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A. REVISION FROM QBANKS > 10/11/2024 > Flashcards

10/11/2024 Flashcards

1
Q

What causes syphilis?

A

The spirochaete treponema pallidum
(Spiral shaped bacteria)

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2
Q

What are the primary features of syphilis?

A

Chancre (note this may not be seen in women as may be on the surface)
Local non-tender lymphadenopathy

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3
Q

What are the secondary features of syphilis and when do they occur?

A

6-10 weeks after primary lesions

Systemic: fevers, lymphadenopathy
Rash on trunk, palms and soles
Buccal snail track ulcers
Condylomata lata - painless moist warty lesions on the genitalia, oral mucosa, under breasts and in axillae
Alopecia

TWO - Trunk rash, Warts, Oral ulcers

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4
Q

Tertiary features of syphilis and when do they occur??

A

15-40 years after initial infection

Gummas - gramulomatous lesions with necrotic centre - normally affect skin and bones
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil

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5
Q

Management of syphilis?

A

IM benzathine penicillin is first line

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6
Q

What reaction can sometimes happen following treatment of syphilis?

A

The jarisch-herxheimer reaction - fever, rash. Tachycardia after first dose of antibiotic due to the release of endotoxins following bacterial death - different from anaphylaxis as no wheeze or hypotension and no Tx is required

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7
Q

Prognosis of syphilis?

A

Curable if Tx before complications
If untreated 1/3rd of pts progress to later stages of disease which can result in severe, irreversible cardiovascular, neurological and ocular complications

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8
Q

What is early and late latent syphilis?

A

Early latent syphilis: asymptomatic for less than 2 years
Late latent syphilis: >2 years after infection but no clinical features

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9
Q

Rates of syphilis by gender and sexual orientation?

A

Men who have sex with men have the highest rates

Important to be aware that syphilis cases have rapidly increased among heterosexual men and women also

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10
Q

Features of congenital syphilis?

A

Hutchinson’s teeth - blunted upper incisor teeth
Rhagades - linear scars at the angle of the mouth
Keratitis
Saber shins
Saddle nose
Deafness

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11
Q

What is retinitis pigmentosa?

A

An inherited retinal degeneration which causes progressive visual loss

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12
Q

How does retinitis pigmentosa present?

A

Sx onset often occurs early in life…
Decreased night vision and night blindness & impaired dark adaptation first
Tunnel vision due to peripheral vision loss
Eventually central vision will be lost too
Can cause photopsia - flashes of light

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13
Q

What would you see on fundoscopy in retinitis pigmentosa?

A

Black bone spicule-shaped pigmentation in the peripheral retina and mottling of the retinal pigment epithelium
Optic disc pallor
Preservation of macular with surrounding depigmentation

May see macular oedema or subscapular cataracts as these are common complications

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14
Q

Investigations for retinitis pigmentosa?

A

Assessment of visual acuity with Shelley chart
Visual fields assessment
Fundoscopy

Electroretinogram
Perimetry to formally assess visual field defects
Genetic testing
Optical coherence tomography

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15
Q

Management of retinitis pigmentosa?

A

Supportive measures to optimise vision e..g glasses, visual rehab, sunglasses
Medical - may treat complications such as cystoid macular oedema with carbonic anhydrase inhibitors e.g. topical dorzolamide
Surgical management of complications e.g. cataracts

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16
Q

complications of retinitis pigmentosa?

A

Refractive errors
Cataracts
Cystoid macular oedema - small pocket of fluid in the centre part of the retina

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17
Q

Pathophysiology of retinitis pigmentosa?

A

It’s the most commonly inherited retinal disease!
Hereditary - autosomal recessive
Degeneration of photoreceptors within the retina - the rods degenerate more than cones so night vision is affected early on & there is progressive vision loss
Mutations in retinal photoreceptors cause apoptosis of these cells. Retinal pigment epithelial cells then detach and deposit in perivascular areas leaving bony spicule-shaped melanin deposits

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18
Q

Assessment and referral for a pt with suspected TIA?

A

Give aspiring 300mg immediately unless CI and get assess within 24 hours by a stroke specialist clinician
If on anticoagulants then must be admitted for urgent imaging to exclude a haemorrhage!

If a patient presents more than 7 days ago they should be seen by a stroke specialist clinician as soon as possible within 7 days.

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19
Q

What are the 2 types of necrotising fasciitis?

A

Type 1 - caused by mixed anaerobes and aerobes - most common type and is often seen post-surgery in diabetics
Type 2 - caused by strep pyogenes

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20
Q

Risk factors for necrotising fasciitis?

A

Recent trauma, burns or soft tissue infection
Diabetes mellitus - particuarly if on SGLT2i
IVDU
Immunosuppression

21
Q

Most commonly affected site for necrotising fasciitis?

A

Perineum - called fourniers gangrene

22
Q

Features of necrotising fasciitis?

A

Acute onset pain, oedema and erythema at the site - the pain will be out of keeping with appearance
Extremely tender over infectied tissue with hypoaesthesia to light touch
Offensive discharge with a typical dishwater appearance
Skin necrosis, crepitus/gas gangrene, fever and tachycardia are late signs

Is often missed because pt may present early in disease process and have non-specific Sx and signs!

23
Q

Tx of necrotising fasciitis?

A

Urgent surgical referral for debridement
IV ABx broad spectrum

24
Q

Mortality rates of necrotising fasciitis?

A

20%

25
Q

Investigations for necrotising fasciitis?

A

Surgical exploration is first - do not wait for investigations!!

Blood and tissue cultures
FBC, U&Es, CRP, LFTs, VBG, clotting, Group&Save
May consider some imaging e.g. CT which could show oedema extending along fascial plane or soft tissue gas. Can help assess the extent of the spread

26
Q

Investigations for necrotising fasciitis?

A

Surgical exploration is first - do not wait for investigations!! It is a clinical diagnosis!!

Blood and tissue cultures
FBC, U&Es, CRP, LFTs, VBG, clotting
May consider some imaging e.g. CT which could show oedema extending along fascial plane or soft tissue gas

27
Q

How is the dose of hydrocortisone given in addisons disease?

A

It’s usually given in 2-3 divided doses and the majority is given in the first half of the day
I.e. 10mg on waking, 5mg at noon and 5mg early evening OR 15mg morning and 10mg early evening - this should resemble the natural cycle of corticosteroid release

28
Q

What are features that suggest a tachyarrhythmia is life threatening and therefore require electrical cardioversion?

A

Shock - hypotension
Syncope
Severe HF manifested by pulmonary oedema or raised JVP
Myocardial ischaemia which may present with chest pain

29
Q

If a pt is over 80 years old and has stage 1 hypertension what should you do?

A

Givelifestyle advise
If it’s >150/90 you can consider Antihypertensive treatment but use clinical judgement

30
Q

What should you do if you have a pt <40 with hypertension?

A

Consider specialist referral to exclude secondary causes

31
Q

Lifestyle advise for hypertension?

A

a low salt diet is recommended, aiming for less than 6g/day, ideally 3g/day. The average adult in the UK consumes around 8-12g/day of salt. A recent BMJ paper* showed that lowering salt intake can have a significant effect on blood pressure. For example, reducing salt intake by 6g/day can lower systolic blood pressure by 10mmHg
caffeine intake should be reduced
the other general bits of advice remain: stop smoking, drink less alcohol, eat a balanced diet rich in fruit and vegetables, exercise more, lose weight

32
Q

Examples of ototoxic drugs?

A

aminoglycosides (e.g. Gentamicin)
furosemide
aspirin
a number of cytotoxic agents e.g. Cisplatin

33
Q

Causes of hypoglycaemia?

A

Insulinoma
Self administration of insulin or sulfonylureas
Liver failure
Addisons disease
Malnutrition
Alcohol - can increase insulin secretion
Nesidioblastosis - beta cell hyperplasia

34
Q

What is a first line investigation for confirmation of a diagnosis of angina?

A

Contrast enhanced CT coronary angiography

35
Q

Firsts line management of COPD?

A

SAMA or SABA

36
Q

Second line management of COPD?

A

If asthma/steroid responsiveness symptoms -> LABA and ICS
If not -> LABA and LAMA

37
Q

Risk of Z drugs in the elderly?

A

Increased risk of falls

38
Q

Management of alcohol withdrawal in hospital?

A

Long acting benzos e.g. chlordiazepoxide or diazepam as a reducing dose protocol (lorazepam if liver failure)
Consider also giving B vitamin replacement

39
Q

How to test function of radial nerve?

A

Wrist extension against resistance
Finger extension against resistance

40
Q

How to test function of ulnar nerve?

A

Finger abduction against resistance

41
Q

How to test function of musculocutaneous nerve?

A

active flexion of the elbow against resistance with the forearm in supination (this position excludes assistance from the brachioradialis muscle)

42
Q

How to test function of axillary nerve?

A

Abduction of shoulder to upper to 90 degrees

43
Q

How to test function of median nerve?

A

Touch thumb to fifth finger and pull against resistance
Thumb abduction against resistance

44
Q

How to test function of median nerve?

A

Touch thumb to fifth finger and pull against resistance
Thumb abduction against resistance

45
Q

Features of SVC obstruction?

A

Dyspnoea
Swelling of face, neck and arms - worse lying flat
Dilated subcutaneous veins over upper limbs, neck and chest
Pembertons sign: facial congestion, cyanosis and respiratory distress after about 1 minute of lifting both pts arms until they touch the side of the face
Headache worse in mornings
Visual disturbance
Pulseless jugular venous distension

46
Q

What causes SVC obstruction?

A

External pressure, malignant infiltration or thrombus formation that reduces venous return to the heart from the head, thorax and upper limbs

Malignancy - most often lung cancer

47
Q

Management of SVC obstruction?

A

Secure airway if airway obstruction
Elevate head, loosen restrictive clothing. May give benzos or opioids to relieve breathlessness or agitation. May give O2
Manage underlyign cancer - radiotherapy, chemo, steroids, surgical

48
Q

MOA of benzodiazepines?

A

Bind to GABA and increase the frequency of chloride channels = increase the inhibitory effects

49
Q

Management of Folliculitis?

A

If uncomplicated then preventative Tx as likely self-limiting
Benzoyl peroxide could be used topically

If more complicated - swab and Tx

A. REVISION FROM QBANKS (11 decks)

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