficial split in dermis.
210
How does erythroderma present? How dangerous is it?
90% of skin is involved w/ inflammatory neoplastic process
| Risk of mortality due to skin failure --> fluid loss, infection, heat loss, catabolic.
211
Name some examples of causes of erythroderma
Eczema, psoriasis, drug reactions, skin lymphomas.
212
What is the pathophysiology behind toxic epidermal necrolysis? What is the most common cause?
Full thickness epidermal loss due to massive keratinocyte apoptosis.
Drugs are the commonest cause
213
Give examples of drugs that can cause toxic epidermal necrolysis
Allopurinol, Abx, anticonvulsants, NSAIDs
214
What is SCORTEN?
A predictive mortality scale used for toxic epidermal necrolysis
Higher mortality if: epidermal detachment; older; malignancy; HR >120; increased Urea and glucose; decreased bicarbonate.
215
What is the treatment for toxic epidermal necrolysis?
Supportive (Silicon mesh). IV Igs.
216
What is the treatment for angioedema?
Regular antihistamines and systemic steroids
217
What is the treatment for guttate psoriasis?
UV light (too widespread for topical TX!)
218
What does guttate psoriasis typically follow?
A strep. infection.
219
What is the treatment for erysipelas?
IV Penicillin
220
What is another name for eczema herpeticum?
Kaposi's varicelliform eruption
221
What is the treatment for eczema herpeticum?
| What should you never ever ever give these patients?
Admit. High-dose anti-viral TX.
| Do NOT give steroids or calcineurin blockers
222
What is the pathophysiology of eczema herpeticum?
Herpes simplex type 1 superinfection of atopic eczema
223
How does eczema herpeticum present?
Widespread. Multiple monomorphic vesicles, rapid onset, systemically v unwell.
224
What is miliaria?
Sweat retention --> tiny vesicles/papules.
225
What causes porphyria cutanea tarda?
How does it present?
What is it exacerbated by?
Disorder of haem synthesis
Blisters & erosions. Photosensitivity
Exacerbated by XS alcohol
226
What is the most common form of photosensitivity and how does it present?
Polymorphic light eruption
| V itchy, erythematous papular eruption
227
What is the pathophysiology of erythema nodosum?
Due to inflammation in subcut tissues.
228
What are the causes of erythema nodosum?
Sarcoidosis, drugs (e.g. the pill), IBD
229
What changes in the hands can be seen in a patient with dermatomyositis?
Proximal nailfolds: Swelling + erythema
| Violaceous erythema over knuckles
230
Pathophysiology behind senile purpura?
Due to loss of supporting collagen in dermis with age +/- steroid TX
231
How does erythema multiforme present?
Symmetrical eruption of discoid inflamed plaques. Some blister in the middle. Affect peripheries.
232
Prognosis of Stevens Johnson syndrome?
Most cases settle spontaneously with symptomatic TX in 1 - 2 weeks
233
How does pyoderma gangrenosum present?
Acutely inflamed, breakdown + ulcerate. Blue edge to ulcer.
234
What measurement is used to assess CKD severity?
eGFR
235
What factor does eGFR take into account?
Creatinine, age, gender, ethnicity.
236
How would you confirm that a patient has proteinuria?
Measure their ACR again using an early morning sample (tell the patient not to eat meat 12 hours before)
237
Define CKD
Abnormal kidney function OR structure for over 3 months.
238
What is the GFR of someone in stage 2 of CKD?
60 - 89
239
What is the GFR of someone in stage 3b of CKD?
30 - 44
240
What is the result for someone with proteinuria classed at A2?
3 - 30
241
What would you do with a young patient who has a family history of autosomal dominant polycystic kidney disease?
I would do US screening when they're in their early 20s
242
How can you screen for renal artery stenosis?
Magnetic resonance angiogram
243
Name 3 investigations you would do for myeloma/MGUS
Serum & urine free light chains +/- protein electrophoresis
244
When should you NOT do a renal biopsy?
If there is evidence of infection/obstruction
245
What should you do in terms of testing if you find an abnormal eGFR?
Repeat eGFR (> 2 weeks to exclude AKI. X3 over 90 days to see rate of progression)
246
Generally, what 2 meds are used to proteinuria?
ACEi / ARBs
247
What is albuminuria a risk factor for?
Cardiovascular disease
248
What does PTH convert?
25 Vit D to 1,25 Vit D
249
Name 2 signs on bone that can arise due to persistent secondary hyperparathyroidism
```
Brown tumour (Cystic degeneration of bone)
Rugger Jersey spine
```
250
What type of laxative would you give for opiate-induced constipation?
Give an example
Stimulant laxatives e.g. Senna
251
What is Danthron and what is its clinical relevance?
It is a type of stimulant laxative. It turns urine orange and burns skin so avoid using in patient's who are urine incontinent. It is a carcinogen so only use in palliative patients.
252
What is a contraindication of a stimulant laxative?
Complete bowel obstruction - can lead to perforation
253
What type of laxative is Docusate sodium?
A stool softener
254
On what part of the bowel do stimulant laxatives act upon?
The large bowel
255
On what part of the bowel do osmotic laxatives act on?
Small bowel
256
Lactulose and Movicol are examples of what type of laxatives?
Osmotic laxatives
257
What is Bisacodyl?
A suppository (--> anorectal stimulation)
258
How does glycerol act as a suppository?
It draws fluid into the rectum which softens and lubricates stool
259
What effect does low blood pressure have on the arterioles in the kidney?
Afferent dilatation and efferent constriction
260
How can Angiotensin receptor blockers be dangerous to the kidneys? (Bear in mind the action of angiotensin II)
ARBs can cause acute renal failure. Angiotensin II leads to efferent vasoconstriction which helps to maintain GFR when renal perfusion is low < ARBs block this :(
261
What effect does NSAIDs have on the arterioles of the kidneys?
NSAIDs block vasodilation of afferent arterioles, leading to reduced GFR (unable to maintain perfusion of kidneys --> decreased urine output)
262
How long does acute tubular necrosis tend to last? What may the patient need in the meantime?
6 weeks
| Patient may need haemodialysis
263
What happens to the GFR of someone with nephrotic syndrome?
Their eGFR is usually normal
264
What happens to the GFR of someone with nephritic syndrome?
Their eGFR is low
265
What is the mechanism behind oedema in someone with nephrotic syndrome?
Decreased oncotic pressure
266
What is the mechanism behind oedema in someone with nephritic syndrome?
Low salt and H20 excretion
267
Out of nephrotic and nephritic syndrome, which one would you see more prominent proteinuria?
What is the mechanism of the proteinuria here?
Nephrotic syndrome
Podocytes lose their foot processes
268
Why do you get hypercholesterolaemia in nephrotic syndrome?
Due to heavy albuminuria
269
What condition can minimal change disease, membranous nephropathy and FSGS all lead to?
Nephrotic syndrome?
270
What are the treatment options for nephrotic syndrome?
Salt +/- water restriction
Loop diuretics
ACEi/ARBs
271
How can nephrotic syndrome lead to AKI?
V low serum albumin could --> reduced circulating volume
272
How can nephrotic syndrome predispose patients to VTEs?
Differential loss of pro + anti - thrombotic proteins from the blood
273
How can nephrotic syndrome predispose to Infection?
Low circulating Igs - lost in urine
274
What condition can ANCA vasculitis, Anti-GBM disease, IgA disease and IE lead to?
Nephritic syndrome
275
What are the 3 diseases that come under the umbrella of ANCA associated vasculitis?
Granulomatosis w/ polyangiitis (Wegener's granulomatosis)
Microscopic polyangiitis (part of polyarteritis nodosa)
Eosinophilic granulomatosis w/ polyangiitis (Churg-Strauss syndrome)
276
Give 2 antibodies that are associated with Granulomatosis w/ polyangiitis (AKA Wegener's granulomatosis)
cANCA and Antiproteinase 3 Antibodies
277
Give 4 ways that microscopic polyangiitis can be differentiated from Granulomatosis w/ polyangiitis (AKA Wegener's granulomatosis)
Microscopic polyangiitis:
- PNS also affected
- Shorter onset
- Less likely to relapse
- No granulomatosis inflammation
278
Name 2 antibodies that are associated with Microscopic polyangiitis
pANCA and anti-myeloperoxidase antibodies
279
How does Eosinophilic granulomatosis w/ polyangiitis (Churg-Strauss syndrome) present?
```
Late onset progressive asthma
Peripheral neuropathy
Nasal polyps
Myocarditis
CNS vasculitis
Pulmonary infiltrates
Peripheral eosinophilia
```
280
What medication should all patients with vasculitis be started on?
Corticosteroids
281
What treatment options are available for patients with mild/moderate vasculitis?
Prednisolone (inhibits T cell function)
| Mycophenolate mofetil, methotrexate
282
What treatment options are available for patients with severe vasculitis?
Cyclophosphamide (decreases B cells/Abs and neutrophils)
Rituximab (eradicates all peripheral B cells and Igs)
Plasma exchange
283
How can cutaneous lupus present?
Malar rash, skin photosensitivity, discoid lesions
284
What options are available for maintenance treatment of SLE?
Low dose steroids, azathioprine or mycophenolate mofetil
285
What treatment options are available for remission induction in someone with severe SLE?
High dose steroids, cyclophosphamide or rituximab
286
How does myeloma lead to hypercalcaemia?
The overexpression of receptor activator nuclear factor in myeloma activates osteoclasts which resorb more bone --> lytic lesions.
287
What does the acronym CRAB stand for in relation to the effects of myeloma?
Calcium
Renal failure
Anaemia
Bone
288
Which light chain is more problematic out of kappa and lambda?
Lambda! It is heavier, less renal clearance, long-half life
289
What is the pathogenesis of cast nephropathy?
Light chains are filtered freely @ glomerulus. Normally all light chains are absorbed in PCT, but if capacity of 10 - 30g a day is exceeded, it continues to travel throughout the tubule and binds to tamm-Horsfall protein and form casts --> micro obstruction of urine
290
What vaccine should you give to patients before they start dialysis?
HBV vaccine (to non-immune patients)
291
When should you start dialysis in a patient with CKD?
When their eGFR <10 ml/min/1.73 m^2
292
When should you start dialysis in a patient with AKI?
Creatinine >500 mcmol/L or oligo/anuric for AKI patients
293
What leads to encapsulating peritoneal sclerosis and what is the danger of it?
A progressive change over 8 - 10 years due to changes that occur in the peritoneal membrane as a result of peritoneal dialysis
Can lead to recurrent bowel obstruction
294
On what cells are HLA class I antigens expressed on?
All nucleated cells (A, B, C)
295
On what cells are HLA class II antigens expressed on?
Antigen presenting cells (DR, DQ, DP)
296
When does warm ischaemia occur?
When a kidney remains in situ in the donor but is under perfused due to hypotension or circulatory death
297
When does cold ischaemia occur?
Following organ retrieval while the kidney is being transported to the recipient centre. A lot of this occurs when the donor is living.
298
What side effects can arise due to tacrolimus?
Tremor, increased risk of post-transplant diabetes, neurotoxic, nephrotoxic
299
What side effects can arise due to ciclosporin?
Hirsutism, gum hypertrophy
300
What drug interaction can occur with azathioprine?
Allopurinol interaction --> bone marrow toxicity
301
Name some examples of nephrotoxic drugs?
NSAIDs, ciclosporin, tacrolimus, penicillamine, chemo, acyclovir, methotrexate, allopurinol, x-ray contrast agent
302
Is GFR over or under estimated in elderly patients based on creatinine measurements?
Over-estimated as production of creatinine is proportional to muscle mass. The elderly/cachetic have decreased muscle mass --> increase in creatinine production --> overestimates GFR.
303
What triad do you get in Alport's syndrome?
Glomerulonephritis, end-stage kidney disease and hearing loss
304
Episodic macroscopic haematuria with throat infections - what is the diagnosis?
IgA nephropathy
305
Normal ACR in men?
Normal ACR in women?
<2.5 in men
<3.5 in women
306
What are the 3 indications for emergency dialysis?
1. Severe hyperkalaemia (>7mmol/L) which is resistant to medical TX
2. Pulmonary oedema
3. Worsening severe metabolic acidosis (pH <7.2 or base XS <10)
307
What is the programme in the UK for cervical cancer screening?
3 yearly 25-50
| 5 yearly 50-64
308
How often is faecal occult blood testing done in the UK?
2 yearly for those between 60 and 74 years old
309
What is the programme in the UK for mammography?
3 yearly for patients aged 50-70
310
What are the diagnostic categories of breast biopsy?
| From B1 to B5b
```
B1: Normal
B2: Benign
B3: Atypical (probably benign)
B4: Suspicious of carcinoma
B5: Malignant
B5a: DCIS
B5b: Invasive disease
```
311
In terms of TNM staging for breast cancer, what stage would a tumour get that is 3 cm
T2: bigger than 2cm but smaller than 5cm
312
In terms of TNM staging for breast cancer, what stage would a tumour get that is 1 cm and has directly extended into the skin
T4 = any size tumour with direct extension into chest wall and/or skin (ulceration or nodules)
313
How many lymph nodes would have to be involved for a breast cancer to be graded as N2?
4 - 9 Lymph nodes
314
If a breast cancer is Her-2 positive, what medication is effective in treating it?
Trastuzumab AKA Herceptin
315
In terms of TNM staging for bowel cancer, how many nodes would have to be involved for it to be graded N2?
Over 4 lymph nodes
316
In terms of TNM staging for bowel cancer, what grade would a tumour get if it invaded the muscularis propria?
T2
317
In terms of TNM staging for bowel cancer, what must have a tumour invaded to be considered T3
T3 = Tumour has invaded subserosa
318
In terms of TNM staging for bowel cancer, what does a grade T4 tumour mean?
It has directly invaded adjacent organs/structures or through the visceral peritoneum
319
In terms of TNM staging for bowel cancer, what grade would a tumour get that has invaded the submucosa?
T1
320
What mutated gene is inherited in FAP?
APC gene (a tumour suppressor gene)
321
What mutation occurs in HNPCC?
Germline mutation in DNA mismatch repair system (diagnosed by loss of expression of MMR proteins on immunohistochemistry
322
Which gene mutation is associated with a reduced response to EGFR targeted treatment (e.g. cetuximab)?
Activating KRAS mutations
323
What are the WHO performance statuses from 0 to 4?
```
0 = fully active
1 = Cannot carry out heavy physical work, but can do anything else
2 = Up and about more than half the day - not well enough to work
3 = In bed/ sitting more than half the day - need some help looking after yourself
4 = In bed/ chair all the time, need a lot of looking after
```
324
A man is still independent but has had to give us his job - what is his WHO performance status?
2
325
A woman spends most of her day in her bed. She can cook for herself but has a carer coming in for an hour or 2 a day to clean her flat for her - what is her WHO performance status?
3
326
What does CHART stand for and in what context may it be used?
CHART = Continuous Hyperfractionated Accelerated Radiotherapy
Is used as radical radiotherapy in lung cancer
327
In which 3 groups are EGFR mutations in lung cancer more common? What is the clinical relevance?
```
More common in...
1) Adenocarcinomas
2) Never smokers
3) Asians
Can use antibodies that target EGFR mutations e.g. Iressa :)
```
328
Where must a small cell carcinoma be to be classed as 'limited'?
Ipsilateral hemithorax and supraclavicular lymph nodes
329
Name the palliative care treatments for the following in patients with lung cancer...
a) Symptomatic pleural effusions
b) Cough
c) Hoarse voice
d) Symptomatic brain mets
a) Drain pleural effusions
b) Opiates
c) ENT referral
d) Dexamethasone
330
What is the most common prostate cancer and where does it occur?
Adenocarcinoma - arising in peripheral prostate
331
At what age would you consider a radical prostatectomy?
< 70 year olds
332
Name 2 ways that radical radiotherapy for prostate cancer can be delivered?
As an external beam or brachytherapy
333
How would you manage someone who is over than 70 years old with low-risk prostate cancer?
Active surveillance
334
What is the role of hormone therapy in prostate cancer? In whom should you consider it?
Hormone treatment alone temporarily delays tumour progression but refractory disease eventually develops - consider in old unfit patients with high-risk prostate cancer
They may give benefit in metastatic disease for 1 - 2 years.
335
What is an example of a hormonal drug used in prostate cancer? How does it work?
Goserelin - it is a LHRH agonist. It first stimulates then inhibits pituitary gonadotrophin
336
Name 5 types of cancer where spinal cord compression is common?
Breast, prostate, lung, myeloma and lymphoma
337
In which part of the spinal cord does spinal cord compression commonly affect?
Thoracic cord
338
List symptoms/signs of spinal cord compression
```
- Radicular pain exacerbated by coughing/ straining, not relieved by bed rest
Late signs:
- Weakness of limbs
- Sensory loss
- Retention
- Dribbling
- Incontinence
```
339
What symptoms would you get in anterior spinal cord compression?
Partial loss of pain and temperature below the lesion
340
What symptoms would you get in posterior spinal cord compression?
Loss of vibration and position.
| Band of dysesthesia (abnormal sensation) @ level of lesion.
341
What is another term for lateral cord compression? How does it present?
Brown-Sequard syndrome.
Ipsilateral loss of vibration and position and UMN weakness
Contralateral loss of pain and temperature
342
At what point in the spinal cord may lesions below cause cauda equina syndrome?
Lesions below L1/2
343
How does cauda equina syndrome present?
- Sciatic pain (often bilateral)
- Bladder dysfunction with retention and overflow incontinence
- Impotence
- Sacral (saddle) anaesthesia
- Loss of anal sphincter tone
- Weakness and wasting of gluteal muscles
- Band of hyperaesthesia at level of lesion
- Motor and sensory loss at and below level of lesion
344
What is a gibbus? When might you see it?
It is a structural kyphosis @ the site of wedged/ collapsed vertebra. Spinal cord compression/ cauda equina syndrome.
345
What imaging must you do in spinal cord compression/ cauda equina compression?
MRI scanning of the whole spine
346
What treatment must you give someone with spinal cord compression/ cauda equina syndrome?
Dexamethasone ASAP to decrease peritumoral oedema
| Surgical decompression then radiotherapy
347
At what level of free Ca2+ does hypercalcaemia become an urgent matter?
If free Ca2+ is 3 mmol/L or over
348
What 2 things is the level of free Ca2+ dependent on?
Serum albumin and arterial pH.
349
List 3 causes of general hypercalcaemia in the context of malignancy?
1) Osteolysis
2) Humoral mediators e.g. PTHrP in SCC
3) Dehydration
350
What is a specific way that myeloma leads to hypercalcaemia?
Myeloma leads to deposition of Bence-Jones proteins which cause renal impairment and decreases calcium excretion.
351
What is a specific way that some lymphomas lead to hypercalcaemia?
They produce active metabolites of vitamin D that lead to increased intestinal absorption of calcium.
352
How does hypercalcaemia present?
Drowsiness, N&V, constipation, polydipsia, dehydration, arrhythmias
353
What 3 ECG changes would you see with hypercalcaemia?
- Increased PR interval
- Decreased QT interval
- Wide QRS
354
What are the treatments for hypercalcaemia?
- Rehydration (3 - 6 L/24 hours, 0.9% saline), monitor U&Es
- Consider bisphosphonates if Ca2+ remains 3.0mmol/L or over despite rehydration
- Loop diuretics
- Avoid immobility (increases osteoclast activity)
355
Define neutropenic sepsis
Temperature over 38 degrees and a neutrophil cound less than 0.5 x 10^9.
356
How do you treat neutropenic sepsis? What medication would you add if you suspect a gram positive organism e.g. Hickmann line sepsis?
Treat empirically with piperacillin/ tazobactam AKA Tazocin.
Add vancomycin if gram positive organism is suspected
357
Other than antibiotics, what is the regimen for neutropenic sepsis patients?
- Barrier nursing
- Avoid IMs
- Do swabs
- Do cultures
- Candida prophylaxis
358
What cultures need to be taken in a patient with neutropenic sepsis?
3 Blood samples peripherally +/- Hickmann line
| Urine, sputum and stool samples
359
What is the MASCC score?
| Which score would reassure you and what would you do about it?
It predicts risk of serious complications in febrile neutropenia.
A score of 21 or above suggests that the risk of complications are low and so the patient should not be admitted.
360
How long should you continue antibiotics for in a person with neutropenic sepsis?
Continue antibiotics until afebrile for 72hrs/5 days and until neutrophils are over 0.5 x 10^9/ L
361
Which antibiotic can be given prophylactically to patients to prevent sepsis?
Give a fluroquinoline e.g. ciprofloxacin before neutropenia gets serious
362
What cancers does Li-Fraumeni syndrome increase your risk of getting?
- Sarcomas
- Adrenocortical cancer in childhood
- Early onset BC
- Brain tumours
- Leukaemia
363
What cancers does Von Hippel Lindau syndrome increase your risk of getting?
- Retinal angiomas
- Cerebellar and spinal cord haemangiomas
- Renal cell carcinoma
- Phaechromocytoma
364
What cancers does Lynch syndrome increase your risk of getting?
What is another name for Lynch syndrome?
AKA HNPCC (Hereditary nonpolyposis colorectal cancer)
- Bowel
- Endometrial
- Ovarian
365
What breast surveillance must take place for women found to be BRCA positive?
Annual MRI and mammogram 30-50 year olds
| Mammograms in 50-70 years olds.
366
What ovarian surveillance must take place for women found to be BRCA positive?
Transvaginal US + CA125 from 35 years old.
367
How can BRCA positive men be affected by this gene mutation?
Increases their risk of prostate and breast cancer.
368
What is a bilateral salpingoophorectomy and when would it decrease the risk of breast cancer in women?
Removal of fallopian tubes and ovaries. It decreases the risk of breast cancer if done 10 years before menopause.
369
What mutation occur in Lynch syndrome?
Mutations in mismatch repair genes: MLH1. MSH2, MSH6, PMS2
370
Which 2 criteria may be used in the diagnosis of Lynch syndrome?
Revised Amsterdam criteria and Bethesda criteria
371
What colorectal screening should occur in someone with Lynch syndrome?
2 yearly colonoscopy from 25 to 75 years old.
372
How does Familial Adenomatous Polyposis present?
Bowel cancer
| >100 adenomatous polyps in the colon and rectum
373
Whom should be offered mutation testing for Familial Adenomatous Polyposis and at what age?
Offer mutation testing age 10-12 years old for those at 50% risk and family mutation known.
374
If found to have the mutation for Familial Adenomatous Polyposis, what screening must be done in those individuals and at what age?
Annual colonoscopy from 10 - 12 years old.
375
When polyp load becomes high in someone with Familial Adenomatous Polyposis, what is the treatment?
Elective colectomy
376
Is Multiple Endocrine Neoplasia 2 (MEN 2) dominant or recessive?
Autosomal dominant
377
Which 3 things do Multiple Endocrine Neoplasia 2 (MEN 2) predispose to?
Medullary thyroid carcinoma and hyperplasia C cells and phaechromocytoma
378
What gene mutation occurs in MEN2?
RET mutation
379
Why must you refer all patients with Medullary Thyroid Carcinoma?
Medullary Thyroid Carcinoma has a high rate of germline RET mutations (think MEN2)
380
A 29 year old patient develops thyroid cancer - which genetic condition are you worried about?
Multiple endocrine neoplasia 2 (MEN 2)
381
In someone with a family history of Multiple Endocrine Neoplasia 2, when should you test them? What should you do if this test comes back as positive?
Should do a pre-symptomatic test in 5 year olds. Perform thyroidectomy if positive.
382
What screening must you do in someone with Multiple Endocrine Neoplasia 2?
Annual urine testing for phaechromocytoma.
383
Which cancer can an infection of EBV cause?
Burkitt lymphoma
384
Which cancer can an infection of Helicobacter pylori cause?
Gastric cancer
385
Define neutropenia
An absolute neutrophil count of <1.0 x 10^9/L
386
Define Nadir. When does it tend to occur?
The lowest count that neutrophils fall to. Usually occurs 7 - 14 days post chemo and after large area radiotherapy.
387
Define severe neutropenia
<0.5 x 10^9
388
Define febrile neutropenia
> 38 degrees and <1.0x10^9/L
389
What can candida albicans lead to in an immunocompromised patient?
Oropharyngeal candidiasis
390
What can Aspergillus lead to in an immunocompromised patient? What is the sign seen on imaging?
Respiratory infection
| Would see a crescent of lucency - 'air crescent' on CXR = typical of invasive aspergillosis.
391
How does pneumocystic jirovecu (carinii) appear on CXR?
Ground glass appearance
392
What can Listeria monocytogenes lead to? Why is it difficult to treat? What is the treatment?
Meningitis
Resistant to harsh conditions (can grow @ 4 degrees!)
TX = High dose amoxicillin
393
What is the treatment for severe Crohn's?
Severe: IV steroids, IV fluids.
394
What 3 other treatment options are available for severe Crohn's if steroids do not work?
- Azathioprine if refractory to steroids (Takes 6-10 weeks to work!)
- Anti-TNF a (decreases disease activity - screen pts for TB before starting!)
- Anti-integrin (Monoclonal Abs targeting adhesion molecules)
395
What diets can you suggest to patients experiencing a Crohn's flare up?
Elemental diets can give remission
396
How many people with Crohn's will eventually need surgery?
Most will need surgery
