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160 Cards in this Set
- Front
- Back
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What drugs are known to exaccerbate acne?
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Lithium, Phenytoin, some OCPs, anabolic steroids, other steroids
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what is the secretory product that is blocked in the follicle, in acne?
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Sebum
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What bacteria overgrows in the follicle, in acne?
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Propionibacterium acnes
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what hormones drives sebum production, and may contribute to acne?
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androgens
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what point of childhood is acne least common?
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ages 2-8
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T or F: acne is usually due to abnormal hormones?
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False: most people with acne are endocrinologically normal
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Name some endocrinological conditions which may contribute to acne?
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PCOS, endocrine-secreting tumours, Congenital adrenal hyperplasia, premature adrenarche
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Name some common lifestyle factors which exacerbate acne?
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greasy skin products; anabolic steroids; hot environments (dehydrates pilosebaceous unit); picking (inc. inflammation)
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which organ should we point the finger at for pre-pubertal acne?
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The Adrenal Glands!
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the most severe type of acne, which contributes to scarring, is known as?
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Nodulocystic Acne
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what is excoriated acne?
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Regular acne, exacerbated by picking
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Blackheads are the form of acne known as?
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Open comedomes
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what topical agents are commonly used for acne?
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tretinoin; benzoyl peroxide; salacylic acid; clindamycin; erythromycin
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how does the topical agent Salacylic acid combat acne?
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it is a keratolytic agent
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Side Effects of topical acne treatment?
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photosensitivity; irritation; scaling; allergic reactions
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what is the first line medication for moderate to severe acne?
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doxycycline PO
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what are alternatives to doxycycline, for oral acne medication?
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minocycline > erythromycin > isotretinoin
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what is the maximum duration of usage suggested for oral antibiotics for acne?
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6 months
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if no improvement is seen with usage of an oral antibiotic for acne, what action should be taken?
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switch antibiotics, and consider augmenting with topical meds
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what is the major benefit and major drawback of (oral) isotretinoin for acne?
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advantage: 80% of people are cured. Disadvantage: teratogenic
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what medication must women be taking simultaneously with isotretinoin, for their acne?
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OCP (teratogen)
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what hormonal medications are available to women, for acne treatment?
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a) progesterone-containing OCPs, b) spironolactone, c) cyproterone acid
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Which type of hepatitis is most associated with sexual transmission?
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B
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Which type of hepatitis is associated with fecal-oral transmission?
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A/E
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Which type of hepatitis is most commonly spread by IV drug use?
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C (and D)
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Which type of hepatitis is most associated with vertical transmission?
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B
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Which type of hepatitis can only occur in association with another hepatitis virus?
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D
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Which type of hepatitis is generally only fatal in women?
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E
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Which type of hepatitis is more likely to be fatal in men?
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C
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Which type of hepatitis is most likely to be fatal?
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D
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Which type of hepatitis integrates itself into the host genome? How does it do it?
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HBV - transcribes DNA into RNA, and then reverse-transcribes RNA into human genome
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Which serum study is the most important prognostic indicator in patients with chronic HBV?
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Viral load
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Which serum study is the most important prognostic indicator in patients with chronic HCV?
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ALT
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What other prognostic factors are important in chronic HCV?
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Alcohol consumption, coinfection with HIV/HBV
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What are the key immunological difference between the response to HBV and the response to HCV?
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HBV causes antibody formation, while HCV triggers cell-mediated immunity
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Which serum markers indicate an immune response to HCV?
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CD4/CD8 response
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Which virus is the most common cause of hepatitis mortality in Australia?
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HCV
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What are the treatment options for HBV?
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Interferon, oral antivirals
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What is the recommended treatment for HCV?
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Interferon + ribavirin
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Which types of hepatitis can be prevented with vaccination?
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A, B, D
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What type of epithelium is common in the esophagus?
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Stratified squamus
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What type of muscle is in the hypopharynx?
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striated
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What is tertiary peristalsis?
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Uncoordinated contrations
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What are typical differences seen on endoscopy between GORD and Reflux Esophagitis
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In GORD endoscopy is most often normal.
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What is happening in a peptic stricture?
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It is a result of severe GORD, causing mechanical obstruction.
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In which esophageal disorder can one see a “Bird's beek?
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Achalasia
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What is the difference between Boerhaave's syndrome and Mallory-Weiss?
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Boerhave is rupture of entire wall of esophagus, Mallory-Weiss is bleeding from the mucosa.
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What is preferred method of pain relief, if you want to use endoscopy for Zenker's Diverticulum?
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Never scope if you suspect Zenker's, fool!
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What are the factors to consider when making a rehab plan?
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Health conditions, Activity limitations, Environmental factors, Personal factors, Specific goals of rehab
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What's the differnce between "participation" and "activity"?
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Participation refers to involvement in a situation at a specific level, while activity refers to execution of a task at a general level
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what are the geriatric giants
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4x Is, immobility incontinence instability intellectual impairment
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why are elderly people prone to the geriatric giants
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accumulation of disease, reduced physiological reserve, failure of homeostasis
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what are clues to delirium in a demented patient
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inattentiveness & decreased alerntess, ask patient to do a countdown, restlessness fidgety restlessness, delusions or hallucinations. Delirium has an acute onset, fluctuating course, and deficits in attention rather than memory.
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causes of reversible dementia
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vitamine deficiencies, endocrine hypothyroidism, SDH, NPH, depression pseudodementia
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The key component of a delirium workup is what?
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review of medications
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What are some risk factures for delirium?
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male sex, severe illness, hip fracture, fever or hypothermia, hypotension, malnutrition, polypharmacy and use of psychoactive medications, sensory impairment, use of restraints, use of IV lines or urinary catheters, metabolic disorders, depression, and alcoholism
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What are important labs for evaluation of delirium?
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CBC, electrolytes, BUN and creatinine, glucose, calcium, albumin, LFTs, UA, and ECG
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How would you manage delirium?
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treat the underlying cause; haloperidol when drugs are necessary
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Define dementia
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an acquired persistent and progressive impairment in intellectual function, with compromise of memory and at least one other cognitive domain
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What's the most common cause of dementia?
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Alzheimer's disease
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Define Lewy body dementia
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fluctuating cognitive impairment with rigidity and bradykinesia
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What is the most common form of urinary incontinence?
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Urge incontinence
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What is the 2nd most common form of urinary incontinence in older women?
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stress incontinence
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Define stress incontinence
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It is urethral incompetence characterized by instantaneous leakage of urine in response to a stress maneuver
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What two incontinence disorders often occur together?
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Urge and stress incontinence
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What is overflow incontinence?
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It is Detrusor underactivity that is usually idiopathic
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How do you treat urge incontinence?
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behavioural therapy
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what should be routine done for elderly patients that develop urinary incontinence?
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DRE, ensure empty bladder and rectum
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what is contributing to the decrease in stroke prevalence?
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decreasing rate of smoking & increased control of hypertension
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what are the two common origins for emboli in TIAs?
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cardiac or carotid
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which is more susceptible to infarction from ischaemia: white or grey matter? Why?
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White matter. It is less vascularized, & has fewer anastomoses to protect it.
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why is subarachnoid haemorrhage a differential diagnosis for a patient with neck stiffness & photophobia?
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blood acts as a chemical irritant, causing 'meningism' in SAH
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a 70 year old patient presents well, but says yesterday family members complained she seemed unable to remember anything & confused what they were doing for several hours. What is the likely syndrome? Are they at risk of stroke?
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Transient Global Amnesia (TGA), which is not a risk factor for stroke. Rather, it is due to basilar artery spasm, causing impairment of mesial temporal lobes and hippocampi.
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in a young patient who is presenting post-stroke, what additional investigations should be considered?
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Those investigating thrombophilias: a) antiphospholipid syndrome, b) Factor V Leiden, c) Protein C & S deficiencies
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what is the gold standard investigating arterial anatomy?
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Selective angiography
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what imaging should be performed in a patient, after a TIA?
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carotid ultrasound
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what imaging modalities are used for investigating vasculature after a stroke?
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1) helical CT angiography, 2) MR angiography
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a patient describes a change of vision in one eye for 5 min, where they saw a shadow in their field of vision. What is this called? What is it associated with?
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This is Amaurosis Fugax, and associated with carotid atheromas
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what presentations of TIA should be considered a medical emergency?
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a) transient hemiparesis, b) quadraparesis + blindness, c) transiet aphasia
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What is Gerstmann syndrome? What cerebral artery is it associated with?
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Agraphia, Acalculia, R/L confusion, Finger agnosia. Associated with the MCA, when the dominant parietal lobe is affected
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you suspect a patient has had a stroke, and they are having difficulty looking to one side. What artery do you suspect?
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MCA
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hemiparesis & sensory disturbance with homonymous hemianopia is characteristic of occlusion of which artery?
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MCA
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Contralateral neglect typically occurs with what type of stroke?
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MCA (in non-dominant hemisphere)
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a patient is brought in by their daughter, and they have a paralyzed, numb left leg. They sit quietly and let their daughter do the talking, but are able to answer your questions without slurring of speech. What artery was likely occluded?
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ACA (note the abulia)
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What is Anton's syndrome, and what type of stroke is it associated with?
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Unawareness of one's visual deficits, due to macular sparing. Associated with PCA strokes.
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A patient presents with an obvious Horner's syndrome, complaining they are having problems swallowing and feeling temperature on the opposite side of the body. You suspect what type of stroke?
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Lateral Medullary Syndrome (PICA involvement)
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what is the greatest known risk factor for lacunar infarcts?
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Hypertension.
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How do Bell's Palsy and Ramsay Hunt differ? How are they treated?
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Ramsay Hunt is caused by VZV. It should be treated with corticosteroids and acyclovir.
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What is the most common cause of peripheral neuropathy?
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Idiopathic
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What are the signs of an UMN lesion?
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Increased reflexes, Clonus, Muscle wasting
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What is the triad found in Miller-Fischer Syndrome?
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ataxia areflexia ophthalmoplegia
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What are signs of a common fibular nerve palsy?
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Weakness on foot dorsiflexion and eversion, Sensory loss in dosrum of foot?
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What is the main reason for doing urodynamic tests in bladder dysfunction?
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To check for renal damage
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What is the most common cause of spinal injury?
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Non traumatic cause: infection, invasion etc
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Which nerve controls the external sphincter?
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pudendal nerve
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Does the sympathetic NS relax or contract the bladder?
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relax
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What is the name of the center controlling micturation?
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Pontine micturation center
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How often should you review patients with neurogenic bladder? How often do you US kidneys?
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Every year/every year first 3 years, then every 2 years.
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What is a typical initial symptom of Multiple Sclerosis?
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Optic neuritis
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What is needed for diagnosis of multiple sclerosis?
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Clinical history of 2 attacks or one attack plus MRI findings
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What is the treatment for multiple sclerosis?
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DMARDs plus steroid for acute attacks
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What is L'hermitte's sign?
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electric shock when flexing neck
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What is known about genetic factors in MS?
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Monozygotic Twin concordance rate of 30%
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What are the MacDonald criteria?
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A diagnostic algorithm for MS
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what percent of Australians are estimated to have diabetes?
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7.5% (half are undiagnosed)
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list five risk factors for diabetes (or more!)
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genetic susceptibility, sedentary lifestyle, obesity, visceral adiposity, inflammation, dyslipidaemia, hypertension, age > 55, FHx, GDM, PCOS, prior IGT/IFG
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what percent of diabetics are Type 1?
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15-20%
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which are T2DM more susceptible to: MiV or MaV complications?
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Macrovascular complications
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when should screening for end-organ complications begin in T2DM?
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at diagnosis, as complications are usually already present
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when should screening for end-organ complications begin in T1DM?
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from 5 years after onset
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what is the primary determinant of end-organ complications in diabetes?
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Blood Glucose Levels
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in diabetes mellitus, what is the target level for LDL-C?
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<2.6 mmol/L
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in diabetes mellitus, what is the target level for HDL-C?
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>1.0 mmol/l
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in diabetes mellitus, what is the target level for TGs?
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<1.7
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in diabetes mellitus, what is the target level for total-cholesterol?
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<4.0
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what is the most common cause of death in T2DM?
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cardiovascular disease
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what is the most common cause of vision loss in the working age?
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T2DM
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how many amputations per year (in Australia) are attributed to T2DM?
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3000
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physical activity and diet can reduce HbA1c by how much?
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1.50%
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by the WHO's definition, what Fasting Plasma Glucose level is considered 'Diabetic'?
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≥ 7.0 mmol/L
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by the WHO's definition, what 2-hour OGTT level is considered 'Diabetic'?
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≥ 11.0 mmol/L
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by the WHO's definition, what Fasting Plasma Glucose level is 'normal'?
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≤ 6.1 mmol/L
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by the WHO's definition, what 2-hour OGTT level is considered 'normal'?
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≤ 7.8 mmol/L
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what are the three cornerstones of treating T2DM?
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education, diet & exercise (and the fourth one is 'love')
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poor glycaemic control of T2DM with oral medication is an indication for augmenting treatment with?
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insulin injections
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Actrapid, Humulin R, Novorapid, Humalog, Apidra are examples of what medication?
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rapid acting insulins (to be taken prior to meals)
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Protaphane, Humilin NPH, Lente, UltraLente, Monotard, Lantus, Levemir are examples of what medications?
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Long-acting insulins (to be taken prior to bedtime)
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Mixtard, Humulin, Humalog Mix25, Novomix 30 are examples of what medications?
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Pre-mixed insulin combinations
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what is the target HbA1c level for T2DM?
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< 7.0%
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what is first line management for T2DM?
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lifestyle intervention, then metformin
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what are the three options that should be considered if diabetes is not controlled with lifestyle & metformin?
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1) basal insulin, 2) sulfonylurea, 3) glitazone
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what is the benefit of adding basal insulin to poorly controlled T2DM?
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it is the most effective option for obtaining control
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what is the benefit of adding sulfonylurea to poorly controlled T2DM?
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it is the least expensive option to add on, of second line options
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what is the benefit of adding glitazone to poorly controlled T2DM?
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there is no increased risk of hypoglycaemia
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what patients with T2DM are considered 'high risk' and should be screened for ischaemic heart disease?
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those with: a) dyslipidaemia, b) hypertension, c) family history
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what investigations should be considered for IHD, in T2DM patients?
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stress ECG, stress echo, stress nuclear scan, hi-res CT
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what management options should be considered for IHD, in T2DM patients?
|
anti-hypertensives, statins, aspirin, stenting/CABG
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in detection of nephropathy, what levels are considered 'microalbuminuria'?
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20-200ug/min
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how is microalbuminuria detected?
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urinalysis: albumin/creatinine ratio
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how long does it take for microalbuminuria to commence in DM, typically?
|
10-15 years
|
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how long does it take for macroalbuminuria to commence in DM, typically?
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15-20 years
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what is the definition of macroalbuminuria?
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> 200ug/min
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how is macroalbuminuria detected?
|
urine dipstick
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which is a more sensitive indicator of renal function decline: serum or urine creatinine?
|
urine; serum creatinine rises late in renal impairment
|
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how many times is it necessary to measure proteinuria to diagnosis nephropathy?
|
2 or more times
|
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what is the antihypertensive of choice to protect the kidneys in diabetes?
|
ACE-I/ARB
|
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callus formation is typically found where on diabetic feet?
|
the tarsal heads
|
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what are risk factors for foot ulceration in diabetes?
|
ischaemia, infection, patient compliance, neuropathy, deformity
|
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in testing diabetics for peripheral neuropathy, what is the best predictor of ulceration in the following year?
|
insensate to monofilament
|
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how should peripheral neuropathy (the feet) of diabetics be managed?
|
proper foot wear, podiatry care, pressure offloading, dress/debride
|
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how should moderate diabetic retinopathy be managed?
|
no immediate treatment; increase frequency of checks, to annual
|
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diabetic retinopathy which demonstrates small haemorrhages and hard exudate, but no new vessels is classified as?
|
'mild' to 'moderate'
|
|
diabetic retinopathy which demonstrates large haemorrhages, soft exudates and dilated/tortuous veins is classified as?
|
'severe', or 'pre-proliferative'
|
|
what is the management strategy for severe diabetic retinopathy?
|
increase frequency of checkups (from annual)
|
|
diabetic retinopathy which demonstrates new vessels on the disc/elsewhere (NVD/NVE) is classified as?
|
proliferative'
|
|
what is the management strategy for proliferative diabetic retinopathy?
|
Pan-retinal laser treatment (often curative)
|
|
T1DM patients are afflicted primarily with what type of retinopathy?
|
Proliferative retinopathy
|
|
T2DM patients are afflicted primarily with what type of retinopathy?
|
Macular oedema
|
|
diabetic retinopathy which demonstrates increased diameter of the macula, proximal exudates, and haemorrhages is classified as?
|
Macular oedema
|
|
what is the management for macular oedema?
|
laser treatment (though not definitive; often recurs)
|
