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Multiple Endocrine Neoplasia (MEN) Overview
What type of enzyme is Protein C?
A vitamin K-dependent serine protease.
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Multiple Endocrine Neoplasia (MEN) Overview
What are the symptomatic manifestations of Protein C deficiency?
Similar to those of antithrombin III deficiency.
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Marfan's Syndrome Clinical Features
What is the genetic cause of Marfan's syndrome?
Mutations of the fibrillin-1 gene on chromosome 15.
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Scleritis and Uveitis Management
What is Budd-Chiari syndrome caused by?
Obstruction of venous hepatic outflow, most commonly due to thrombosis.
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Hyphaema Management and Risks
What is hyphaema?
Bleeding from iris vessels that fills the anterior chamber with blood.
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Scleritis and Uveitis Management
What should be given if a patient has an acute flare of pain before the syringe driver is commenced?
A breakthrough dose of analgesia subcutaneously as required.
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Diabetic Retinopathy Grading
What does the presence of microaneurysms indicate in diabetic retinopathy?
Background diabetic retinopathy, graded R1.
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Multiple Endocrine Neoplasia (MEN) Overview
What is the role of Protein C in coagulation?
It inactivates the active forms of procoagulant cofactors factors Va and Villa.
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Multiple Endocrine Neoplasia (MEN) Overview
What activates Protein C?
Thrombin when bound to thrombomodulin.
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Marfan's Syndrome Clinical Features
What are some characteristic features of Marfan's syndrome?
Flattened facial appearance, cleft palate, micrognathia, high myopia, retinal detachment, cataracts, and glaucoma.
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Scleritis and Uveitis Management
Why should morphine be avoided in renal impairment?
It accumulates in poor kidney function, increasing and prolonging effects.
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Infectious Mononucleosis Diagnosis
Why are needle aspirates not useful in diagnosing lymphoma?
Because a whole node needs to be removed for histological analysis.
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Hyphaema Management and Risks
What are some effects of blunt ocular trauma?
Subconjunctival haemorrhage, corneal abrasion, traumatic pupillary mydriasis, hyphaema, vitreous haemorrhage, commotio retinae, choroidal rupture, retinal detachment.
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Giant Cell Arteritis and Visual Loss
What condition is characterized by optic disc swelling and sudden unilateral visual loss?
Giant cell arteritis (GCA).
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Infectious Mononucleosis Diagnosis
What is the most appropriate test for hepatitis C?
Polymerase chain reaction (PCR) testing.
p.5
Cisplatin Mechanism and Side Effects
What is a potential positive impact of increased morphine dose?
It may have a positive impact on preload.
p.2
Giant Cell Arteritis and Visual Loss
What is a potential complication of Giant Cell Arteritis related to the central retinal artery?
Central retinal artery occlusion (CRAO).
p.7
Multiple Endocrine Neoplasia (MEN) Overview
How common is Protein C deficiency?
Occurs in 1 in 500 individuals.
p.4
Scleritis and Uveitis Management
What is Beck's triad comprised of?
Raised JVP, reduced BP, and muffled heart sounds.
p.6
Infectious Mononucleosis Diagnosis
What are the clinical features of Waldenström's macroglobulinaemia?
Lymphadenopathy, hepatosplenomegaly, and hyperviscosity.
p.2
Marfan's Syndrome Clinical Features
What ocular condition may occur in patients with Marfan's syndrome?
Ectopia lentis, which is a displacement of the lens.
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Urgent Referral for Red Painful Eye
What should be done for a red painful eye in a patient with a history of connective tissue disease?
Refer urgently to the Ophthalmology Clinic for diagnosis and treatment.
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Hyphaema Management and Risks
What does a 100% hyphaema indicate?
The entire anterior chamber is full of blood, also referred to as 'eight-ball hyphaema'.
p.7
Multiple Endocrine Neoplasia (MEN) Overview
What is the risk associated with Protein C deficiency?
Increased risk of thromboembolism.
p.2
Giant Cell Arteritis and Visual Loss
What is the significance of a temporal artery biopsy in diagnosing GCA?
It may be performed to confirm the diagnosis of Giant Cell Arteritis.
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Diabetic Retinopathy Grading
What can new vessels on the disc lead to?
Vitreous haemorrhage and loss of vision.
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Hyphaema Management and Risks
What should not be done if a penetrating injury is suspected?
Digital palpation of the eye.
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Diabetic Retinopathy Grading
What do isolated cotton-wool spots reflect in diabetic screening criteria?
Grade RO, which does not require ophthalmologist referral.
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Infectious Mononucleosis Diagnosis
What age range is typically associated with monospot-negative infectious mononucleosis?
Outside the classic 15-25 year age range.
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Infectious Mononucleosis Diagnosis
What treatment is offered if seroconversion occurs in hepatitis C?
Interferon (usually in combination with ribavirin) or a newer agent such as daclatasivir.
p.6
Infectious Mononucleosis Diagnosis
What is Waldenström's macroglobulinaemia associated with?
Lymphoplasmacytic cells that secrete an IgM paraprotein.
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Infectious Mononucleosis Diagnosis
What should be done if there is no reduction of swelling after 3 weeks of antibiotic therapy?
Further evaluation is needed, as antibiotic therapy is not indicated in the absence of other symptoms.
p.4
Scleritis and Uveitis Management
What are clinical signs of Budd-Chiari syndrome?
Abdominal pain, hepatomegaly, and ascites.
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Cisplatin Mechanism and Side Effects
What are the risks associated with increased morphine dosage?
Depressed consciousness and CO2 retention.
p.5
Cisplatin Mechanism and Side Effects
What are common side effects of cisplatin?
Nephrotoxicity, neurotoxicity, ototoxicity, and electrolyte disturbances.
p.5
Multiple Endocrine Neoplasia (MEN) Overview
What is the inheritance pattern of MEN?
Autosomal dominant disorder.
p.6
Infectious Mononucleosis Diagnosis
Who are the patients at higher risk for infections in chronic care facilities?
Elderly patients, those with chronic cardiopulmonary, lung or renal diseases, diabetes mellitus, haemoglobinopathies, and the immunocompromised.
p.4
Scleritis and Uveitis Management
What are common causes of malignant pericardial effusions?
Lung cancer, breast cancer, melanoma, lymphoma, and leukaemia.
p.2
Marfan's Syndrome Clinical Features
What are the risks associated with Marfan's syndrome?
Aortic dilatation, mitral valve abnormalities, corneal abnormalities, and retinal detachment.
p.2
Giant Cell Arteritis and Visual Loss
What are common symptoms of Giant Cell Arteritis?
New-onset headache, temporal artery tenderness, jaw claudication, scalp tenderness, weight loss, loss of appetite, and polymyalgia rheumatica.
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Hyphaema Management and Risks
Why is strict rest vital in the presence of hyphaema?
To reduce the risk of a second bleed.
p.5
Cisplatin Mechanism and Side Effects
What is the initial preferred intervention for preventing opiate-induced constipation?
A stimulant laxative, such as senna.
p.4
Scleritis and Uveitis Management
Is home oxygen routinely prescribed for symptom relief in end-stage heart failure according to NICE guidelines?
No, it is not supported by the guidelines.
p.1
Diabetic Retinopathy Grading
When is referral to an ophthalmologist required for hard exudates?
When exudates or retinal thickening are within one disc diameter of the fovea, or if there are microaneurysms or haemorrhage with reduced vision of 6/12 or worse.
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Hyphaema Management and Risks
What can cause raised intraocular pressure (IOP) in hyphaema?
Red blood cells clogging up the trabecular meshwork.
p.5
Cisplatin Mechanism and Side Effects
What is the mode of action of cisplatin?
To promote cross-linking of DNA to form DNA adducts.
p.5
Multiple Endocrine Neoplasia (MEN) Overview
What characterizes Multiple Endocrine Neoplasia (MEN)?
High frequency of peptic ulcer disease and primary endocrine abnormalities.
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Cisplatin Mechanism and Side Effects
Why is increased furosemide unlikely to help this patient?
There are no signs of significant fluid overload.
p.2
Giant Cell Arteritis and Visual Loss
What is the typical treatment for Giant Cell Arteritis to prevent visual loss?
Immediate initiation of steroids.
p.1
Cataract Management and Referral Criteria
When should a patient with a symptomatic cataract be referred to an ophthalmologist?
When they complain of blurring of vision or night glare, on a routine basis.
p.5
Multiple Endocrine Neoplasia (MEN) Overview
What is the most common abnormality in MEN?
Primary hyperparathyroidism.
p.5
Infectious Mononucleosis Diagnosis
What is diagnostic of infectious mononucleosis?
Presence of serum IgM antibodies to Epstein-Barr virus-capsid antigen (VCA).
p.1
Marfan's Syndrome Clinical Features
What is a characteristic of Stickler's syndrome?
Patients may have hypermobile joints.
