What type of enzyme is Protein C?
Click to see answer
A vitamin K-dependent serine protease.
Click to see question
What type of enzyme is Protein C?
A vitamin K-dependent serine protease.
What are the symptomatic manifestations of Protein C deficiency?
Similar to those of antithrombin III deficiency.
What is the genetic cause of Marfan's syndrome?
Mutations of the fibrillin-1 gene on chromosome 15.
What is Budd-Chiari syndrome caused by?
Obstruction of venous hepatic outflow, most commonly due to thrombosis.
What is hyphaema?
Bleeding from iris vessels that fills the anterior chamber with blood.
What conditions must be ruled out in a patient with a red painful eye?
Scleritis and uveitis.
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.
What is a sign of significantly raised intraocular pressure?
Corneal oedema.
What does the presence of microaneurysms indicate in diabetic retinopathy?
Background diabetic retinopathy, graded R1.
What is the role of Protein C in coagulation?
It inactivates the active forms of procoagulant cofactors factors Va and Villa.
What activates Protein C?
Thrombin when bound to thrombomodulin.
What are some characteristic features of Marfan's syndrome?
Flattened facial appearance, cleft palate, micrognathia, high myopia, retinal detachment, cataracts, and glaucoma.
Why should morphine be avoided in renal impairment?
It accumulates in poor kidney function, increasing and prolonging effects.
Why are needle aspirates not useful in diagnosing lymphoma?
Because a whole node needs to be removed for histological analysis.
What are some effects of blunt ocular trauma?
Subconjunctival haemorrhage, corneal abrasion, traumatic pupillary mydriasis, hyphaema, vitreous haemorrhage, commotio retinae, choroidal rupture, retinal detachment.
What condition is characterized by optic disc swelling and sudden unilateral visual loss?
Giant cell arteritis (GCA).
What is the most appropriate test for hepatitis C?
Polymerase chain reaction (PCR) testing.
What is the best diagnostic test for a pericardial effusion?
ECHO.
What percentage of patients with Protein C deficiency experience deep venous thrombosis by age 30-45?
50%.
What is a common side effect of intravenous carbonic anhydrase inhibitors like acetazolamide?
Tingling of the fingers.
What is a potential positive impact of increased morphine dose?
It may have a positive impact on preload.
What is a potential complication of Giant Cell Arteritis related to the central retinal artery?
Central retinal artery occlusion (CRAO).
How common is Protein C deficiency?
Occurs in 1 in 500 individuals.
What is Beck's triad comprised of?
Raised JVP, reduced BP, and muffled heart sounds.
What are the clinical features of Waldenström's macroglobulinaemia?
Lymphadenopathy, hepatosplenomegaly, and hyperviscosity.
What ocular condition may occur in patients with Marfan's syndrome?
Ectopia lentis, which is a displacement of the lens.
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.
What does a 100% hyphaema indicate?
The entire anterior chamber is full of blood, also referred to as 'eight-ball hyphaema'.
What is the risk associated with Protein C deficiency?
Increased risk of thromboembolism.
What can intravenous carbonic anhydrase inhibitors quickly lower?
Intraocular pressure.
How often should a syringe driver be reviewed after setup?
Every four hours.
What is the significance of a temporal artery biopsy in diagnosing GCA?
It may be performed to confirm the diagnosis of Giant Cell Arteritis.
What can new vessels on the disc lead to?
Vitreous haemorrhage and loss of vision.
What should not be done if a penetrating injury is suspected?
Digital palpation of the eye.
What do isolated cotton-wool spots reflect in diabetic screening criteria?
Grade RO, which does not require ophthalmologist referral.
What age range is typically associated with monospot-negative infectious mononucleosis?
Outside the classic 15-25 year age range.
How often is pneumococcal vaccination repeated?
Every 5 years.
What treatment is offered if seroconversion occurs in hepatitis C?
Interferon (usually in combination with ribavirin) or a newer agent such as daclatasivir.
What is Waldenström's macroglobulinaemia associated with?
Lymphoplasmacytic cells that secrete an IgM paraprotein.
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.
What are clinical signs of Budd-Chiari syndrome?
Abdominal pain, hepatomegaly, and ascites.
What are the risks associated with increased morphine dosage?
Depressed consciousness and CO2 retention.
What is the grading for proliferative diabetic retinopathy according to the English National Diabetic Eye Screening Programme?
R3.
What is the recommended dose of low-dose lorazepam for a patient with heart failure?
0.5 mg.
What are common side effects of cisplatin?
Nephrotoxicity, neurotoxicity, ototoxicity, and electrolyte disturbances.
What is the inheritance pattern of MEN?
Autosomal dominant disorder.
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.
What is the primary cause of enteric infection with non-A/non-B hepatitis?
Hepatitis E.
What are common causes of malignant pericardial effusions?
Lung cancer, breast cancer, melanoma, lymphoma, and leukaemia.
What is a suitable alternative to morphine in renal impairment?
Oxycodone.
What are the risks associated with Marfan's syndrome?
Aortic dilatation, mitral valve abnormalities, corneal abnormalities, and retinal detachment.
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.
Why is strict rest vital in the presence of hyphaema?
To reduce the risk of a second bleed.
What is the initial preferred intervention for preventing opiate-induced constipation?
A stimulant laxative, such as senna.
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.
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.
What test can be used to detect infectious mononucleosis?
Monospot test.
How long does it take for medications in a syringe driver to achieve steady serum concentration?
3-4 hours.
What can cause raised intraocular pressure (IOP) in hyphaema?
Red blood cells clogging up the trabecular meshwork.
What is the mode of action of cisplatin?
To promote cross-linking of DNA to form DNA adducts.
What characterizes Multiple Endocrine Neoplasia (MEN)?
High frequency of peptic ulcer disease and primary endocrine abnormalities.
Why is increased furosemide unlikely to help this patient?
There are no signs of significant fluid overload.
What is the typical treatment for Giant Cell Arteritis to prevent visual loss?
Immediate initiation of steroids.
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.
What is the most common abnormality in MEN?
Primary hyperparathyroidism.
What is diagnostic of infectious mononucleosis?
Presence of serum IgM antibodies to Epstein-Barr virus-capsid antigen (VCA).
What is a characteristic of Stickler's syndrome?
Patients may have hypermobile joints.
