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vb406
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What happens to TfTs during times of acute illness?
Sick euthyroid. So you're TSH is normal but your t3 and t4 are low.
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Fragmented red cells. Uremia. Low platelets. Febrile. High wcc. Confusion. in a pregnant pregnant woman. Diagnosis?
TTP
overlaps with HuS
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Autoimmune poly glandular syndrome type 1?
Rarer form of APS
- hypoparathyroidism
- mucocutaneous candidiasis
- Addison's
- vitiligo
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Autoimmune poly glandular syndrome type 2?
- T1DM
- Autoimmune thyroid disease
- vitiligo
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What can PCV transform into?
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Drugs that cause pancreatitis?
- Steroids
- valproate
- azathioprine and mesalazine
- furo and bendro
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Causes of a raised protein in CSF?
- tuberculous, bacterial and fungal meningitis
- viral encephalitis
- GBS
- Spinal block
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Drug causes of a long QT?
- Amiodarone, sotalol, class 1a
- antipsychotics
- tricyclics
- Chloroquine
- erythromycin
- Terfenadine
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What causes downbeat nystagmus?
Foramen magnum lesion - Arnold chiari malformation
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Upbeat nystagmus?
Cerebellum vermis lesion
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Drugs for motion sickness?
Hyoscine>cyclizine>promethazine
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Raised ALP and normal bone chemistry =?
Pagets disease
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In hypothyroidism what's the first thing you do is some ones hyperlipidemic?
Give them thyroxine and control their TSH adequately.
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What happens to serum caeruloplasmin in Wilson's?
Low baby!
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What's the most appropriate investigation in someone with a chronic venous ulcer?
ABPIs cus you're going to stocking them and you need to work out whether it's mixed or not.
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What drugs precipitate lithium toxicity?
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What drug improves prognosis in stable angina?
Aspirin
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When is it best to give the pneumococcal vaccine to a pt due to have splenectomy?
1 month before op.
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A normal PaCO2 during an acute asthma attack?
Life-threatening. Shud always be low.
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What is PEP?
3 drugs for 1 month.
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Murmur in HoCM?
Ejection systolic. Louder on Valsalva. Quieter on squatting.
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What drugs precipitate AACG?
Anticholinergics.
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Met common side effect of progestogen only pill?
Irregular periods
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Treatment options fir aplastic anaemia?
- Supportive with blood products
- avoiding infection
Antithymocyte globulin or anti lymphocyte globulin.
stem cell transplantation - allo grafts have 80% success rate.
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How does toxic multinodular goitre present?
what doe investigations show
what is the treatment of choice?
- Thyrotoxic with irregular nodular goitre.
- patchy uptake on scintigraphy
- best rx is radioiodine
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Amiodarone induced thyrotoxicosis type 1?
Excess iodine uptake.
Goitre
carbimazole or potassium perchlorate. + stop amiodarone (unlike AIH)
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Amiodarone induced thyrotoxicosis type 2?
Destructive thyroiditis
No goitre
treat with corticosteroids + stop amiodarone (unlike AIH)
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Commonest site for an atrial myxoma?
Fossa ovalis border in the Left atrium.
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Dentistry in warfarin patients?
Check INR 72 hrs before. If less than 4.0 Then continue.
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Feature of cholesterol embolisation?
- Eosinophilia
- purpura
- livedo reticularis
- Renal failure
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V for vigabagrin?
V for visual field defects.
irreversible
check fields every 6 months
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Vitamin d resistant rickets?
X linked dominant presents as failure to thrive
problem with reabsorbing phosphate in the kidney.
low serum phosphate, normal calcium, raised ALP,
cupped metaphysis and widening epiphysis
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When do you start ARV in a pregnant woman with HIV?
20-32 weeks
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What drugs do you avoid in HOCM?
Nitrates, ace inhibitor, inotropes.
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Pendred's syndrome?
- Sensorineural deafness
- goitre
- euthyroid or mild hypothyroid
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Adding progesterone to HRT?
- Increased risk of breast cancer
- decreased risk of endometrial cancer
- Increased risk of venous thromboembolism
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Discoid lupus treatment?
Topical steroids then oral hydroxychloroquine
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Treatment of pulmonary hypertension?
All dependent on acute vasodilator testing.
if positive then calcium channel blockers
if negative then prostacyclin analogues, phosphodiesterase inhibitors and endothelin receptor antagonists.
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Causes of a warm AIHA?
Features on investigation?
What do you treat with?
- Neoplasia eg lymphoma and CLL
- autoimmune eg SLE
- drugs eg Methyldopa
IgG, extravascular, haemolytic in the spleen.
steroids, immunosuppresion, splenectomy.
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Causes of a cold AIHA? Features on investigation?
- Neoplasia eg lymphoma
- infections eg mycoplasma and EBV
IgM, intravascular, can cause Raynaud's and acrocyanosis.
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Fibrosis affecting the lower zones?
ACDC baby!
- Cryptogenic
- drugs
- asbestosis
- Connective tissue disorders except AS
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Causes of tricuspid regurg?
- Right vent dilation
- cor pulmonale
- rheumaric heart disease
- IE assoc with IVDU
- Carcinoid
- ebsteins anomaly
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Causes of predominant hypercholesterolaemia?
- Cholestasis
- nephrotic syndrome
- hypothyroidism
everything else causes hypertriglyceridaemia.
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Target BP in hypertension?
- Age Clinic BP ABPM / HBPM
- < 80 years. 140/90. 135/85
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- > 80 years. 150/90 145/85
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