MRCP cont 2
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What is AIP?
Autosomal dominant abnormality in the synthesis of haem due to defect in porphobilinogen deaminase.
- More common in females.
- Abdo pain + neuropsych symptoms
Precipitated by drugs that act on the brain (alcohol, BDZs, halothane, barbiturates) + OCP
Which opiods are best to use in pts with CKD?
Alfentanyl, bruprenorphine, and fentanyl
In what situations could the Mantoux test be falsely negative?
- Miliary TB
- <6months old
Which effects of Hereditary haemochromotosis are reversible and which are irreversible?
Reversible = Cardiomyopathy, Skin pigment, hepatomegaly, elevated liver enzymes.
Irreversible = Liver cirrhosis, Diabetes, Hypogonadotrophic hypogonadism, Arthropathy
Jervell-Lange-Nielsen syndrome is assoc with?
Treatment for early keloid scars?
What subset of diabetics would you give meglitinides?
If poorly controlled on metformin and glicazide and have an ERRATIC LIFESTYLE.
Which intervention has the greatest effect on survival in MND pts?
Investigation of choice in PCP?
BAL and silver staining to show characteristic cysts
Treatment for norwegian scabies?
Most common in immunocompromised individuals.
How do you differentiate betwee Acute tubular necrosis and Pre-renal uraemia?
Pre renal uraemia:
- Low urinary sodium
- High urinary urea (x10)
- Bland sediment
- Responds to fluid challenge
- Urinary osmolality will be far greater than Plasma osmolality
What are granuloma annulare?
Collections of white cells in a ring. cause a smooth firm lesion with a central depression (hence annular). Assoc diabetes, thyroid disease, sle, RA, addison's
Treatment for homocystinuria = ?
Vit B6 Pyridoxine
Why has the use of B-blockers declined in the past 5 years?
Less likely to prevent strokes + can impair glucose tolerance.
Which renal stones are semi-opaque and which are radio-lucent?
Cystine - semi opaque
Urate + xanthine = Radiolucent
Best marker for monitoring disease activity in SLE?
Drugs that precipitate acute angle closure glaucome?
Clinical features of HOCM?
- Jerky pulse
- Large 'a' waves
- Ejection systolic murmur: louder on valsalva, quieter in squatting.
Often asymptomatic, otherwise dyspnoea, angina, syncope, arrythmias, sudden death.
When would you consider stoppping AEDs and over how long?
- If seizure free for >2yrs
- Stop obver 2-3 months
Drugs to avoid in Long QT?
- Amiodarone, sotalol and class 1a
What is the pathophysiological difference between Amiodarone induced Thyrotoxicosis type 1 and 2?
Type 1 = excess iodine induced thyroxine oversynthesis. Leads to a goitre and best treated with carbimazole.
(the opposite to amiodarone induced hypothyroidism where excess iodine causes less thyroxine to be synthesized)
Type 2 = Amiodarone-related destructive thyroiditis. No goitre and best treated with corticosteroids.
Criteria for transplantation in liver failure due to paracetamol overdose?
Arterial pH <7.3 in the first 24hrs
OR ALL of the following
- Creat > 300
- Prothrombin time > 100seconds
- Grade 3 or 4 encephalopathy.
What defines a staggered overdose?
Tablets taken in a time period >1hr
Feature of cholesterol embolisation?
- Livedo reticularis
- Renal failure
Necrotic ulcers start after commencing warfarin...
Protein C deficiency
Abx for SPB?
Septic arthritis abx?
Which drug makes clopidogrel less effective?
What rash is associated with Reactive arthritis? DESCRIBE IT too.
Cherry-red lesion in the lung?
Drugs to avoid in HOCM?
- Ace inhibs
How does lead poisoning present?
- Abdo pain
- Motor signs in limbs
- Blue lines on gums
- Urinary Coproporphyrin
- Blood Lead levels
- Basophillic-stippling + Clover-leaf cells
- Microcytic anaemia
What risks are assoc with Combined HRT over oestrogen only?
What advantage does progesterone give?
Combined: Increased VTE, breast cancer.
Progesterone confers a decreased risk of endometrial cancer.
Risk of stroke and IHD are the same.
Discoid Lupus erythematous:
How many convert to systemic lupus?
- Topical steroids then oral hydroxychloroquine
- 5% convert to systemic lupus.
Associations of Aortic dissection?
- Collagens: Marfans + Ehlers
- Turner's + Noonans
- Bicuspid aorta
What ECG pattern may be seen in aortic dissections?
Inferior pattern due to the ter involving the ostia of the RCA.
What is the BNF advice on trying to withdraw benzos?
- Switch to diazepam
- Decrease by 2-2.5mg per fortnight.
- Can take between 4 weeks and a year.
Factors which increase pulse pressure apart from aortic regurg?
- Less compliant aorta
- Increased stroke volume
What test would you use to statistically compare percentages?
What investigation is characteristic of Autoimmune Haemolytic anaemia?
- Direct Antiglobulin test or Coomb's test
- Positive in AIHA
- Mainly IgG in Warm
- Mainly IgM in Cold
Autoimmune polyendocrinopathy syndrome type 2 = ?
- Autoimmune thyroid disease
Autoimmune polyendocrinopathy syndrome type 1 = ?
MEDAC - Multiple endocrine deficiency autoimmune candidiasis
- Chronic mucocutaneous candidiasis
Roundworm infection that burrows thru skin to get into you.
Abdo pain, diarrhoea, cough + haemoptysis,
Treat with ivermectin + albendazole
What antibody you guna find in the skin bipopsy of dermatitis herpetiformis?
IgA deposits in granular pattern.
What are Looser's zones?
Bands of translucency on X-ray. Indicative of osteomalacia.
Causes of osteomalacia?
- Vit d deficiency
- renal failure
- liver disease
- vit d resistance
- drugs eg anticonvulsants
What can precipitate churg-strauss?
Eosinophillia, asthma, paranasal sinusitis, pANCA +ve, mononeuritis multiplex.
Leukotriene receptor antagonists can precipitate it.
What do you know about ARVC?
What are the ECG changes?
Arrythmogenic right ventricular cardiomyopathy is an AD disease and the second commonest cause of Sudden cardiac death in the young after HOCM.
Characterised by fibrofatty change in the RV myocardium.
ECG changes are TWI in V1-3 and an episilon wave (terminal notch) after the QRS complex.
Controlled with Sotalol, ablation or ICD.
What is Naxos disease?
Autosomal recessive version of ARVC with wooly hair and palmoplantar keratosis.
Symptoms of POAG?
- Blurred visiondecreased visual acuity
- Loss of the nasal visual field
- Optic disc cupping
When do you start antiretro virals in HIV?
When CD4 < 350.
Which vaccines are contraindicated in HIV +ve individuals?
- Intranasal influenza
- Oral polio
Most common cause of drug induced angioedema?
Managment of Angina?
- GTN spray + Bblocker or Ca2+blocker till maximal dose.
- Once that hasnt worked then add in Ca2+ blocker like nifedipine or Bblocker (vice versa)
Only add third drug if awaiting PCI or CABG. Long acting nitrate, nicorandil or ivabradine.
How do you manage pregnant ladies that have antiphospholipid syndrome?
Aspirin 75 from the frst +ve UPT
LMWH once the 12 week scan shows a viable fetus.
Stop LMWH at 34 weeks.
What are the similarities between pheytoin and ciclosporin?
- Both cause gingival hyperplasia
- Both need levels checking during their trough.
How do you discriminate between scleritis, episcleritis and keratoconjunctivitis sicca?
- Episcleritis = unilateral, not painful
- Scleritis = unilateral, painful
- KCJ = Bilateral, dry, itching, burning.
Which thyroid cancer is most likely to cause pressure symptoms?
Which cytogenetics confer good prognosis in AML and which confer bad prognosis?
15:17 PML-RAR = good prognosis
- Deleteions of 5 = bad prognosis
- Deletions of 7 = bad prognosis
Anti-epileptics and pregnancy...
What is the general philosophy?
What are some key facts about the AEDs relevant to pregnancy?
Aim for monotherapy. No need to monitor levels.
Sodium Valproate: Assoc neural tube defects
Phenytoin: Assoc cleft palate + need to give Vit K in last month of pregnancy to prevent clotting disorders in newborn
Carbamazepine: Considered the safest in pregnancy of the old AEDs
Lamotrigine: Rate of malformations low. May need to increase the dose.
What enhances the effect of Adenosine and what decreases the effect?
- Dipyradimole enhances
- Aminophylline decrease (inhibits the ADP receptor as well as PDE)
What type of infection is most likely with platelet transfusion?
Bacterial cuz they are stored at room temperature.
Sjogren's patients have an increased risk of what type of malignancies?
Causes of Hypercholesterolaemia rather than hypertriglyceridaemia?
- Nephrotic syndrome
What is tinea capitis?
What organism causes it?
How do you treat it?
- Scalp ringworm
- Can cause a boggy swollen raised pustular area called a kerion
Causes scarring alopecia
Common organisms include Trichophyton tonsurans and Microsporum Canis.
Microsporum fluoresce under wood's. Tirchophyton dont.
Investigate with skin scrapings
- Treat with Terbinafine for tricho
- Griseo for microspora
- Ketoconazole to decrease transmission.
What does tinea corporis look like?
What causes it?
How do you treat it?
Annular, erythematous, pustular lesions on body.
Trichophyton rubrum and verrucosum. Usually caught from cattle.
Treat with oral fluconazole.
Which way does the lens dislocate in marfans and which way in homocystinuria?
- Marfans Superotemporal
- Homocystinuria = Inferonasal
Risk factors for IIH?
Female, obese, pregnancy
Drugs: OCP, Vit A, Tetracyclines
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