Year 2 Flashcards
(132 cards)
1
Q
Name the genetic condition associated with the following tumours:
Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas
A
MEN2a
2
Q
Describe the pathophysiology of pemphigus vulgaris
A
Type II hypersensitivity - IgG4 antibodies against desmosomal proteins leads to loss of keratinocyte adhesion in the skin and mucous membranes, leading to superficial blisters, erosions, and mucosal ulcers
3
Q
In _____________ hyperparathyroidism, caused by a autonomous parathyroid following years of renal failure, PTH will be high and calcium will be high
A
Tertiary
4
Q
What hearing test results (using a tuning fork) would indicate sensorineural hearing loss?
A
Air conduction > bone conduction (Rinne’s)
Head in good ear (Webers)
5
Q
Name the genetic condition associated with the following tumours:
Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas
Mucosal neuromas
A
MEN2b
6
Q
Vertical double vision with hypertropia/hypotropia on cover test suggests a problem with which of the ocular muscles?
A
SO, SR, IR, IO
7
Q
What is nephrotic syndrome?
A
Indicative of a non-proliferative process affecting podocytes
Clinical features:
- Heavy proteinuria (> 3 g/day)
- Hypoalbuminaemia
- Non-dependent oedema, classically periorbital
8
Q
Name the enzyme deficient in acute intermittent porphyria, and the porphyrin which will accumulate as a result
A
Porphobilinogen deaminase, porphobilinogen
9
Q
Which condition is associated with anti-centromere antibody?
A
Limited systemic sclerosis
10
Q
Which cranial nerve supplies all the extraocular muscles except the superior oblique and lateral rectus?
A
CN III - oculomotor
11
Q
Where is the lesion? Name the defect
A
Lesion of optic nerve → ipsilateral monocular visual loss
12
Q
A patient with CN _____ palsy typically presents with horizontal diplopia which is worsened when they attempt to look towards the affected side; unopposed adduction of the eye results in a convergent squint or esotropia (eye turns inwards)
A
CN VI
13
Q
Describe the mechanism of action of SGLT2 inhibitors
A
Lower renal threshold for glucose so increase urinary glucose excretion
14
Q
Describe the clinical presentation of a meniscal tear
A
Pain and tenderness localised to joint line (medial or lateral)
Usually twisting sports injury in younger patients
15
Q
What is Anderson-Fabry’s disease?
A
X-linked lysosomal storage disease - inborn error of glycosphingolipid metabolism (deficiency of ⍺-galactosidase A)
16
Q
Describe the clinical presentation of Alport’s syndrome
A
Suspect in patients with microscopic haematuria +/- hearing loss in the early years
Proteinuria seen later but confers bad prognosis
17
Q
Injury to which nerve results in wrist drop?
A
Radial nerve
18
Q
What hearing test results (using a tuning fork) would indicate conductive hearing loss?
A
Bone conduction > air conduction (Rinne’s)
Head in bad ear (Webers)
19
Q
Which nerves can be damaged by a supracondylar fracture of the humerus?
A
Median, ulnar
20
Q
What is the most common cause of nephrotic syndrome in adults?
A
Focal segmental glomerulosclerosis
21
Q
How would you manage an intracapsular hip fracture in a previously low-functioning patient?
A
Hemi-arthroplasty
22
Q
Describe the usual mechanism of injury of a PCL injury
A
Tend to occur following a direct blow to anterior tibia (e.g. dashboard, motorbike)
23
Q
How would you manage a displaced intracapsular fracture in a previously high-functioning patient?
A
Total hip replacement
24
Q
Cover test: uncovered eye moves up
A
Hypertropia
25
Cover test: uncovered eye moves inward
Exotropia
26
Describe the biopsy findings in focal segmental glomerulosclerosis
Light microscopy - small areas of mesangial collapse and sclerosis
Electon microscopy:
- Primary FSGS → diffuse podocyte process fusion
- Secondary → podocyte process fusion limited to sclerotic areas
Minimal Ig/complement deposition on IF
27
A patient with a CN ____ palsy typically presents with a ‘down and out’ appearance of the affected eye
CN III
28
Damage to which nerve will cause the following clinical signs:
Radial nerve
29
Describe the clinical presentation of Meniere's disease
Attacks are comprised of a triad of severe paroxysmal vertigo, with sensorineural hearing loss and tinnitus on the affected side
Vertigo is recurrent, spontaneous, rotational vertigo with at least 2 episodes \>20 mins (often lasting hours)
30
Which nerve supplies the first webspace of the foot?
Deep peroneal nerve
31
Describe the usual mechanism of injury of an LCL injury
Usually occur with varus stress and hyperextension, often occurs in combination with PCL or ACL injury
32
What is the second most common cause of nephrotic syndrome in adults?
Membranous nephropathy
33
Injury to which nerve will result in a winged scapula?
Long thoracic nerve
34
Injury to which nerve results in a positive Trendelenburg sign?
Superior gluteal nerve
35
Describe the pathophysiology of bullous pemphigoid
Type II hypersensitivity – anti-hemidesmosome antibodies (IgG) react with an antigen of the hemidesmosomes anchoring basal cells to the basement membrane
36
Describe the mechanism of action of TZDs
Reduce insulin resistance by interaction with PPAR-y
37
Describe the usual mechanism of injury of an ACL injury
Usually twisting sports injury
38
A patient with CN ____ palsy typically presents with a vertical diplopia when looking inferiorly, and the affected eye turned upward when in primary position?
CN IV
39
Which nerve is affected in carpal tunnel syndrome?
Median nerve
40
Damage to which nerve will cause the following clinical signs:
Median nerve
41
Describe the mechanism of sulphonylureas
Close ATP-sensitive K+ channels which stimulate insulin release
42
Describe the findings in a right-sided CN IV palsy
Right eye turns upwards
43
Where is the lesion? Name the defect
Lesion at parietal upper radiation → contralateral homonymous inferior quadrantanopia
44
Describe the classical clinical presentation of porphyria cutanea tarda
Middle-aged man, associated with liver disease
45
Describe the clinical presentation of an ACL injury
Audible pop followed by deep knee pain and swelling (haemarthrosis) within an hour of the injury
Pain settles but leaves rotatory instability (gives way on turning on a planted foot due to excessive internal rotation of the tibia)
Excessive anterior translation of the tibia on the anterior drawer test and Lachman test
46
Which condition is associated with anti-cardiolipin antibody and lupus anti-coagulant?
Anti-phospholipid syndrome
47
What type of hearing loss is demonstrated by the audiogram?
Sensorineural hearing loss
48
Which condition is associated with anti-Scl-70 antibody?
Diffuse systemic sclerosis
49
What is a vestibular migraine?
Episode of vertigo in someone who has a history of migraines - about 25% of migraine sufferers have spontaneous attacks of vertigo and ataxia
50
Which nerve is affected in cubital tunnel syndrome?
Ulnar nerve
51
Injury to which nerve results in foot drop?
Common peroneal nerve
52
What is the Dix-Hallpike manoeuvre?
Diagnostic examination for benign positional paroxysmal vertigo - positive test will invoke the symptoms and geotropic, tortional nystagmus will be present
53
Damage to which nerve will cause the following clinical signs:
Axillary nerve
54
Describe the clinical presentation of IgA nephropathy
Nephritic - asymptomatic microhaematuria +/- non-nephrotic range proteinuria
Macroscopic haematuria after resp/GI infection
AKI/CKD
55
Which condition is associated with anti-dsDNA, anti-Smith, anti-Ro, anti-RNP?
SLE
56
How would you manage a subtrochanteric hip fracture?
IM nail
57
Describe the biopsy findings in membranoproliferative glomerulonephritis
LM - big lobulated hypercellular glomeruli with thick membranes - tram tracks
IF - granular deposits of C3
EM - electron dense sub-endothelial deposits +/- sub-epithelial +/- mesangial
58
Name the vasculitis:
cANCA, PR3 70-90%, MPO 5-10%
GPA
59
Which cranial nerve supplies the superior oblique extraocular muscle?
CN IV - trochlear
60
Which form of MEN is commonly associated with:
Parathyroid: hyperplasia/adenomas
Pancreas: gastrinoma, insulinoma
Pituitary: prolactinoma
MEN1
61
Where is the lesion? Name the defect
Lesion at optic tract → contralateral homonymous hemianopia
62
Which form of glomerulonephritis is associated with anti-phospholipase A2 antibodies?
Membranous nephropathy
63
What type of hearing loss is demonstrated by the audiogram?
Conductive hearing loss
64
What type of drug is liraglutide?
GLP-1 antagonist
65
What is Meniere's disease?
Idiopathic disorder causing vertigo
66
What is Alport's syndrome?
X-linked mutation in COL4A5 gene leads to deficient collagenous matrix deposition
67
Which form of MEN is commonly associated with:
Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas
Mucosal neuromas
MEN2b
68
Describe the biopsy findings in minimal change glomerulonephritis
Normal renal biopsy on LM and IF
Foot process fusion on EM
69
Describe the mechanism of action of metformin
Biguanide, regulates gluconeogenesis and increases gut glucose metabolism via AMP kinase
70
Describe the usual mechanism of injury in an MCL injury
Valgus stress with possible external rotation (e.g. rugby tackling from the side)
71
Describe the findings in a right-sided CN III palsy
Right eye turns down and out
72
Name the vasculitis:
pANCA, PR3 10-30%, MPO 70-90%
MPA
73
Describe the clinical presentation of an LCL injury
Knee swelling with ecchymosis, pain, deformity and instability
Lateral joint line tenderness
Varus stress test - lateral joint laxity
74
How would you manage a non-displaced intracapsular hip fracture in a previously high-functioning patient?
Compression hip screw
75
Name the enzyme deficient in porphyria cutanea tarda, and the porphyrin which will accumulate as a result
Uroporphophyrinogen decarboxylase, uroporphyrinogen 3
76
What is nephritic syndrome?
Indicative of a proliferative process affecting endothelial and mesangial cells
Clinical features:
- Haematuria/active urinary sediment (RBC and granular casts, proteinuria)
- Oliguria
- Oedema/fluid retention
- Hypertension
- Acute renal failure
77
In _____________ hyperparathyroidism, e.g. caused by low calcium or vitamin D, or CDK, PTH will be high and calcium will be low or normal
Secondary
78
How does primary adrenal insufficiency lead to volume depletion and hypertension?
Decreased mineralocorticoids → K+ retention and Na+ loss
79
Damage to which nerve will cause the following clinical signs:
Musculocutaneous nerve
80
What is benign positional paroxysmal vertigo?
Vertigo caused by the presence of otoliths in the semi-circular canal instead of the utricle; most common cause of vertigo on looking up
81
Which condition is associated with anti-Ro, anti-La?
Sjogren's
82
Which cranial nerve supplies the lateral rectus extraocular muscle?
CN VI - abducens
83
Where is the lesion? Name the defect
Lesion at optic chiasm → bitemporal hemianopia
84
Which condition is associated with anti-CCP?
Rheumatoid arthritis
85
Describe the biopsy findings in IgA nephropathy
LM - mesangial cell proliferation and expansion, diffuse mesangial IgA deposition
IF - IgA and C3 deposits in mesangium
EM - electron dense deposits in mesangium
86
Describe the clinical presentation of a PCL injury
Popliteal knee pain and bruising
Positive posterior drawer test
Positive sag sign
87
Which nerve can be damaged during an anterior hip dislocation?
Obturator nerve
88
What diagnosis should you consider in an infant presenting with bilious (green) vomiting?
Midgut volvulus caused by malrotation
89
What type of drug is sitagliptin?
DPP4 inhibitor
90
What type of drug is empagliflozin?
SGLT2 inhibitor
91
Damage to which nerve will cause the following clinical signs:
Motor: paralysis of the hamstring muscles, weakness of hip extension
Sensory: sensation lost below the knee except for the medial side of leg and medial border of the foot (saphenous area)
Sciatic nerve
92
Immunofluorescence of which blistering skin disorder will show chicken wire deposition of IgG within the epidermis
Pemphigus vulgaris
93
How can nephrotic syndrome predispose to infections, renal vein thrombosis, and pulmonary emoboli?
Protein loss includes antibodies, complement and proteins in clotting cascade
94
In _____________ hyperparathyroidism, caused by a parathyroid tumour, PTH will be high and calcium will be high
Primary
95
Cover test: uncovered eye moves outward
Esotropia
96
Describe the clinical presentation of an MCL injury
Knee swelling with ecchymosis, pain, deformity and instability
Medial joint line tenderness (over origin/insertion of MCL)
Medial joint laxity and pain on valgus stress
97
Cover test: uncovered eye moves down
Hypertropia
98
Which nerve can be damaged by a fracture of the proximal humerus, humeral shaft or proximal radius?
Radial
99
Damage to which nerve will cause the following clinical signs:
Ulnar nerve
100
What type of drug is pioglitazone?
TZD
101
Describe the clinical presentation of vestibular neuritis and labyrinthitis
Vertigo - first attack severe, lasting days with N+V
Labyrinthitis is associated with tinnitus or hearing loss (not seen in vestibular neuritis)
May be viral symptoms
102
Describe the classical clinical presentation of erythropoietic protoporphia
Baby crying in the sun
103
Describe the findings in a right-sided CN VI palsy
Right eye turns inwards
104
Where is the lesion? Name the defect
Lesion at occipital visual cortex → contralateral homonymous hemianopia (macular sparing)
105
How would you manage an intertrochanteric hip fracture?
Dynamic hip screw
106
Which form of MEN is commonly associated with:
Thyroid: medullary thyroid cancer
Adrenal: pheochromocytoma
Parathyroid: hyperplasia/adenomas
MEN2a
107
What is the most common cause of nephrotic syndrome in children?
Minimal change glomerulonephritis
108
Describe the mechanism of action of GLP-1 antagonists
Enhance the incretin effect
109
Describe the biopsy findings in membranous nephropathy
Light microscopy - thickened basement membranes, spikes on a silver stain
IF - granular deposits of IgG and C3 along GBM
EM - electron dense sub-epithelial deposits
110
Describe the clinical presentation of benign positional paroxysmal vertigo
Vertigo on looking up, turning in bed, bending forward, moving head too quickly etc.
Attacks last seconds
Associated with N+V
111
Describe the clinical presentation of Anderson-Fabry's disease
Renal failure
Cutaneous - angiokeratomas
Cardiac - cardiomyopathy, valvular disease
Neuro - stroke, acroparaesthesia
Psychiatric
112
How would you manage Anderson-Fabry's disease?
Enzyme supplementation - fabryzyme
Management of complications
113
Damage to which nerve will cause the following clinical signs:
Motor: weakness of adduction
Sensory: paraesthesia on the medial side of the thigh
Obturator nerve
114
Which nerve can be damaged during a fracture of the humeral neck or anterior dislocation of the humerus?
Axillary nerve
115
Describe the management of epistaxis
Stepwise approach:
1. First aid measures - pinching the fleshy anterior part of the nose, leaning forward, spitting out into a bowl, ice pack compression
2. On arrival to secondary care: resuscitation if necessary, arrest/slow flow (e.g. ice, topical vasoconstrictor), anterior rhinoscopy/nasal endoscopy to investigate source of bleeding
3. Direct therapy - silver nitrate cautery if there is an identifiable anterior bleeding point
4. Indirect therapy e.g. nasal packs to compress difficult to identify bleeding points (likely posterior) or heavy bleeding points
5. Surgery - sphenopalatine artery ligation (endoscopic)
116
Immunofluorescence of which blistering skin disorder will show liner IgG and complement deposited around the basal membrane?
Bullous pemphigoid
117
Name the genetic condition associated with the following tumours:
Parathyroid: hyperplasia/adenomas
Pancreas: gastrinoma, insulinoma
Pituitary: prolactinoma
MEN1
118
Which cranial nerve supplies the lateral rectus muscle?
CN VI (abducens)
119
Which cranial nerve innervates the superior oblique muscle?
CN IV (trochlear)
120
Describe the clinical presentation of minimal change glomerulonephritis
Facial/generalised oedema
Heavy proteinuria - nephrotic syndrome
121
Damage to which nerve will cause the following clinical signs:
Motor: loss of knee extension, weakness of hip flexion
Sensory: loss of skin over the front and medial side of the thigh and over the medial side of the leg and medial border of the foot
Femoral nerve
122
Describe the biopsy findings in Alport's syndrome
Variable thickness of the glomerular basement membrane
123
What type of drug is gliclazide?
Sulphonylurea
124
Describe the mechanism of action of DPP4 inhibitors
DPP4 usually deactivates GLP-1
125
Which cranial nerve supplies all extraocular muscles except superior oblique and lateral rectus?
CN III (oculomotor)
126
Where is the lesion? Name the defect
Lesion at temporal lower optic radiation → contralateral homonymous superior quadrantanopia
127
Describe the classical clinical presentation of acute intermittent porphyria
Females ~30 years, acute abdomen, mood disturbance, neuro symptoms
128
Horizontal double vision with esotropia/exotropia on cover test suggests a problem with which of the ocular muscles?
LR or MR
129
Name a blistering skin disorder which is Nikolsky sign positive
Pemphigus vulgaris
130
A normal Rinne's test would be \_\_\_\_\_\_\_\_
Air conduction is greater than bone conduction (also seen in sensorineural hearing loss)
131
Name the vasculitis:
pANCA, PR3 \<2%, MPA 10-30%
EPGA
132
Name the enzyme deficient in erythropoietic protoporphia, and the porphyrin which will accumulate as a result
Ferrochelase, protoporphyrin IX
