08/09 Flashcards
1
Q
hypokalaemia + hypertension
A
primary hyprealdosteronism
2
Q
blood test before carbimazole
A
FBC- can cause agranulocytosis
3
Q
warfarin administration PT APTT bleeding time platelet count
A
PT- prolonged
APTT- normal
bleeding time- normal
platelet count- normal
4
Q
aspirin administration PT APTT bleeding time platelet count
A
PT- normal
APTT- normal
bleeding time- prolonged
platelet count- normal
5
Q
heparin PT APTT bleeding time platelet count
A
PT- often normal
APTT- prolonged
bleeding time- normal
platelet count- normal
6
Q
DIC PT APTT bleeding time platelet count
A
PT- prolonged
APTT- prolonged
bleeding time- prolonged
platelet count- prolonged
7
Q
thresholds for treansfusion
A
patients with ACS= 80g/L, target is 80-100
patients without ACS= 70g/L target 70-90
8
Q
pneumonic for transfusion reactions
A
Got a Bad Unit
G raft vs host disease
O verload
T hrombocytopaenia
A lloimmunisation
B lood pressure unstable
A cute haemolytic reaction
D elayed haemolytic reaction
U rticaria
N eutrophilia
I nfection
T RALI
9
Q
Hyposplenism causes
A
post-splenectomy
coeliac disease
10
Q
hyposplenism blood film
A
target cells howell-jolly bodies pappenheimer bodies siderotic granules acanthocytes
11
Q
iron-deficiency anaemia blood film
A
target cells
pencil poikilocytes
if combined with B12/folate deficiency a dimorphic film occurs with mixed microcytic and macrocytic cells
12
Q
myelofibrosis blood film
A
tear-drop poikilocytes
13
Q
intravascular haemolysis blood film
A
schistocytes
14
Q
megaloblastic anaemia blood film
A
hypersegmented neutrophils
15
Q
G6PD anaemia blood film
A
megaloblastic anaemia blood film
16
Q
TIBC + transferrin levels are typically ______ in iron deficiency anaemia
A
raised
17
Q
why must B12 deficiency be treated before folic acid deficiency
A
because replacing folic first can cause subacute degeneration of the cord
18
Q
reed stenberg
A
hodgkin lymphoma
19
Q
ALD bloods
A
thrombocytopenia and macrocytic anaemia
20
Q
sudden anaemia and a low reticulocyte count
A
parvovirus
21
Q
rouleax formation
A
stacking of RBCs- myeloma
22
Q
where are spherocytes seen
A
autoimmune haemolytic anaemia and spherocytosis
23
Q
patients with sickle cell should get the pneumococcal vaccine every
A
5 years
24
Q
Mirror image nuclei
A
reed-stenberg
25
incubation period of gastroenteritis bugs
Staph aureus, bacillius cereus = 1-6 hours
salmonella, e. coli= 12-48hrs
shigella, campylobacter= 47-72 hours
> 7 days: giardiasis, ameobiasis
26
features of staphylococcal toxic shock syndrome
diffuse erythematous rash
| desquamation of rash
27
swab site for chlamydia and gonorrhoea
vulvovaginal
28
investigation for mycoplasma
- mycoplasma serology
| - positive cold agglutination test
29
treatment for mycoplasma
doxycycline or a macrolide (erythromycin/clarithromycin)
30
what is dengue fever
form of DIC
| 20-30% develop dengue shock syndrome
31
features of dengue fever
```
headache (often retro-orbital)
fever
myalgia
pleuritic pain)
facial flushing (dengue)
maculopapular rash
```
32
treatment of dengue fever
symptomatic e.g. fluid resuscitation, blood transfusion
33
hepatitis A incubation
2-4 weeks
34
spread of Hep A
faecal- oral
35
features of hep A
```
flu-like prodrome
abdominal pain: RUQ
tender hepatomegaly
jaundice
cholestatic LFTs
```
36
who should be vaccinated for Hep A
travelling or residing in endemic area if >1 y/o
chronic liver disease
haemophilia
MSM
IVDU
lab worker, staff in residential institutions, sewage workers, people who work with primates
37
when should UTIs be tested for cure
in pregnant women- MSU culture
38
organism in central line infections
staph epi
39
treatment of legionella
macrolides- clarithromycin
40
features of typhoid
```
systemic upset
bradycardia
abdo pain, distension
constipation
rose spots on trunk
```
41
IVDU with descending paralysis
clostridium botulinum
42
features of botulism
fully conscious with no sensory disturbance
flaccid paralysis
diplopia
ataxia
bulbar palsy
43
treatment of botulism
antitoxin if given early
44
what is lemierre's syndroe
spread of oropharyngeal infection to the carotid sheath- infectious thrombophlebitis of the IJV
45
what are the variations of leishmaniasis
cutaenous, mucocutaneous, visceral
46
describe cutaenous leishmaniasis
crusted lesion at site of bite
| south or central america must be treated
47
describe mucocutaenous leishmaniasis
caused by leishmania braziliensis
| spread to involve mucosae of nose and pharynx
48
describe visceral leishmaniasis
occurs in med, asia, south america, africa
causes fever, sweats, rigors
massive splenomegaly, hepatomegaly
poor appetite ad weight loss
grey skin
pancytopenia
49
diagnosis of visceral leishmaniasis
bone marrow or splenic aspirate
50
who will now be offered the HPV vaccine
girls and boys aged 12-13
51
live attenuated vaccines
```
BCG
MMR
influenza
oral rotavirus
oral polio
yellow fever
oral typhoid
```
52
inactivated preparations
rabies
hep A
influenza (intramuscular)
53
toxoid vaccines
tetanus
diptheria
pertussis
54
Complications of mycoplasma
- cold agglutins: haemolytic anaemia
- erythema multiforme, erythema nodosum
- meningoencephalitis, guillain-barree
- bullous myringitis
- pericarditis/myocarditis
- GI: hepatitis, pancreatitis
- renal: acute glomerulonephritis
55
management of genital herpes outbreak
oral aciclovir
56
investigation of herpes
NAAT
57
what is an aspergilloma
mycetoma (mass-like fungus ball) which often colonises an existing lung cavity ]
cough, haemoptysis
58
investigation of aspergilloma
CXE- crescent sign
| high titres aspergillus precipitins
59
cause of gas gangrene
clostridium perfringens
60
features of c. perfringens
a-toxin, causing myonecrosis and haemolysis
| tender, oedematous skim with haemorrhagic blebs and bullae
61
trimethoprim is contraindicated by
methotrexate
62
india ink stain
cryptococcus neoformans
63
treatment of gonorrhoea
IM ceftriaxone
64
incubation period of ebola
2-21 days
65
when are people with ebola infectious
not until they develop symptoms
66
symptoms of ebola
sudden onset of fever, fatigue, muscle pain, headache and sore throat
followed by; vomitting, diarrhoea, rash, internal and external bleeding
67
respiratory syncytial virus Associated condition
bronchiolitis
68
parainfluenza virus Associated condition
croup
69
rhinovirus Associated condition
common cold
70
influenza virus Associated condition
flu
71
streptococcus pneumoniae Associated condition
CAP
72
haemophilus influenzae Associated condition
CAP, bronchiectasis, acute epiglottitis
73
staphylococcus aureus Associated condition
pneumoina, particularly following influenzae
74
mycoplasma pneumonia Associated condition
atypical pneumonia
dry cough, haemolytic anaemia, erythema multiforme
75
legionella pneumophilia associated condition
atypical pneumonia
air-conditioning sytems, dry cough, lymphopenia, deranged LFTs and hyponatraemia
76
pneumocystic jiroveci Associated condition
pneumonia in HIV patients
few chest signs and exertional dyspnoea
77
mycobacterium tuberculosis associated condition
asymptomatic to disseminated disease
cough, night sweats and weight loss
78
e coli gram stain
facultative anaerobe, gram -ve rod
79
trichomonas vaginalis + bacterial vaginosis pH
>4.5
80
what is hepatitis E common in
shellfish and pork
81
bloods in hep E
elevated bilirubin and significant transaminitis
82
incubation of hep E
3-8 weeks
83
management of gonorrhoea in needle phobia
oral cefixime + oral azithromycin
84
post-exposure prophylaxis hep A
human normal immunoglobulin or Hep A vaccine
85
post-exposure prophylaxis hep B
HBsAg +ve source: booster dose of vaccine, if in process of being vaccinated give Hepatitis B immune globulin (HBIG) and the vaccine
86
post-exposure prophylaxis hep C
monthly PCR - if seroconversion then interferon +/- ribavirin
87
post-exposure prophylaxis HIV
risk is small from bites/needlesticls
a combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) as soon as possible (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks
serological testing at 12 weeks following completion of post-exposure prophylaxis
reduces risk of transmission by 80%
88
post-exposure prophylaxis varicella zoster
VZIG for IgG -ve pregnant woman/immunosuppressed
89
HIV, neuro symptoms, widespread demyelination
progressive multifocal leukoecephalopathy
90
when should anti-retroviral therapy be started in HIV
as soon as diagnosed
91
what is antiretroviral therapy
2 x nucleoside reverse transcriptase inhibitors (zidovudine, abacavir)
and either protease inhibitor ( indi-navir) or a non-nucleoside reverse transcriptase inhibitor (nevirapine)
integrate- gravir
92
chlamydia management
doxycycline
93
most common cause of infective diarrhoea in HIV +ve patients
cryptosporidium
94
treatment of chlamydia in pregnancy
azithromycin, erythromycin or amoxicillin
95
treatment of pubic lice
malathion or permethrin cream
96
treatment of trichomonas vaginalis
metronidazole
97
cellulitis in pregnancy in penicillin allergy
erythromycin
98
s. pneumonia is a ____ ___ ______/_____
s. pneumonia is a gram +ve diplococci/chain
99
h. influenzae is a ____ ______ ________
h. influenzae is a gram negative coccibacilli
100
L. monocytogenes is a ____ _____ _____
L. monocytogenes is a gram +ve rod
101
neisseria meningitidis is a ____ ______ _______
neisseria meningitidis is a gram negative diplococci
102
bacterial meningitis CSF
cloudy
low glucose
high protein
10-5000 wcc polymorhps
103
viral meningitis CSF
clear/cloudy
60-80% of plasma glucose
normal/raised protein
15-1000 lymphocytes
104
tuberculous CSF
slightly cloudy, fibrin web
low glucose
high protein
30-300 lymphocytes
105
fungal CSF
cloudy
low glucose
high protein
20-200 lymphocytes
106
when are antibiotics indicated in sinusitis
if symptoms are present for prolonged period of time
107
antibiotic treatment of sinusitis
phenoxymethylpenicillin, doxycline or clari
108
management of prostatisi
ciprofloxacin
109
UTI in breastfeeding
trimethoprim over nitro- (nitro-G6PD)
110
farmer, fever, transaminitis
q fever
111
what is Q fever
caused by coxiella burnetti- from abattoir, cattle/sheep
112
features of Q fever
```
typically prodrome: fever, malaise
pyrexia of unknown origin
transaminitis
atypical pneumonia
endocarditis (culture-neg)
```
113
treatment of q-fever
doxycycline
114
amoebic liver abscess
anchovy sauce
115
itchy bumps of arms, torso or legs
bed bugs- topical hydrocortisone
| hot-washing linen and using mattress covers
116
commonest most severe type of malaria
falciparum malaria
117
features of severe malaria
```
schizonts on blood film
parasitaemia
hypoglycaemia
acidosis
temperature > 39
severe anaemia
```
118
complications of malaria
```
cerebral malaria
acute renal failure
ARDS
hypo
DIC
```
119
treatment of uncomplicated falciparum malaria
artemether plus lumefantrine
120
treatment of complicated falciparum malaria
parasite >2% = parenteral treatment
IV artesunate
if parasite count >10% then exchange transfusion
shock = coexistent bacterial septicaemia
121
management of herpes in pregnancy
women who present with 1st episode of genital herpes in pregnancy (3rd trimester) should be managed with daily oral aciclovir 400mg until delivery- then c-section
122
BV organism
gardnerella
123
atypical lymphocytes
glandular fever
124
primary features of syphillis
chancrea
| local non-tender lymphadenopathy
125
secondary features of syphillis
6-10 weeks after infection
- systemic symptoms: fevers: lymphadenopathy
- rash on trunk, palms and soles
- buccal snail track ulcers
- condylomata lata
126
tertiary syphillis features
```
gummas (granulomatous lesions of skin and bone)
Ascending AA
general paralysis of the insane
tabes dorsalis
argyll-robertson pupil
```
127
features of congenital syphillis
```
blunted upper incisors
rhagades (linear scars at angle of mouth)
keratitis
saber shins
saddle nose
deafness
```
128
reinfection with syphillis
rpr rises by 4 fold or more
| treat with benzathine penicillin G
129
1st line treatment for early lyme disesae
14-21 day course of oral doxy
130
management of early syphillis in pregnancy
IM benzathine penicillin G
131
If patients over 16 years need intravenous fluid resuscitation, use crystalloids that contain sodium in the range 130–154 mmol/litre with a bolus of ____ ml over less than 15 minutes.
500
132
commonest caus of encephalitis
herpes simplex
133
cause of mumps
RNA paramyxovirus - winter and spring
134
spread of mumps
- droplets
- respiratory tract epithelial cells -> parotid glands -> other tissues
- infective 7 days before anf 9 days after swelling starts
135
clinical features of mumps
fever
malaise, muscluar pain
parotitis
136
management of mumps
rest
praracetamol
notifiable disease
137
complications of mumps
orchitis
hearing loss
meningoencephalitis
pancreatitis
138
HAP
piptaz
139
most common cause of travellers diarrhoea
e. coli
140
management of pneumocystis jivroveci
co-trimoxazole
141
most worrying complication of chagas
cardiomyopathy
142
treatment of severe campylobacter
clarithromycin
143
what causes kaposi's sarcoma
Human herpes virus 8
144
treatment of kaposi's sarcoma
radiotherapy + resection
145
meningococcal sepsis management
benzylpenicillin
146
testing for HIV in asymptomatic patients should be done at _ ___ after possible exposure
testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure
147
LRTI causes in CF patients
pseudomonas aeruginosa
148
how does miliary TB spread
through the pulmonary venous system
149
immunocompromised patients with toxoplasmosis are treated with
pyrimethamine plus sulphadiazine
150
immunocompetent patients with toxoplasmosis
don't usually require treatment
151
EBV associated malignancies
burkitt's lymphoma
hodgkin's lymphoma
nasopharyngeal carcinoma
152
testing after syphillis
cardiolipin tests- VRDL ad RPR
negative after treatment
treponemal specific antibody tests: TPHA remains +ve
153
ground glass hepatoxytes on light microscopy
chronic hep B
154
single lesion and +ve thallium SPECT
positive
155
genital wart treatment
multiple- topical podophyllum
| solitary- cryotherapy
156
patients with haemachromatosis are at increased risk for
hepatocellular carcinoma
157
MSH2
| MLH1
HNPCC
158
APC gene
FAP
159
PTEN gene
cowden
160
LKB1 STK11
peutz-jeghers
161
p53
li-fraumeni
| sarcoma and leukaemia
162
who are DPP-4 inhibitors useful inn
obese patients
163
causes of hypoglycaemia
EXPLAIN
```
e xogenous drugs (sulfonylureas, insulin)
p ituitary insUfficiency
L iver failure
a ddisons
i slet cell tumours
n on pancreatic neoplasms
```
164
glucocorticoid treatment can induce
neutrophilia
165
acronymn for thyroid ca
PFMAL
166
treatment of MODY
sulfonylureas- gliclazide
167
MODY inheritance
autosomal dominant
168
Diabetic drug contraindicated in HF
pioglitazone- thiazoledinedione
