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Terms in this set (287)
HEART DIES: HF, Embolus (pulmonary), AF, Renal failure (due to ↓clearance), Thrombus (acute MI), Dissection of the aorta, Inflammation (myo/pericarditis), Excercise (very strenuous), Sepsis.
what are the possible causes of a raised troponin?
What is the commonest causative organism in pneumonia in patients with COPD?
Which organism causes pneumonia which follows influenza infection?
Which type of pneumonia presents with a dry cough and atypical chest signs and xray findings?
Which pneumonia commonly presents with hyponatraemia and lymphopenia?
Which pneumonia is classically seen in alcoholics?
Which pneumonia commonly occurs in patients with HIV and presents with dry cough, exercise induced desats and absence of chest signs?
Which pneumonia is associated with erythema multiforme and cold autoimmune haemolytic anaemia
Which condition can cause the following complications?
- cold agglutins (IgM) may cause an haemolytic anaemia, thrombocytopenia
- erythema multiforme, erythema nodosum
- meningoencephalitis, Guillain-Barre syndrome
- bullous myringitis: painful vesicles on the tympanic membrane
- gastrointestinal: hepatitis, pancreatitis
- renal: acute glomerulonephritis
Pneumocystis pneumoniae (PCP)
All patients with a CD4 count < 200/mm³ should receive prophylaxis for what condition?
Which medication is used to treat PCP and for PCP prophylaxis?
Lymphopenia, deranged liver function tests and hyponatraemia may be seen in which pneumonia?
Alcoholics and diabetics
Klebsiella pneumonia is commoner in which two groups of population?
Which pneumonia causes the typical 'red-currant jelly' sputum?
Which bacterial infection typically causes a bright green sputum?
It is a GnRH agonist which decreases LH and FSH. It is used to treat prostate cancer.
What is the MOA of Decapeptyl / Triporelin? What are its medical uses?
Congenital Adrenal Hyperplasia
which condition presents with sexual ambiguity, hypotension and hyponatraemia?
which condition is caused by a deficiency in 21 hydroxylase deficiency?
it will be increased due to the absence of negative feedback of cortisol
what would the level of ACTH be in a patient with CAH?
replacement of glucocorticoid and mineralocorticoid activity
what is the treatment of CAH?
What is the commonest cause of encephalitis in the UK?
Which medication can cause a rise in WCC to around 13?
What eye condition is people with hyperferritinaemia at an increased risk of developing?
What are the components of CREST syndrome of scleroderma?
MI, hypotension or tachycardia
Name three cardiac cause of elevated troponin?
Stable angina or acute coronary syndrome.
What are the two subgroups of ischaemic heart disease?
IV low molecular weight heparin
What is the treatment of NSTEMI and unstable angina?
What are the 6 subgroups of complications after MI?
heart failure, cardiogenic shock, mitral valve dysfunction, aneurysms, cardiac rupture.
What are the possible mechanical complications of MI?
Urea crystals on the skin - sweat has urea in it, hyperuraemia leads to high sweat urea concentration
What skin sign could be observed in a patient with hyperuraemia?
- Blood loss
- Impaired RBC production
- Abnormal destruction of RBCs
What are the three groups of causes of anaemia?
A broad spectrum antibiotic which penetrates well to CSF, bile, heart valve, lungs and peritoneal fluid
preauricular, submental and submandibular
Which lymph nodes drain into the tonsilar lymph node?
A thyroglossal cyst
A lump in the neck which would move up and down when swallowing and when protruding the tongue
Von Graefe's sign
upper eyelid lag during downgaze
What is the leading cause of hyperthyroidism?
Ultrasound to determine whether it is solid or cystic
What is the next step in a patient who is found to have a thyroid swelling on examination?
hyperthyroidism or diabetes
What are the two most common differentials in patients presenting with weight loss and normal appetite?
Pre renal - causes thickening of the afferent arterioles.
Systemic sclerosis can cause which type of renal impairment?
Post renal - formation of granulomas in the urinary tract.
Schistosomiasis can cause which type of renal impairment?
EBV and drugs (over 50 drugs which can cause drug induced Lupus)
What are the two main risk factors for developing SLE?
When is the malar flush of SLE at its worst?
Which test is positive in 95% of patients with SLE?
Which condition causes multisystem symptoms with high ESR but normal CRP?
4/11 of (A RASH POIN MD):
Immunology - Anti DsDNA, anti-smith
How is SLE diagnosed?
Prosthetic Heart valve . Valvular defects
Congenital heart disease / HOCM
Name three risk factors for the development of bacterial endocarditis
The DUKE criteria is used to diagnose which condition?
Positive ECHO - vegetation
Positive blood culture showing 2 typical organisms or 3 atypical organisms
What are the major criteria for the diagnosis of bacterial endocarditis using the Duke Criteria?
Which artery is most commonly affected in ischaemic colitis?
What condition would cause a cramp like, usually left sided pain lasting several hours followed by rectal bleeding?
Plain AXR = thumb printing (non specific)
Lactate may be increased in severe forms
Barium enema, colonoscopy and histology may also be done.
What tests are used to diagnose Ischaemic colitis?
-most are transient - supportive, bowel rest, IV fluids, antibiotics, analgesia
- Acute - Thrombolytics, vasodilators, Surgery
What is the management of Ischaemic Colitis?
Which test is mandatory to investigate patients with unaccounted AF?
Rate control = beta blocker or cardioselective CCB
Rhythm control = Flecanide or amiodarone
Anticoagulation based on HASBLED / CHADVASc
What are the aspects of management of AF?
To identify cause / to rule out differentials
(MRI, thrombophilia screen if infarct shown, Metabolic and gene testing, EEG in seizures, TORCH titres in infection)
What is the approach for investigating Cerebral palsy?
Typical - IBS like symptoms, change in bowel habit, oral ulcers, vomiting, anaemia.
Atypical - Asymptomatic, alopecia, osteoporosis, hepatomegaly, oral ulcers, arthropathy
What is the difference between typical and atypical presentation of Coeliac's disease?
Endomysial antibodies (EMA), Tissue transglutaminase (TTG) and Deamindates gliadin peptide (DGP)
What does a Coeliac serology consist of?
An itchy, blistering rash which is seen usually on the trunk and extensor surfaces.
- Iron deficiency - dietary or blood loss
- Chronic disease
- Sideroblastic anaemia
- Haemolytic anaemia
What are the causes of microcytic anaemia?
High Iron, high ferritin and low TIBC
What are would be observed to the iron, ferritin and TIBC values in sideroblastic anaemia?
Acute blood loss
Anaemia of chronic disease
Bone marrow failure (low wcc and low platelets)
Renal failure (decreased EPO)
What are the causes of normocytic anaemia?
B12 or folate deficiency
What are the causes of macrocytic anaemia?
Must always be taken with Folate as giving B12 alone can cause low folate leading to subacute degeneration of the cord.
What caution must be taken when prescribing B12 for B12 deficient anaemia?
Chest and Stomach, then spreads to other part of the body
Where does the rash of Scarlet fever usually start?
breaks in fragile capillaries in body folds causing classic red streaks. Occurs in scarlet fever.
What are pastia lines and in what condition are they seen in?
Measles, Glandular fever, slapped cheek
What are the differentials for scarlet fever?
At the face and behind the ears
Where does a measles rash typically start?
Lymphadenopathy - usually retroauricular, occipital and posterior cervical.
What feature is nearly always present in a Rubella infection?
- Throat swab and culture
- Anti deoxyribonueclease B and antistreptolysin O titres
what are the possible methods of diagnosing Scarlet fever?
Penicillin V for 10 days or Azithromycin for 5 days
What are the treatment options for Scarlet Fever
- Megakaryocyte = Platelets
Which blood cells belong to the myeloid stem cell lineage?
- B lymphocyte = Plasma cell
- T lymphocyte
What blood cells belong to the lymphoid stem cell lineage?
- Red marrow of axial skeleton
- Liver and spleen can take over in disease
Where does heamatopoiesis occur in adults in health and in disease?
AML and ALL
What are the two undifferentiated blood cell malignancies?
Normal differentiation = myeloproliferative
Abnormal differentiation = myelodysplastic
How can chronic myeloid leukaemia be further subdivided?
- Polycythaemia Vera
- Essential Thrombocythaemia
- Primary myelofibrosis
What are the four subtypes of myeloproliferative disorders?
What blood malignancy is diagnosed by the presence of >20% of blasts in blood or marrow?
- Fatigue and lethargy (low RBCs)
- Infections (low WBC)
- Bleeding or bruising (low platelets)
- Bone pain
What are the symptoms of the Acute Leukaemias?
Which blood malignancy has a greater incidence in Down's Syndrome?
Which blood malignancy can follow CML?
What blood malignancy would show Myeloblasts and auer rods?
What is the commonest blood malignancy in adults?
What blood malignancy is characterised by the accumulation of small mature B lymphocytes in bone marrow and peripheral blood (smear cells on microscopy)?
Development of Non hodgkin lymphoma as a result of CLL
What is Richter's syndrome
Site of accumulation of B cells. CLL = bone marrow and peripheral blood. Lymphoma = Lymph nodes
What is the difference between CLL and Lymphoma?
What is the usual presentation of CLL?
Which blood malignancy is diagnosed with high WBC and lymphocytes >5000 which have persisted for more than 3 months?
Which blood malignancy shows lymphocytosis and smudge cells on microscopy?
Which blood malignancy is staged using the Binet system?
A group of disorders which result from overproduction of normal myeloid cells.
Myeloproliferative disorders mainly affects which age group?
Which disorder is associated with the Philadelphia chromosome?
What is the name of the tyrosine kinase inhibitor which is used to treat CML?
Neutrophils = CML
RBC = Polycythaemia Vera
Platelets = Essential Thrombocythaemia
What are the subdivisions of myeloproliferative disorders?
Which condition causes leukoerythrpblastosis and and distorted 'tear drop' RBCs on biopsy?
What is the main mutation seen in polycythaemia vera?
Which infection should you think about in a returning traveller complaining of fever on alternate days?
A raised ESR and osteoporosis represents what unless proven otherwise
ophthalmoplegia/nystagmus, ataxia and confusion
What is the classical triad of Wernicke's encephalopathy?
Sarcoidosis or Lymphoma
What are the differentials for perihilar lymphadenopathy?
Well defined left ventricular anneurysm
What would be seen on xray in a left ventricular anneurysm?
TB, idiopathic, connective tissue disorder
What are the differentials for pericardial calcification?
- Young = Marfan's aortic dissection
- Old = atherosclerosis, anneurysm
What would be the differentials if a large aortic knuckle is observed on CXR?
- Young = likely mucous plugging with infection
- Old = more likely caused by tumour
What are the differentials for a lobar collapse?
When 2 heart borders are seen, suggests left lower lobe collapse
What is the sail sign?
Double wall sign of the bowel
What is Rigler's sign?
- Positive pressure ventilation
- Thoracic surgery
- Pericardial drainage
- penetrating trauma
- infectious pericarditis with gas producing organism
What can cause pneumopericardium?
Air in the aorta
What does a black line down the heart suggest?
- Alveolar oedema
- Kerley B lines
- Upper lobe diversion
What are the CXR signs of Heart failure?
Mediastinal shift and depression of diaphragm
What two cxr signs are seen in tension pneumothorax?
TB or streptococcus
What are the two cavitating pneumonias?
Used to treat TB in the 1900 by crushing lung
What is thoracoplasty and what was it used for?
What causes the heart to appear as if it has a fluid level within it?
Benign, well defined areas of calcification caused by asbestos exposure. Holly leaf plaque
What are holly leaf plaques?
What causes a U shaped appearance within the bronchus?
What would be the diagnosis in an immunosuppressed patient with a round cavitated lesion with a crescent around it?
Subluxation of a joint is more common in which condition?
a tendon forcibly extracts a piece off of the bone
fracture of the distal radius with volar (ventral) displacement
fracture of the distal radius at the wrist causing dorsal displacement
Articular fracture, simple two part fractures, oblique fractures and forearm fracture
Which fractures need to heal by primary bone healing?
Primary bone healing
-Healing without external fibrocartilagenous callus formation, must make sure that anatomical reduction is perfectly aligned and absolute stability
Secondary bone healing
Bone repair process that is characterized by the formation of fracture callus, which then remodels to form new bone
Secondary bone healing - stimulated callus formation
Which type of bone healing is allowed some degree of movement?
Which diabetic medication is cardioprotective?
Mobitz type 2 AV block
What are the causes of a regularly irregular heart rhythm?
- Ectopic source in ventricles
- Defect of conductive system
- Accessory pathway from atrium
What are the three broad categories of causes of a wide QRS complex?
Wolf Parkinson White
Which disorder is associated with a delta wave on an ECG?
Left ventricular hypertrophy
Which disorder may show large QRS voltages on an ECG?
Myocardial ischaemia or strain
What does ST depression on an ECG suggest?
What does a new LBBB suggest when seen on an ECG?
P mitrale is seen on an ECG in which condition?
Peaked P waves due to R heart strain seen in COPD, Asthma, PE and chronic heart failure
What is P pulmonale and what conditions is it seen in?
- Coronary artery disease
- LV aneurysm
- Mitral valve disease
- Aberrant conduction pathways
What are the cardiac causes of arrhythmias?
- Caffeine, smoking, alcohol
- Drugs (beta agonists, digoxin, Ldopa, tricyclics, doxorubicin)
- Metabolic imbalance
- Thyroid disease
What are the non cardiac causes of arrhythmias?
- Calcium and magnesium
Which blood tests would be performed in an individual presenting with an arrhythmia?
Severe Hypokalaemia or bradycardia
When are U waves seen on an ECG?
A small deflection sometimes seen after the T wave and usually to the same direction as the T wave
Atropine 0.6-1.2 mg IV up to 3mg
What is the treatment of symptomatic or bradyarrthymia <40bpm?
Temporary pacing wire
If necessary, start Isoprenaline (beta agonist) infusion or external cardiac pacing
What are the treatment options of bradyarrhythmias if there has been no response to atropine?
Name two physiological causes of bradyarrhythmias?
Calcium channel blockers
What three medications may cause bradyarrhythmias?
What two metabolic causes can cause bradyarrhythmias?
Cholestasis, Raised ICP and Obstructive sleep apnea can have what effect on the heart?
sick sinus syndrome
arrhythmia in which bradycardia alternates with tachycardia
Sick sinus syndrome (SSS)
SA node dysfunction causing bradyarrhythmia, SA block or alternating brady and tachy
Ambulatory ECG due to transient nature
How is sick sinus syndrome diagnosed?
- idiopathic fibrosis of the SAN due to IHD, Cardiomyopathy, myocarditis, sarcoidosis, amyloidosis, haemochromatosis, chagas disease or drugs
What causes sick sinus syndrome?
- Artificial pacemakers
- Ablation therapy to manage tachyarrhythmias
- Anticoagulation (thromboemboli are common)
What is the management of sick sinus syndrome?
Carotid sinus syndrome
When presyncopal or syncopal symptoms follow carotidd sinus massage causing bradyarrhythmia or BP drop
Postural Orthostatic Tachycardia syndrome - Sudden increase in HR and mild drop in BP produced by standing
What are the changes that occur during POTS syndrome?
2nd degree heart block = Mobitz type 1
Which heart block is also referred to as Wenkeback heart block?
Infranodal (bundle of his)
Where is the defect in a Mobitz type 2? (2nd degree heart block)?
Permanent pacemaker is symptomatic
What is the management of mobitz type 2?
Acute = IV atropine
Chronic = Pacemaker
What are the management options of 3rd degree heart blocks?
Bundle branch conduction delay = QRS up to 0.11s
Complete block of bundle branch = QRS >0.12s
What is the difference between bundle branch delay and bundle branch block?
Multifocal atrial tachycardia
A rare type of SVT which is characterised by multiple (>3) P wave morphologies and an irregular RR interval seen in chronic lung disease
A SVT which has no visible P wave or an inverted p wave immediately before or after the QRS complex
AVRT (AV reciprocating tachycardia)
An SVT caused by an accessory pathway with P waves visible between QRS and T waves
The valsalva manouver can be used to manage which SVT?
Queens Live Forever
Quinidine (class 1a)
Lidocaine (class 1b)
Flecanide (class 1c)
Name an example of class 1a, 1b and 1c antiarrhythmic drug?
Na+ channel blockade
Lengthens AP, increases refractory period and decreases AV conduction
What is the MOA of class 1 anti arrhythmic drugs?
Potassium channel blocker (type 3 anti arrhythmic)
Amiodarone belongs to which group of antiarrhythmic medication?
Class 2 anti arrhythmics / Beta blocker
Which anti arrhythmic medications work by slowing pacemaker activity and increases AVN refractory period?
Propranolol and Atenolol
What are the beta blocker antiarrhythmic drugs?
What are the therapeutic indications of beta blockers?
atenolol, bisoprolol, metoprolol
What are the B1 (cardioselective) beta blockers?
Potassium channel blockers / class 3 antarrhythmic
Which anti arrhythmic medications work by widening the AP and refractory period and can prolong the QT interval on an ECG?
Calcium channel blocker / class 4
Which anti arrhythmic drugs may be inappropriate in patients with Heart failure?
CCB / class 4 anti arrhythmic
Which group of anti arrhythmic drugs allow the body to retain adrenergic control of the HR and contractility?
Which antiarrhythmic drugs work predominantly on the AVN?
- Primary PCI
What are the two options to undergo coronary re-perfusion in patients presenting with STEMI?
If PCI cannot be delivered within 120 minutes and if onset of symptoms was more than 12 hours ago
When would fibrinolysis be offered for the management of STEMI?
What are the fibrinolytic drugs that can be used to re perfuse a STEMI?
Which fibrinolytic drug cannot be used for the second time due to the production of antibodies making it ineffective the second time?
ECG after 60-90 minutes
IF ST elevation persists, immediate coronary angiography should be offered and fibrinolytic therapy not repeated
What is the follow up required after the administration of fibrinolytic therapy?
Nasal cannulae at 2-4 L / minute
What is the oxygen requirement for the management of STEMI?
If risk is >1.5% and no contraindications, give Clopidogrel 300mg in addition to aspirin
If risk >3%, offer glycoprotein inhibitors (IV epitifibatide or tirofiban)
Which scoring system should be used to aid in the prescription of medications for patients presenting with NSTEMI?
- Aspirin (loading dose 300mg)
- Antithrombin unless angiography within 24h
- Ticagrelor or 12 months
What are the drug therapies offered to patients presenting with NSTEMI?
- Persistence of underlying cause
- Duration of AF
What two main factors influence the likelihood of success of cardioversion for the treatment of AF?
Rate control - (control ventricular response)
Rhythm control - (restore and maintain sinus rhythm)
What are the two main approaches to the treatment of AF?
Beta blocker or calcium channel blocker (verapamil)
Which medications are usually used to rate control atrial fibrillation?
- Group 1c antiarrhythmic (flecanide) or group 3 (amiodarone)
Which pharmacological agents are used to cardiovert or maintain sinus rhythm after cardioversion?
Coronary artery disease
Contraindications to antiarrhythmics
Unsuitable for cardioversion
Which group of people will likely receive rate control for the management of their AF?
- Paroxysmal or persistent AF
- Who are symptomatic
- Who are younger
- First presentation with lone AF
- Secondary to treated precipitant
- With congestive heart failure
Which group of people would be more likely to receive rhythm control to attempt to treat their AF?
squamous cell carcinoma
Which lung cancer is most likely to be associated with hypercalcaemia?
Lung Squamous cell carcinoma
Which lung cancer is likely to cause obstructive lesions of the bronchus with postobstructive fections
Adenocarcinoma - peripheral lesions on CXR
Which lung cancer is the commonest in non smokers, where is the abnormality on a CXR?
- Lymph nodes
Where does lung adenocarcinoma commonly metastasise to ?
Neurone specific Enolase
What is the tumour marker for small cell lung cancer?
Small cell lung cancer
Which lung cancer usually metastasises relatively early and is usually managed with palliative chemotherapy?
Small cell or non small cell lung cancer
What are the two broad categories of lung cancers?
Guillian-Barre Syndrome (GBS)
The commonest cause of acute polyneuropathy
Which condition is also known as post infective neuropathy?
CMV and campylobacter jejuni
Which two organisms are well known causes of severe GBS?
- Clinical diagnosis
- Nerve conduction studies
- CSF protein elevated
What are the methods of diagnosing GBS?
Neurological deficit lasting less than 24 hours. (may change to <1 hour)
What is the definition of a TIA?
What scoring system may be used to differentiate between stroke and stroke mimics?
- Loss of consciousness
- Seizure activity
According to the ROSIER score which symptoms if present would decrease the likelihood of stroke as a cause?
What needs to be done before ROSIER score when suspecting a stroke?
What ROSIER score makes the diagnosis of acute stroke likely?
- Hemiparesis +/- hemisensory loss
- Homonymous hemianopia
- Cortical dysfunction (dysphasia / perceptual problem)
According to the Bamford classification, what are the symptoms of a total anterior circulation stroke?
2/3 of following
- Hemiparesis +/- hemisensory loss
- Homonymous hemianopia
- Cortical dysfunction (dysphasia / perceptual problem)
- Cortical dysfunction alone
According to the Bamford classification, what are the symptoms of a partial anterior circulation stroke?
OR - Hemi sensory loss
OR - Hemisensory motor loss
OR - Ataxic hemiparesis
(no cortical dysfunction (speech) or hemianopia)
According to the Bamford classification, what are the symptoms of a lacunar stroke (LACS)?
- Brainstem nuclei or cerebellar signs (DANISHV signs) (vertigo)
- Occipital signs
- Diplopia, vertigo, ataxia, bilateral limb problems, hemianopia, cortical blindness
According to the bamford classification, what are the symptoms of a posterior circulation stroke?
Which classification system is used to classify ischaemic strokes?
Total anterior circulation stroke
A type of stroke caused by a large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries.
A subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions
TACS = worst prognosis
LACS = best prognosis
Which type of stroke has the best prognosis and which has the worse?
Total anterior circulation stroke
What type of stroke is seen here?
Aspirin 300mg oral if able to swallow, otherwise given PR
What is the immediate drug therapy of an ischaemic stroke once confirmed on CT scan?
- Per rectum
What are the possible routes of administering Aspirin for the management of acute stroke?
- As early as possible within 4.5 hours of onset of symptoms
What is the recommended time frame for the use of Alteplase for the management of a stroke?
As a bolus (10% of total dose / 0.9mg/kg)
Then remainder infused over 1 hour
What is the method of administering Alteplase?
Recent head injury
Recent GI bleed
What are the contraindications of alteplase therapy?
Repeat CT after 24 hours to check for any bleed
What is the follow up that needs to be done after the administration of alteplase for the management of an ischaemic stroke?
<6 hours since onset of symptoms
What is the recommended time frame of thrombectomy for the management of stroke?
1st line = thrombolysis (alteplase)
2nd line = thrombectomy after failed thrombolysis
What is the first and second line management of ischaemic stroke?
- Social worker
What other MDT members will be involved in the care of patients after a stroke?
Clopidogrel 75mg after 2 weeks of aspirin 300mg
What antiplatelet therapy is given to patients after a stroke?
- Antiplatelet therapy
- Cholesterol control - target <4
- BP control
- Diabetes screen and treat
- Smoking cessation
What secondary prevention measures are considered for patients after a stroke?
For the reviving / prevent death of the penumbra (section which has a dual blood supply - may be recovered with treatment but will die without intervention)
Why is early intervention crucial in the management of strokes?
Most people do not have a penumbra after 4.5 hours and the ischaemic core becomes more friable and risk of bleeding is higher.
Why is there a 4.5 hour mark for thrombolysis of stroke patients?
Malignant MCA syndrome
A term used to describe rapid neurological deterioration due to the effects of space occupying cerebral oedema following a stroke
Elderly - oedema tends to have less effect due to overall decrease in brain mass
Malignant MCA syndrome tends to be less symptomatic in which population?
Referral to neurosurgeon for a hemicarniectomy
What is the management of a malignant MCA syndrome?
If shows infarct, there is an increased risk of bleeding into the infarct. Should not give thrombolytic if evidence of haemorrhage
What should the CT show in order to receive thrombolysis for stroke?
- CT / presentation suggests haemorrhage
- Neurosurgery / trauma or stroke in last 3 months
- Uncontrolled HTN (>185/110)
- Hx of haemorrhage / AV malformations
- active internal bleeding / known bleeding diathesis
- Suspected or confirmed endocarditis
- Abnormally low blood glucose
What are the absolute contraindications of thrombolysis?
Transient and painless loss of vision indicative of retinal ischaemia due to stenosis of ipsilateral carotid artery or emboli
Modified Rankin Scale (mRS)
A classification system used to measure level of disability or dependence in people who have suffered a stroke.
Age>60 = 1
BP >140/90 = 1
Clinical (speech = 1, weakness = 2)
Duration (10-59 mins = 1, 1hr+ = 2)
Diabetes = 1
What is the algorithm used to predict the risk of developing a stroke after a TIA?
allergies and parasitic infections
What causes an elevation in basophil levels?
Infections and malignancies
What causes an elevation in macrophage levels?
- Bleeding (esp as pt may already have low plts)
- Nerve damage
- Not enough sample
- Sample not yielding result
What are the risks of a bone marrow biopsy?
Iliac crest or sternum
where on body is bone marrow aspirated to diagnose haematological disorders?
Acute Myeloid Leukemia
In which blood malignancy are auer rods seen in?
Which Acute leukaemia has the worst prognosis?
If also Philadelphia positive
When would Imatinib be added to the treatment of ALL?
Mucositis (given prophylactic mouthwash)
What is the possible route of infection in acute leukaemia which occurs as a consequence of the chemotherapy, what is done to prevent it?
myelodysplatic syndrome (MDS)
What should be considered in patients with macrocytic anaemia with normal haematinics?
Disorders which result from the over production of mature blood cells
Chronic myeloid leukaemia
Which myeloproliferative disorder occurs as a consequence of abnormal neutrophil proliferation?
Polycythaemia rubra vera
Which myeloproliferative disorder occurs as a consequence of abnormal erythrocyte proliferation?
Which myeloproliferative disorder occurs as a consequence of abnormal platelet proliferation?
Myeloproliferative syndrome in which bone marrow is gradually replaced by collagen fibrosis causing extramedullary hematopoiesis (splenomegaly) and tear drop RBCs on histology
Chronic lymphocytic leukaemia
Which blood malignanacy causes the lymphocytes to have patchy nuclei creating a "back of turtle" appearance?
Which blood malignancy has a very slow rise in the number of lymphocytes
Classical hodgkin's lymphoma and nodular lymphocyte predominant hodgkin lymphoma
What are the two types of hodgkin lymphoma?
Autologous (own) Stem cell transplant
Which treatment can be curative for Hodgkin's lymphoma?
- Auer rods
- Low platelets
- Increased cytoplasm
- Increased granulocytes
- Hypochromic RBCs
What are the histological findings for AML?
Chromosome 22 and 9 BCR - Abl fusion
What is Philadelphia chromosome?
Which haematological malignancy overlaps with myeloproliferative disorders?
Which haematological malignancy overlaps with lymphoma?
Polycythaemia rubra vera
Some Essential thrombocytopenia
Which blood disorders are associated with JAK2 mutations?
Which blood disorder frequently causes difficulty obtaining bone marrow aspirate?
CLL to check for progression to lymphoma
Which haematological disorder requires 3 monthly monitoring?
Genetics - NOD2/CARD15 mutations
Appendectomy in the last 4 years
What are the risk factors thought to increase risk of Crohn's disease?
What is the most prominent feature of Crohn's disease in adults?
NOD2 and CARD15
Which genetic mutations may be associated with Crohn's disease?
What is the most prominent symptom of Crohn's disease in children?
Skin changes - erythema nodosum, pyoderma
Joint - seronegative arthritis, spondyloarthropathy, Ank Spond, Sacroiliitis
Eyes - conjunctivitis, episcleritis, iritis
What are the extraintestinal mainfestations of Crohn's disease?
Erythema nodosum on shins
What are the two associated skin related extra intestinal manifestation of Crohn's disease?
Seronegative arthritis of large joints
What are the joint problems associated with Crohn's disease?
A subtype of Crohn's disease which only affects the colon?
- Raised inflammatory markers
- Increased fecal calprotectin
- Low vitamin B12 and low vitamin D
What changes may be seen in a blood test of someone with Crohn's disease?
- Viral cause
In the presence of bowel symptoms, what diagnoses could a negative fecal calprotectin suggest?
- Bacterial infections
- parasitic infection
- Colorectal cancer
- NSAID use
What factors can cause an increase in fecal calprotectin?
Montreal and Paris Classification is used to classify which disease?
Which investigation method is most useful to assess for fistulas and abscesses?
What is the commonest extrintestinal manifestation of Crohn's disease?
Mild attack - oral prednisolone
Severe attack - Admission, IV hydrocortisone, NBM and IV fluids
What is the management of exacerbations of Crohn's disease?
positive anti-mitochondrial antibody and/ or raised ALP blood result
How is PBC diagnosed?
Which of PSC or PBC has an available medical treatment?
MRI of bile ducts
How is PSC diagnosed?
What diseases are associated with PSC?
PSC - 60%men, 40% women
PBC - 10% men, 90% women
What are the difference in sex categories in the incidence of PSC and PBC?
Medication used to treat PBC
Lewy body dementia
Which form of dementia is characterised by visual hallucinations and fluctuating cognition
Acetylcholinesterase inhibitors (Rivastigamine, Donepezil, Galantamine)
NMDA receptor antagonist (memantine)
Which two groups of medications are used to treat dementia and what are the examples of both?
What are the two main subtypes of frontotemporal dementia?
A type of dementia which may not have as much on memory but involves personality changes, disinhibition and verbal difficulties?
Which antibody is found in goodpasteur's syndrome?
Which disorder is a syndrome consisting of pulmonary haemorrhage and glomerulonephritis without upper respiratory tract involvement?
Which disorder is a syndrome consisting of pulmonary haemorrhage, glomerulonephritis and upper respiratory tract involvement?
Necrotizing granulomatous inflammation with eosinophils involving multiple organs, especially lungs and heart
2nd degree heart block = Mobitz type 1