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RACP 2022 Written > Things To Memorise String of Pearl + other > Flashcards

Things To Memorise String of Pearl + other Flashcards

1
Q

Causes of NAGMA?

A

U- Ureteric Fistula
S Small bowel fistula
E Extra Chloride
D Diarrhoea
C Carbonic anhydrase inhibitors
A Addison’s (type 4 - RTA hyperK)
R RTA (1&2, hypo K)
P Pancreatic fistula

NAGMA vs HAGMA?

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2
Q

Metabolic Acidosis - High Anion GAP - Causes

A

CAT MUDPILES, >12.
C - Cyanide
A Alcohols
T Toluene
M methanol metformin
U uraemia
D DKA
P Paracetamol paraldehyde
I Isoniazid Iron
L Lactate
E ethylene glycol
S Salicylates sepsis

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3
Q

Causes of Metabolic Alkalosis?

A

CLEVER PD
Contraction - dehydration
Liquroice , laxative abuse
Endocrine (Conn’s and Cushings
Vomiting
Excess alkali (antacids)
REnal (bartter’s, severe K depletion
Poster hypercapnia
Diuretics

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4
Q

Abx Protein Synthesis Inhibitors acting on ribosomes>

A

50s Subunit: Erythromycin, Clindamycin
30s: Aminoglycosides (gent), Tetracylces
Both: linezolid

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5
Q

Abx Mech Folic Acid Synthesis in cytoplams

A

sulfonamids, trimethoprim

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6
Q

ABx Mech : cell walll inhbiors - blocks synthesis/repair

A

penicillins, cephalosproins
carbapensems
vanc
fosfomycin, ioniazide

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7
Q

Abx mech Cell Membrane - loss of permeability

A

Daptomycin, polyxins

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8
Q

ABx Mech: act at DNA/RNA

A

Inhibit replication and transcription inhibiyt gyrase - quinolones,

Inhibit RNA polymerase - Rifampin

DNA Damage - metronidazole nitrofurantoin

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9
Q

Mech of Colistin Abx?

A

Binding to LPS and phospholipids in the outer cell membrane

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10
Q

Anti-epileptic Drugs: Act at sodium channel

A

Carbamazepine, Lacosamide, lamotrigine, phenytoin, topiramate, zoniamide (Act where?)

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11
Q

Anti-Epilepetic Drugs Alpha2-gamma modification mechanism at voltage gated calcium channels which drugs?

A

gabepentin, pregabalin

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12
Q

Anti-eplileptic Drugs: Which are calcium channel blockage

A

Ethosuximide, Lamotrigine, Zonisamdie

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13
Q

Anti-Epileptic Drugs: act by modulation of SV2a medicated neurotransmitter realease - at synatpic vesicle proteins

A

Levetiracetam (keppra) mechanism?

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14
Q

Anti-Epileptic Drugs: mech potassium channel activation

A

Retigabine

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15
Q

Anti- Epileptic Drugs: mech antagonism of glutamate (at NMDA or AMPA receptors) at synapse?

A

Lamotrigine (NMDA), Topiramate (AMPA)

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16
Q

ANti-Epileptic Drugs: mech potentiation of GABA activity at inhbitor neuron

A

Barbiturates, Benzodiazepines, Topiramate, Valporate

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17
Q

Drug Interaction: Valproate + lamotrigine

A

Lamotrigine metabolised by N-glucorondiation, Valporate may cause sig rise in plasma concetration by competitively inhibiting its glucoronidation&raquo_space; increased lamotrigine levels

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18
Q

Interaction Valproate + carbapenems

A

Decreased efficacay of sodium valproate - 60 to 100% decrease in valproate plasma conc

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19
Q

Carbamaz, phenytoin, phenobarb effect on lamotrigine?

A

All CYP3A4 inducers > decrease lamotrigine levels

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20
Q

Carbamaz, Phenytoin, Phenobarb interaction with OCP?

A

All decrease efficacy of OCP and of Cyclosporin > better to use Valproate inhbits CYP2C9 not CTP3A4

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21
Q

Proportion of breakthrough?

A

1/6th of 24 hour dose of regular opioids

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22
Q

Incontinence in elderly? common type and meds?

A

Common = urge - anticholinergic drugs eg oxybutyin (dementia, can increase IOP, tachycardia), Mirabegron B3 adrenergic (HTN)
Stress = duloxetine, pelvic floor, sling surg for 100% stress.

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23
Q

SE Amitriptyline - anti-cholinergic

A

dry mouth, urinary retention, blurred vision, mydriasis, constipation

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24
Q

SE - cholinestersase inhibitor aka Donepezil

A

GI symptoms (diarrhea, nausea, cramps), vivid dreams and benign bradycardai

25
Q

Mechansim of memantine?

A

NMDA antagonist.
can be used in combo with donepezil (cholinesterase inhibitor)

26
Q

What kind of memory spared in vascular dementia?

A

Episodic memory?

26
Q

What kind of memory spared in vascular dementia?

A

Episodic memory?

27
Q

What type of dementia is ApoE4 assoicated with?

A

ApoE4 - late onset AD

Early onset Alzheimers disease:
- Presenilin 1 & 2
- B amyloid precusor gene
- Down’s Syndrome

28
Q

Anti-psych/dep assoc weight loss?

A

Citalopram, Fluoxetine, Paroxetine

29
Q

What hormones decrease with aging?

A

male testosterone, growth hormone, basal renin and aldosterone, DHEA

30
Q

Hormones incrase with normal aging?

A

FSH/LH both sexes
Increased insulin resistance
incidence of auto-immune throiditis
Bone resorption 2nd raise PTH
vassopression with increase risk of hypoNA
ANP in response to rise in intravascular volume leading to nocturia

31
Q

Neurofibromatosis:
Skin changes:
Malignancy Assoc:

A

Skin changes: cafe-au-liat macules, neurofibromas, freckling
Malignancy Assoc: schwannoma, gliomas, leukaemias, CNS tumours, sarcoma

32
Q

Tuberous sclerosis (skin and cancer associations?)

A

Skin: angiofibromas, periungual fibromas, shagreen patches
Ca: Sarcoma, rhabdomyoma, renal, angiomyolipoma

33
Q

Gorlin syndrome
Skin and Ca associations?

A

skin: BCCs, palmar pits, typical facies
Ca: Medulloblastoma, breast, lymphoma

34
Q

Von hippel Lindau Disease
skin/cancer

A

Cafe-au-lait, haemangiomas
cancer: Haemangioblastoma, renal phaeochromaocytoma

35
Q

Wiskott-Aldridge Syndrome (canc/skin assoications)

A

skin: Eczema
Ca: lymphoma, leukaemia

36
Q

Myeloma cut offs

A

> 60% marrow or >100 ratio

37
Q

APTT checks which Pathway? hence which factors?
What about the other one?

A

Checks Intrisnic pathway: prekallikren, HMWK, VIII , IX, XI, XIII, (8.9,11, 12).

Extrinsic = III (TF) and VII (7)

Common = I, II, IV, V, VI, X, XIII (1,2,4,5,6,10.13)

38
Q

Role of vWF? Featues of vWF Disease. Treatment?

A

Major Adhesion molecule sticks platelet to exposed subendothelium. Binds FVIII, prolongs half life.

In vWF Disease bleeding, prolonged APTT low levelsof vZWF and factor VIII

DDAVP releases vWF and FVIII from stores
Major side ffect hypoNa

39
Q

Mechansim of Romiplostim/Eltrombopag?

A

Increased platelet production in marrow.
SE: myalgia, joint and extremeity discomfort, insomina, thromboytoiss. fatal clots and bone marrow fibrosis.

40
Q

Intravascular Haemolysis?
and characteritic?

A

Mismatched transfusion
g6PD
TTP, DIC, HUS, red cell frag from Heart valves
PNH
Cold AIHD

free haemoglobin is excreted in urine a haemoglobinuria.
Raised plasma haemoglobin

41
Q

Extravascular hemolysis

A

Haemoglobinopathies
Hereditary spherocytosis
Hemolytic disease of newborn
Warm AHA

42
Q

Schiztocytes what type of anaemia?

A

MAHA or TTP or HUS

43
Q

microspherocytes type of anaemia?

A

Autoimmune hemolytic anemia

44
Q

Macrocytosis and PMN with hypersegmented nuclei

A

B12 deficiency

45
Q

Target cells?

A

Thalassemias and liver disease.

46
Q

What does Cryoprecipitae contain, Used in Tx for?

A

5 F’s, Fibrinogen, F VIII, F XIII, von willebrane factor and fibronectin

Used: dysfibrogenmia, DIC, vWD

47
Q

Which factors Heamophilia B vs Heamophilia A

A

A - VIII, B IX

48
Q

Common translocations
t(9;22)
T(15:17)
T(8:14)
t(11:14)

A

t(9;22) - phli - 95% of CML (good), also in ALL bad factor
T(15:17) aPML (fusion PML and RAR alpha genes
T(8:14): Burkitts - Myc oncogene + Ig
t(11:14): Mantle cell cyclin D1 and Ig.

49
Q

HypoSpleen associations?

A

Sickle cell, Celiac disease, graves, SLE, amyloid.
HOwell jolly bodies
Siderocytes

49
Q

HypoSpleen associations?

A

Sickle cell, Celiac disease, graves, SLE, amyloid.
HOwell jolly bodies
Siderocytes

50
Q

Tx aplastic anaemia

A

blood products + prevent infection
ATG and ALG (anti-thymocyge and antilymphocyt eglobulin) - can provoke serum sickness.
Stem cell transplant
ciclosporin

51
Q

Conditions associated with low uptake radioacitve iodine thyroid scan?

A

1: patients on thyroxine
2: subacute thyroiditis
3: postpartum throiditis
4:amiodarone therapy
5: ectopic thyroid tissue

52
Q

Factors cause low T3

A

High cortisol, cytokines, drugs inhbiti deiodinase (propranolol, amiodarone)

53
Q

Factorrs cause low T4

A

reduce dhormone binding proteins
reduced binding to proteins

54
Q

factors cause low TSH

A

Glucocorticoids
Dopaimine

55
Q

Step of VIt D synthesis

A

1 SKIN: 7 Dehydrocholesterol > vitamind D3 cholecalciferol

UV light

2 Livers: D3 hydroxylated to 25 hydroxycholecalciferol (calcidiol)

25-hydroxylase

  1. Kidney Calcidiol > to 1,25-dihydroxycholecalciferol (Calcitriol)

enzyme 1-aplha hydroxylase_

56
Q

Decrease SHBG

A

Obesity
nephrotic syndrome
hypothyroid
use of glucocorticiod, progestins and androgenic steriods
DIabetes

RACP 2022 Written (21 decks)

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