summary of specialties Flashcards
(184 cards)
1
Q
ACR values and when to refer
A
3 or more is significant
if 3-70, repeat test
refer:
- ACR 70 or more
- ACR 30 or more with persistent haematuria and no UTI
- ACR 3-29 with persistent haematuria and risk factors e.g. declining eGFR, CVD
2
Q
how many times should you measure eGFR?
A
once:
- eGFR > 60
- eGFR 45-59 and ACR < 30
twice:
- eGFR 45-59 and ACR > 30
- eGFR 15-29 and ACR < 30
three:
- eGFR 15-29 and ACR > 30
four: - eGFR < 15
3
Q
managing proteinuria in CKD
A
- ACEi if ACR > 30 and HTN
- ACEi if ACR > 70 regardless of BP
- SGLT2i
4
Q
ECG territories
A
V1-V4: anteroseptal, LAD
II, III, aVF: inferior, R coronary
V1-V6, I, aVL: anterolateral, prox LAD
I, aVL: lateral, left cx
V1-V3: posterior, L cx, RCA
5
Q
nephrotic/nephritic syndrome microscopy findings
A
focal segmental glomerulosclerosis:
effacement of foot processes
goodpastures:
IgG deposits on BM
6
Q
flash pulmonary oedema can be a sign of what renal disease?
A
renal vascular disease
7
Q
causes of diffuse proliferative glomerulonephritis
A
post strep
SLE
8
Q
causes of metabolic acidosis
A
normal anion gap:
GI bicarb loss
RTA
acetazolamide, ammonium chloride
addison’s
raised anion gap:
lactate (shock, sepsis, hypoxia, metformin)
ketones (DKA, alcohol)
urate (renal failure)
acid poisoning (salicylates, methanol)
9
Q
management of thyroid storm
A
IV propranolol
methimazole/propylthiouracil
Lugol’s iodine
IV dexamethasone/hydrocortisone to block conversion of T4 to T3
10
Q
diagnosing acromegaly
A
serum IGF-1 levels
> if raised, OGTTt
11
Q
types of renal tubular acidosis
A
1 (distal):
- inability to secrete H+
- hypokalaemia, nephrocalcinosis
- RA, CLE, sjogrens, toxicity
2 (prox):
- reduced bicarb reabsorption in PCT
- hypokalaemia, osteomalacia
- fanconi, wilsons, carbonic anhydrase inhib
3 (mixed):
- carbonic anhydrase deficiency, hypokalaemia
- rare
4 (hyperkalaemic):
- reduced aldosterone, reduced PCT ammonia excretion
- hypoaldosteronism, diabetes
12
Q
Gitelman’s vs Bartter’s
A
Gitelman’s: like taking thiazide, DCT
- hypoK, , hypoMg, metab alkalosis
Barrter’s: defective NaK2Cl in ascending loop
- hypoK, polyuria and polydipsia
both normotensive
13
Q
Multiple Endocrine Neoplasia
A
1: 3Ps
parathyroid, pituitary, pancreas
adrenal and thyroid
MEN1 gene
2a: 2Ps
parathyroid, phaeochromocytoma
medullary thyroid ca
RET oncogone
MEN 2b: 1P
phaeochromocytoma
marfinoid, neuromas, medullary thyroid
RET oncogene
14
Q
drug induced lupus vs SLE and causes of drug induced lupus
A
renal and nervous system involvement rare in drug induced
procainamide
hydralazine
isoniazid, minocycline, phenytoin
15
Q
managing steroid induced osteporosis
A
offer bone protection if > 65y or fragility #
DEXA if < 65y
T between 0 and -1.5: repeat DEXA in 1-3y
T < - 1.5: offer bone protection
alendronate, calcium + vit D
16
Q
causes of erythema multiforme
A
HSV, Orf
idiopathic
mycoplasma, strep
penicillin, sulfonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapine
SLE, sarcoid, malignancy
17
Q
causes of acanthosis nigricans
A
T2DM
GI cancer
obesity
PCOS
acromegaly
cushings
hypothyroid
prader willi
familial
COCP, nicotinic acid
18
Q
drugs affect4ed by acetylator status
A
Sulfasalazine
Hydralazine
Isoniazid
Procainamide
Dapsone
19
Q
gaucher’s disease features
A
defective glucocerebrosidase
most common lipid storage disorder
hepatosplenomegaly, aseptic necrosis of femur
20
Q
tay sachs features
A
defective hexosaminidase A
accumulation of GM2 ganglioside within lysosomes
developmental delay, cherry red spot on macula
normal sized liver and spleen
21
Q
niemann pick features
A
defective sphingomyelinase
hepatosplenomegaly, cherry red spot on macula
22
Q
krabbes disease features
A
defective galactocerebrosidase
peripheral neuropathy, optic atrophy, globoid cells
23
Q
metachromic leukodystrophy features
A
arylsulfatase A defective
demyelination of CNS and PNS
24
Q
fabry disease features
A
peripheral neuropathy (burning sensation)
angiokeratomas, lens opacities
proteinuria
x linked recessive
25
types of hypersensitivity reaction
1: anaphylactic
2: cell bound
3: immune complex free antigens combine (SLE, post strep GN, serum sickness, extrinsic allergic alveolitis)
4: delayed (TB, graft b host, contact dermatitis, scabies, chronic phase extrinsic allergic alveolitis, MS, GBS)
5: antibodies binding to cell surface receptor (graves, MG)
26
which chromosome codes for HLA antigens?
chromo 6
27
neurofibromatosis vs tuberous sclerosis
NF- axillary freckles, phaeochromocytomas, iris hamartomas (lisch nodules), acoustic neuromas (NF2)
TS- ash leaf spots, shagreen patches, subungual fibromata, adenoma sebaceum, epilepsy and developmental problems, retinal hamartomas, renal angiomyolipomata
28
anterior cerebral artery stroke
contralateral hemiparesis and sensory loss
lower extremity > upper
29
middle cerebral artery stroke
contralateral hemiparesis and sensory loss
upper extremity > lower
contralateral homonymous hemianopia
aphasia
30
posterior cerebral artery stroke
contralateral homonymous hemianopia
macular sparing
visual agnosia
31
webers syndrome
stroke from branches of posterior cerebral artery supplying midbrain
ipsi CNIII palsy
contralateral upper and lower weakness
32
posterior inferior cerebellar artery stroke
lateral medullary/wallenberg syndrome
ipsi facial pain and temp loss
contra limb/torso pain and temp loss
ataxia, nystagmus
33
anterior inferior cerebellar artery stroke
lateral pontine syndrome
similar to PICA stroke but also ipsi facial paralysis and deafness
34
lacunar stroke presentation
isolated hemiparesis or hemisensory loss or hemiparesis with limb ataxia
35
normal fasting glucose
6 or less
6-7: pre diabetes
7 or more: diabetes
36
diagnostic thresholds for gestational diabetes
fasting glucose 5.6 or more
2h glucose 7.8 or more
target fasting glucose: 5.3
37
Pseudohypoparathyroidism and how to diagnose
PTH target cell insensitivity
High PTH and PO4, low Ca
DX: PTH infusion and measure urinary po4 and cAMP
38
Causes of SIADH
Sulfonylureas
SSRI, TCA
Carbamazepine
Vincristine
Cyclophosphamide
PEEP, porphyrias
TB, pneumonia
CVA, SAH, subdural haemorrhages, meningitis
SCLC, pancreas, prostate ca
39
MODY inheritance
Autosomal dominant
40
congenital adrenal hyperplasia
autosomal recessive
low cortisol, high ACTH
21 hydroxylase deficiency 90%
11 beta hydroxylase deficiency 10%
rarely 17 hydroxylase deficiency
confirm dx with ACTH stimulation test
41
features of parietal lesions
sensory inattention
apraxias
inferior homonymous quadratanopia
gerstmanns (alexia, acalculia, right left disorientation, finger agnosia)
42
temporal lesion features
wernickes aphasia
superior homo quadratanopia
auditory agnosia
prospagnosia (difficulty recognising faces)
43
features of frontal lobe lesions
Broca's aphasia
disinhibition
perseveration
anosmia
inability to generate a list
44
wernicke and korsakoff syndrome are a result of damage to what areas of brain?
medial thalamus and mamillary bodies of hypothalamus
45
hemiballism is a result of damage to what area of brain?
subthalamic nucleus of basal ganlia
46
huntington chorea is result of damage to what part of brain?
striatum (caudate nucleus) of basal ganglia
47
waterhouse friderichsen syndrome
adrenal insufficiency secondary to adrenal haemorrhage
may occur in meningococcal meningitis
48
osteoporosis risk factors
RA
hyperthyroid
hypogonadism (turners, testosterone def)
GH def
hyperparathyroid
DM
multiple myeloma, lymphoma
IBD, liver disease
CKD
osteogenesis imperfecta, homocystinuria
SSRIs, antiepileptics
PPIs
glitazones
long term heparin
aromatase inhib
49
DEXA values
T score:
> -1.0 normal
-1.0 to - 2.5 osteopenia
< -2.5 osteoporosis
Z score is adjusted for age, gender, ethnicity
50
polyarteritis nodosa
fever, malaise, arthralgia
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure
pANCA in 20% of cases
hep B in 30%
51
ANCA targets
cANCA serine proteinase 3 PR3
pANCA myeloperoxidase MPO
52
what drugs may exacerbate myaesthenia gravis?
penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoin
gent, macrolides, quinolones, tetracyclines
52
extradural vs subdural haematoma
extradural: lucid period, usual major injury, middle meningeal artery
subdural: fluctuating consciousness, usually minor injury, bridging veins
53
Miller Fisher syndrome
guillain barre variant
ophthalmoplegia, areflexia and ataxia
descending rather than ascending
anti GQ1b in 90%
54
guillain barre antibodies
anti GM1
55
site of lesion causing bitemporal hemianopia
upper quadrant defect: pituitary
lower quadrant defect: craniopharnygioma
56
demyelinating vs axonal peripheral neuropathies
axonal:
alcohol, DM, vasculitis, HSMN type 2, B12 def (may also be demyelinating)
demyelinating:
GBS, HSMN type 1, paraprotein neuropathy, amiodarone, chronic inflam demyelinating polyneuropathy
57
phenytoin side effects
fever, rash, hepatitis, dupuytrens, aplastic anaemia, drug induced lupus
dizziness, diplopia, nystagmus, slurred speech, ataxia
gingival hyperplasia, hirsuitism, coarsening of facial features
megaloblastic anaemia
peripheral neuropathy
enhanced vit D metabolism, osteomalacia
dyskinesia, lymphadenopathy
cleft palate and congenital heart disease
58
management of restless legs
dopamine agonists (ropinirole, pramipexole)
benzos
gabapentin
59
homocystinuria
autosomal recessive
deficiency of cystathionine beta synthase
fine, fair hair, marfinoid, osteoporosis, kyphosis
LDs, seizures, inferonasal dislocation of lens, myopia
arterial/venous VTE, malar flush, livedo reticularis
tx with vit B6 pyridoxine
60
HLA DRB1 is associated with what?
HLA DR4
61
examples of G protein coupled receptors
generally slow transmission, metabolic processes
Gs (stimulates adenylate cyclase to increase cAMP): beta1, beta2, H2, D1, V2, ACTH, LH, FSH, PTH, PGs
Gi (inhibits adenylate cyclase to decrease cAMP): M2, alpha2, D2, GABAB
Gq (activates phospholipase C): alpha1, H1, V1, M1, M3
62
examples of guanylate cyclase receptors
ANP, BNP
63
examples of tyrosine kinase receptors
insulin, IGF, EGF
PRL, immunomodulators, GH, GCSF, EPO, TPO
64
examples of ligand gated ion channel receptors
generally fast responses
nicotinic acetylcholine, GABAA, GABAC, glutamate
65
cushing's reflex
HTN, bradycardia, wide pulse pressure
result of increased ICP
66
B2 (riboflavin deficiency)
angular cheilitis
67
B3 (niacin) deficiency
pellagra
dermatitis, diarrhoea, dementia
may occur in carcinoid syndrome
68
nerves running through foramen ovale, foramen rotundum
ovale: mandibular nerve
rotundum: maxillary nerve
69
cytokines and their sources
IL-1 macrophages (acute, fever)
IL-2 Th1 (
IL-3 activated Th
IL-4 Th2
IL-5 Th2 (eosinophils)
IL-6 macrophages, Th2
IL-8 macrophages (neutrophil chemotaxis)
IL-10 Th2 (inhibits Th1 cytokines)
IL-12 dendritic cells, macrophages, B cells (activates NK)
TNFa macrophages (fever, neutrophil chemotaxis)
IFNgamma Th1 (activates macrophages)
70
layers of epidermis
stratum corneum: flat scaley cells filled with keratin
stratum lucidum: clear layer present in thick skin only
stratum granulosum: cells form link with neighbours
stratum spinosum: squamous cells synthesise keratin, thickest layer
stratum germinativum: basement membrane, columnar, gives rise to keratinocytes and contains melanocytes
71
RAAS and where the hormones are secreted from
adrenal cortex GFR ACD
zona Glomerulosa: Aldosterone, mineralocorticoids
zona Fasciculata: Cortisol, glucocorticoids
zona Reticularis: androgrens, DHEA
72
lysosome vs peroxisome vs proteosome
lysosome: breaks down large molecules e.g. proteins, polysaccharides
peroxisome: breaks down v long chain FAs and amino acids
proteosome: degrades protein that has been tagged with ubiquitin
73
nucleolus vs ribosome vs nucleus
nucleus: DNA maintenance, RNA transcription, RNA splicing
ribosome: RNA translation > proteins
nucleolus: ribosome production
74
T helper 1 vs T helper 2 cells
Th1: cell mediated response and type IV hypersensitivity, secrete IFN gamma, IL2, IL3
Th2: antibody (humoral) immunity e.g. IgE in asthma, secrete IL4, IL5, IL6, IL10, IL13
75
how to calculate number needed to treat
NNT= 1/ absolute risk reduction
76
how to calculate standard error of the mean
standard deviation/sq root of n
77
causes of drug induced thrombocytopenia
quinine
abciximab
furosemide
penicillins, sulfonamides, rifampicin
carbamazepine, valproate
NSAIDs, heparin
linezolid
78
diphtheria features and management
grey membrane on tonsils
bulky cervical lymphadenopathy
heart block
neuritis
mx: antitoxin + IM penicillin
79
mumps meningitis
low CSF glucose
80
lyme disease management
doxy (amox if c/i e.g. pregnant)
ceftriaxone if disseminated
81
what ophthalmological conditions are associated with charles bonnet syndrome?
mostly ARMD
glaucoma, cataracts
82
tamiflu vs relenza
tamiflu- oral, neuraminidase inhibitor and prevents new viral particles being released
relenza- inhaled, neuraminidase inhibitor, c/i in asthmatics
83
what drugs can cause toxic epidermal necrolysis?
phenytoin, carbamazepine
sulfonamides
allopurinol
penicillins
NSAIDs
84
What does Antithrombin III do?
Inhibits thrombin, factor X, factor IX
Mediates effects of heparin
85
gram negative and gram positive cocci
G neg: neisseria, moxarella
G pos: staph, strep
86
gram positive bacilli (rods)
ABCDL
Actinomyces
Bacillus antracis
Clostridium
Diphtheria
Listeria
87
aminoglycoside mechanism
binds to 30s > misreads mRNA
88
tetracycline mechanism
binds to 30s > blocks binding of tRNA
89
chloramphenicol mechanism
binds to 50S > inhibits peptidyl transferase
90
mechanism of macrolides
binds to 50S > inhibits translocation
91
calculating variance
square of standard deviation
92
what organs are in direct or indirect contact with kidneys?
right kidney:
direct- right suprarenal gland, duodenum, colon
indirect- liver, distal small intestine
left kidney:
direct- left suprarenal, pancreas, colon
indirect- stomach, spleen, distal small intestine
93
what drugs can be cleared with haemodialysis?
BLAST
Barbiturates
Lithium
Alcohol
Salicylates
Theophylline
94
causes of autoimmune haemolytic anaemia
warm: SLE, lymphoma, CLL, methyldopa
cold: lymphoma, mycoplasma, EBV
95
causes of haemolysis: intravascular vs extravascular
intravascular:
mismatched transfusion
G6PD def
heart valves, TTP, DIC, HUS
paroxysmal nocturnal haemoglobinuria
cold AIHA
extravascular:
sickle, thalassaemia
hereditary spherocytosis
haemolytic newborn
warm AIHA
96
rasburicase mechanism
converts uric acid to allantoin
for tumour lysis
97
diagnosing paroxysmal nocturnal haemolysis
flow cytometry- low levels of CD59, CD55
mx: anticoag, eculizumab, stem cell
98
leukaemioid reaction
caused by severe infection, haemolysis, haemorrhage or metastatic cancer with marrow infiltration
> immature cells pushed out into circulation
high ALP
toxic granulation (dohle bodies) in white cells
left shift of neutrophils
99
causes of rapidly progressive GN
goodpastures, ANCA vasculitis
100
IgA nephropathy
Bergers/mesangioproliferative
haematuria after URTI
101
diffuse proliferative GN
post strep
SLE
102
membranoproliferative
type1: cryoglobulinaemia, hepC
type 2: partial lipodystrophy
103
focal segmental glomerulosclerosis
HIV, heroin, idiopathic
104
CLL treatment
FCR
fludarabine + cyclophosphamide + rituximab
105
apremilast
PDE4 inhibitor
(reduces hydrolysis of cAMP)
used for psoriatic arthropathy
106
DRESS
triad: extensive skin rash, high fever, organ involvement
eosinophils
reaction to medications 2-8 weeks after starting drug
107
management of pyoderma granulosum
PO prednisolone
108
brugada inheritance
auto dominant
109
criteria for starting statin in T1DM
over 40y or
diabetes > 10y or
established nephropathy or
other CVD risk factors
110
which chemo agents are cardiotoxic?
anthracyclines- doxorubicin, epirubicin
111
treating ovale or vivax malaria
chloroquine then primaquine to destroy liver hypnozoites
112
acute intermittent porphyria vs porphyria cutanea tarda
AIP: defective porphobilinogen deaminase
PCT: defective uroporphyrinogen decarboxylase
photosensitive blistering rash on face and dorsal hands, hypertrichosis, hyperpigmentation
113
management of multifocal atrial tachycardia
correct hypoxia and electrolytes
rate limiting CCB
114
location of G protein coupled receptors
span cell membrane
115
pyrazinamide mechanism and side effects
inhibits fatty acid synthase
hyperuricaemia, gout
arthralgia, myalgia
hepatitis
116
ethambutol mechanism
inhibits arabinosyl transferase so prevents polymerisation of arabinose into arabinan
117
mechanism of thiazide diuretics
block NaCl symptorter
> inhibit Na reabsorption at beginning of DCT
increased delivery of sodium to distal DCT
118
conditions associated w/ pseudogout
haemochromatosis
acromegaly
wilsons
hyperPTH
low Mg, low PO4
119
breakthrough morphine dose
1/6th total daily dose
120
increasing opioid dose
30-50%
121
drugs for metastatic bone pain
opioids
bisphosphonates
RTX
denosumab
122
codeine to morphine
divide by 10
123
tramadol to morphine
divide by 10
124
morphine to oxycodone
divide by 1.5 to 2
125
PO morphine to SC diamorphine
divide by 3
126
12 microgram patch of fentanyl is equivalent to how much PO morphine?
30mg
127
10micrograms transdermal buprenorphine is equivalent to how much PO morphine?
24mg
128
pulsus paradoxus
> 10mmHg fall in SBP during inspiration
faint or absent pulse on inspiration
seen in severe asthma and cardiac tamponade
129
collapsing pulse
aortic regurgitation
PDA
hyperkinetic states (anaemia, thyrotoxicosis, fever, exercise, pregnancy)
130
pulsus alternans
regular alternation of force
seen in severe LVF
131
non pulsatile JVP
SVC obstruction
132
parts of JVP waveform
A- atrial contraction (large in TS, PS, pHTN; absent in AF)
cannon A- complete HB, VT, V ectopics, nodal rhythm, single chamber pacing
C- tricuspid closure
V- passive filling against closed tricuspid. (giant in TR)
X descent- fall in atrial pressure during ventricular systole
Y descent- opening of tricuspid valve
133
when is metformin indicated in T1DM?
BMI > 25
134
dipyridamole mechanism
non specific phosphodiesterase inhibitor
decreases cellular uptake of adenosine
135
ticagrelor mechanism
directly blocks P2Y12 platelet activator
136
clopidogrel mechanism
prodrug
metabolites inhibit ADP binding to P2Y12 receptor
> stops activation of GPIIb/IIIa
137
actions of vitamin D
increases renal reabsorption of PO4
increases renal reabsorption and gut absorption of calcium
increases osteoclast activity
138
asthma ladder
1. SABA
2. SABA + ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA + LTRA
5. SABA +/- LTRA, switch ICS/LABA for ICS/LABA MART
6. SABA +/- LRTA + medium dose ICS/LABA MART or SABA +/- LRTA + medium dose ICS + LABA
7. SABA + LRTA + high dose ICS or SABA + LRTA and trial theophylline or refer to resp
139
which part of nephron is impermeable to water?
ascending limb of Henle
140
which drugs cause hypoglycaemia?
sulfonylureas (gliclazide)
141
which diabetes drugs can cause weight gain?
sulfonylureas (gliclazide), glitazones/thiazolidinediones
142
COPD ladder
1. SABA or SAMA
2. LABA + ICS if steroid responsive/asthma features
LABA + LAMA if no asthmatic features
3. LABA + LAMA + ICS
143
inducing remission in UC
mild/mod: rectal aminosalicylate > add PO aminosalicylate > add corticosteroid
extensive disease: rectal aminosalicylate + PO aminosalicylate > PO aminosalicylate + PO steroid
severe colitis: IV steroids or ciclosporin
144
maintaining remission in UC
mild/mod: topical aminosalicylate
mild/mod extensive or left sided: PO aminosalicylate
severe or 2 exacerbations last year: PO azathioprine or mercaptopurine
145
inducing and maintaining remission in crohn's
glucocorticoids
5 ASA drugs second line
azathioprine/mercaptopurine/MTX add ons
infliximab
metronidazole for isolated perianal disease
maintaining: azathioprine/mercaptopurine 1st line, MTX second line
146
rapidly progressive glomerulonephritis
AKA crescenteric
causes: Goodpastures, ANCA vasculitis
147
mixed nephrotic/nephritic presentation
diffuse proliferative/post strep
membranoproliferative/mesangiocapillary
148
membranoproliferative glomerulonephritis
AKA mesangiocapillary
presents as mixed nephrotic/nephritic
1: cryoglobulinaemia, hep C
2: partial lipodystrophy
149
nephrotic syndromes
min change (Hodgkins, NSAIDs)
membranous GN (infections, rheum drugs, malignancy)
focal segmental (HIV, heroin)
150
glucose and protein in CSF in meningitis
protein:
high in bacterial/TB and fungal
normal/high in viral
glucose:
< 1/2 plasma in bacterial/TB
60-80% plasma in viral. lower in HSV and mumps
151
sick euthyroid
everything is low (TSH, T3, T4)
sometimes TSH is normal
152
amiodarone induced thyrotoxicosis
type 1: goitre present, excess iodine. mx w/ carbimazole or percholate
type 2: destructive. no goitre. mx w/ steroids
stop amiodarone in both types
153
subacute/de Quervains thyroiditis
phases:
1- hyperT, painful goitre, ESR raised
2: euthyroid
3: hypothyroid
4: normal
globally reduced uptake of iodine 131
154
papillary thyroid ca features and mx
most common type
often young females, good prognosis
papillary projections and pale empty nuclei, seldom encapsulated
lymph node mets mostly; haem mets rare
mx: total thyroidectomy then radioiodine to kill residual cells. annual thyroglobulin levels to detect recurrence
155
follicular thyroid ca features and mx
solitary thyroid nodule
second most common thyroid malignancy
mx: total thyroidectomy then radioiodine to kill residual cells and annual thyroglobulin levels to detect recurrence
156
medullary thyroid ca
parafollicular C cells, secrete calcitonin
derived from neural crest tissue
nodal disease associated w/ poor prognosis
157
secondary hyperparathyroidism
PTH hyperplasia as a result of low calcium (usually CKD)
PTH high, Ca low or normal, PO4 high, vit D low
158
tertiary hyperparathyroidism
ongoing hyperplasia of PTH after correction of underlying renal disorder
PTH high, ca normal/high, PO4 normal/low, ALP high
159
acromegaly management
surgery first line
somatostatin analogue (ocreotide)
GHr antagonist (pregvisomant)
dopamine agonist (bromocriptine)
160
addisons investigations
ACTH stimulation test
hyperK, hypoNa, metabolic acidosis
161
cushing's investigations
dexa suppression test
24h urinary cortisol x2
hypoK metabolic alkalosis
162
hyperaldosteronism investigations
hypoK, metabolic alkalosis, HTN
plasma aldosterone/renin ratio
> CT abdomen and adrenal vein sampling
163
drugs that can exacerbate MG
penicillamine
procainamide, quinidine
beta blockers
aminoglycosides, macrolides, quinolones, tetracylines
phenytoin
lithium
164
target BP
< 80: 140/90
> 80: 150/90
165
ciclosporin and tacrolimus mechanism
inhibit calcineurin in T cells
> decrease IL2
166
mycophenolate mofetil mechanism
inhibits inosine monophosphate dehydrogenase
167
dermatitis herpetiformis biopsy
IgA deposits
168
cutanea larva migrans mx
thiabendazole
169
PRV may progress into what?
AML or myelofibrosis
170
tetanus management
immunoglobulin + metronidazole IV
171
leprosy management
rifampicin + dapsone + clofazimine
12 months
172
sarcoidosis indications for steroids
CXR stage 2/3 disease and symptomatic
hypercalcaemia
eye/heart/neuro involvement
173
sarcoidosis CXR stages
0: normal
1: b/l hilar lymphadenopathy
2: BHL + interstitial infiltrates
3: diffuse interstitial infiltrates only
4: diffuse fibrosis
174
TB management
active TB:
2 months RIPE then 4 months R+I
latent TB:
3 months RIP or 6 months IP
175
features of MS
mid-late diastolic murmur
loud S1
low volume pulse
opening snap if leaflets are still mobile
longer murmur if more severe
AF from left atrial enlargement
176
which cells mediate organ rejection?
hyperacute: B cells
acute and chronic: cytotoxic and helper T cells
177
causes of aortic regurgitation
rheumatic fever
calcific valve disease
rheumatoid, SLE, marfans, EDS, AS
bicuspid valve
infective endocarditis
syphilis
HTN
aortic dissection
> early diastolic murmur, collapsing pulse, wife pulse pressure, head bobbing and nail pulsation
178
reversible vs irreversible features of haemochromatosis
reversible:
cardiomyopathy, skin pigmentation
irreversible:
liver cirrhosis, DM, hypogonadotrophic hypogonadism, arthropathy
179
causes of diabetes insipidus
nephrogenic:
ADH receptor or aquaporin 2 channel defects
hypercalcaemia
hypokalaemia
lithium
demeclocycline
tubulointerstitial disease (obstruction, sickle cell, pyelonephritis)
cranial:
head injury, pituitary surgery, craniopharyngiomas
histiocytosis X, sarcoidosis
DIDMOAD
haemochromatosis
180
scleritis vs episcleritis
scleritis painful; episcleritis not painful
181
features of congenital rubella
sensorineural deafness
cataracts
182
causes of membranous GN
hep B, malaria, syphilis
malignancy
gold, penicillamine
SLE, RA, AI thyroiditis
183
drugs to avoid in HOCM
nitrates
ACEi
inotropes
