MRCP cont 3.
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- Parathyroid (95%)
- Pituitary (70%)
- Pancreas (50%)
MEN1 gene - Autosomal dominant
Most common presentation = hypercalcaemia therefore measure that.
2 Ps and the medullary
RET 2 oncogene
1 P and the medullary + marfanoid
Ret 2 oncogene
Which antibodies suggest Sjogrens syndrome?
What other investigations can point towards it?
- RhF positive in nearly 100%
- ANA postive in 70%
- Anti-Ro (SSA) positive in 70%
- Anti-La (SSB) positive in 50%
Hypergammaglobulinaemia and low C4
What are the treatment options for Grave's?
- ATD titration
- Block and replace
Propanalol early to block adrenergic side-effects.
Detail of ATD titration.
- Start at 40mg of carbimazole and reduce gradually until pt euthyroid
- Usually lasts 12-18months
- Generally entails less side effects.
Detail Block-replace regimen.
- start carbimazole at 40mg
- Start thyroxine when pt euthyroid
- Usually lasts 6-9months
- Usually entails more side-effects.
Pigment laden macrophages on biopsy of colon =?
General principles of managing a person with high INR on warfarin?
- If theyre bleeding = IV VIT K
- If INR is > 8. Need to do a check at 24hrs and if still high give another dose of vit K.
- Only ever restart warfarin when INR below 5.
What reduces the absorption of levothyroxine?
Iron tablets. Give 2 hrs apart
If you're thinking its a Paradoxical embolus in a young woman...what questions is it important to ask to rule out the differential?
Recurrent miscarriages and DVTs.
Cuz antiphospholipid syndrome is more common and you might be jumping the gun.
Most common inherited thrombophilias?
- Activated protein C deficiency (FactorVleiden)
- Antithrombin III deficiency
- Protein C deficiency
- Protein S deficiency
Most common inherited bleeding disorder?
Von Willebran's disease.
Features of syringomyelia?
- Can start unilateral but then become bilat
- Wasting of muscles + weakness
- Spinothalamic sensory loss
- Loss of reflexes and upgoing plantars.
- Stronly assoc with Arnold-chiari
- Progressive over years.
Management of Prolactinomas?
- ALWAYS dopamine agonists.
- even with visual field defects and midline shift.
Only tumors that dont respond to that get surgery.
Exacerbating factors in MG apart from exertion?
- Quinidine, procainamide
Safest TCA in overdose?
Investigation for aspergilloma?
- Aspergillus precipitins
Management on Ank Spond?
- Encourage exercise like swimming
- NSAIDs are first line
- DMARDS only useful if peripheral disease present
- Anti-TNFs useful for very severe disease only
Drugs that cause erythema multiforme?
Which drug is mainly used for drug-induced parkinsonism?
Best way to assess response to treatment in Hep C?
Where is the insulin resistance in IFG and IGT?
Which typre of glucose abnormality is most likly to develop T2DM
- IFG = hepatic insulin resistance
- IGT = Impaired muscle glucose
IGT most likely to develop T2DM
Is dialysis useful in TCA overdose?
What percentage of chronic HEP C patients develop cirrhosis over a 20-30year period?
What is Reye's syndrome? Cause + presentation + management.
Usually caused by aspirinviral illness:
- Encephalopathy: Confusion, seizure, cerebral oedema, coma
- Fatty infiltration of kidneys, liver and pancreas
Management is supportive
Causes of a false positive VDRL?
Causes of dilated cardiomyopathy?
- Infections: Coxsackie, HIV, diptheria, parsitic
- Endocrine: hyperthyroidism
- Deposition: Haemochromotosis, Sarcoid
- Nutritional: Kwashikorr, pellagra, Selenium, thiamine
- Drugs: doxorubicin
- Neuromuscular: Duchenne's
How long is treatment for dermatophyte finger or toe nail infection?
- Finger nail = 6weeks to 3 months.
- Toenail = 3-6 months!!
Order of agents for neuropathic pain?
- Amitriptyline or pregabalin
- If Ami effective but adverse effects not tolerated then switch to IMI or NOR
- If Ami not effective, add pregabalin
- Then add tramadol or topical lidocaine
What chromosomes are APKD 1 and 2 genes on?
Which features predict a poor prognosis in Rheumatoid Arthritis?
- Rheum Factor
- ANti-CCP antibody
- poor functional status at presentation
- insidious onset
- extra articular symptoms
- Xray feature in <2years.
What do you do with babies born to Hep B +ve mothers?
Full course of immunisation when they are born and Hep B Ig.
Breast feeding is FINE
C-section doesnt change anything
What factors differentiate between
Acute tubular necrosis?
- Urine sodium
- PRU < 20 mmol/L
- ATN > 30 mmol/L
- Fractional sodium excretion*
- PRU < 1%
- ATN > 1%
- Fractional urea excretion**
- PRU < 35%
- ATN >35%
- Urine:plasma osmolality
- PRU > 1.5
- ATN < 1.1
- Urine:plasma urea
- PRU > 10:1
- ATN < 8:1
- Specific gravity
- PRU = > 1020
- ATN = < 1010
- Pre-renal uraemia = 'bland' sediment
- ATN = brown granular casts
- Response to fluid challenge
- PRU = Yes
- ATN = No
Indications for NIV?
- COPD with pH 7.25-7.35
- Type 2 resp failure secondary to Obx sleep apnoea, chest wall deformity or neuromusc conditions.
- Weaning of intubation
- Cardiogenic pulmonary oedema.
How do you differentiate Drug-induced parkinsons from Parkinsons?
Rest tremor and rigidity not present in drug induced.
Drug induced tends to be bilateral and has a rapid onset of symptoms.
Which class of drugs cause Osteomalacia?
What measure is best used to express survival over time?
Similar to relative risk but when risk is not constant over time.
Features of HIT?
Heparin induced thrombocytopaenia
Antibody mediated ACTIVATION of platelets
Despite causing paenia its a PROTHROMBOTIC condition
Usually develops in day 5-10 post treatment
Greater than 50% reduction in platelets + thrombosis + skin allergy
Features of waldenstroms?
- monoclonal IgM paraproteinaemia
- systemic upset: weight loss, lethargy
- hyperviscosity syndrome e.g. visual disturbance
- cryoglobulinaemia e.g. Raynaud's
Risk fctors for oesophageal cancer?
- Barrett's oesophagus
- Plummer-Vinson syndrome
- rare: coeliac disease, scleroderma
Hairy cell leukemia features?
- skin vasculitis in 1/3 patients
- 'dry tap' despite bone marrow hypercellularity
- tartrate resistant acid phosphotase (TRAP) stain positive
Hairy cell leukaemia management
- chemotherapy is first-line: cladribine, pentostatin
- immunotherapy is second-line: rituximab, interferon-alpha
Alternative anticoagulants during HIT?
lepirudin and danaparoid
What is ebstein's anomaly?
Displacement of the septal leaflet towards the apex causing a smaller ventricle and a larger atrium.
Causes a Pansystolic murmur due to tricuasapid incompetence and WPW.
Assoc with lithium exposure in utero.
Complications of Pagets disease?
- Deafness (due to nerve entrapment)
- Bone sarcomas
- Skull thickening
- High-output cardiac failure.
What is a hydatid liver cyst?
How do you treat it?
Caused by Echinococcus larvae.
Best treated with albendazole
What is cysticercosis?
How to you Rx?
Tapeworm disease contracted from Taenia Solium (from pigs) or saginata (from cows).
Treat with niclosamide
Causes of a high Leucocyte alkaline phosphatase score?
- Leukamoid reactions
- Pregnancy, OCP
Causes of a low Leucocyte alkaline phosphatase score?
- Pernicious anaemia
Antibody for Mixed connective tissue disease?
Axonal causes of peripheral neuropathy?
- Vit B12
- HSMN II
Demyelinating causes of peripheral neuropathy?
- HSMN 1
- Paraprotein neuropathy
- Autosomal dominant
- Abnorm in the SCN5A gene.
- Convex ST elevation in leads V1-3
- Right bundle branch block
- Exacerbated by flecanide
- More common in asians
Management of a single keratinised genital wart compared to multiple genital warts (non-keratinised).
- Single keratinised = Cryo
- Multiple non-keratin = Topical podophyllum
Investigation for Lewy body
DAT scan (type of SPECT)
ANK SPOND features: the As?
- Apical fibrosis
- Anterior uveitis
- Aortic regurg
- Achilles tendonitis
- AV node block
Acute meds for cluster headaches?
Prophylactic meds for cluster headaches?
- Acute = 100% O2, subcut triptan, nasal lidocaine
- Prophylaxis = Verapamil, prednisolone
Stages of diabetic nephropathy?
- Stage 1 = hyperfiltration
- stage 2 = Latent phase
- stage 3 = microalbuminuria
- stage 4 = proteinuria + glomeruli sclerosis + hypertension
- Stage 5 = ESRF
What percentage of patients with Graves develop eye disease?
where do 90% of VIPomas arise from?
what are the symptoms?
- Hypokalemia, hypochlorhydia
when HLA matching for a renal transplant what is the relative importance of the HLA antigens?
DR > B > A
What types of graft failure can occur to a transplanted kidney?
what causes them?
- Hyper-acute (min to hrs)
- Pre-existent antibodies
- type 2 rcn
- Avoided by Hla matching
- Due to cytotoxic t cells
- Also caused by CMV
- can be reversed with steroids and immunosuppresants
- due to cell mediated and antibody mechanisms causing Fibrosis
In chronic graft rejection that has not fibrosed. Which renal disease recurr and in what order of commonality?
Hashemites predisposes to which type of thyroid cancer?
How does PCT present?
which enzyme is deficient?
- photosensitive blistering skin rash
deficient in uroporphyrinogen decarboxylase
Management of Long QT syndrome?
- Avoid drugs that prolong QT
- Offer Bblockers (but NOT sotalol)
- ICD if QT>500ms or if had previous cardiac arrest.
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