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14/06 Flashcards

1
Q

anterior MI

A

v1-v4
left anterior descening

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2
Q

lateral MI

A

V5-V6, I
left circumflex

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3
Q

inferior MI

A

II,III and AVF
right coronary artery

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4
Q

mx of ACS

A

Morphine - if pt in pain
Oxygen - if pt hypoxic
Nitrates - caution in hyPOtension
Aspirin 300mg

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5
Q

when should be PCI be offered in STEMI

A

presentation within 12 hrs of symptom onset + can be delivered within 120 mins

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6
Q

PCI

A

drug eluting stents through radial access

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7
Q

what to do after fibrinolysis

A

repeat ECG within 60-90 mins and PCI if still changes

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8
Q

what is used to stratify risk post MI

A

kilip class

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9
Q

termination of supraventricular tachys

A

adenosine (avoid in asthma)

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10
Q

epsilon wave

A

Arrhythmogenic right ventricular cardiomyopathy

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11
Q

S2A2DCHAVS

A

S2 - prior stroke, TIA or thromboembolism
A2 - age >=75
D - diabetes
C - congestive HF
H - hypertension or treated hypertension
A - age 65-74
V - vascular disease
S - sex female

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12
Q

MI cardiac enzymes

A

myoglobin is first to rise
CK-MB useful to look for re-infarction

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13
Q

chronic heart failure diagnosis

A

N-terminal pro-B-type natriuretic peptide (NT‑proBNP)
high levels - specialist assessment ECHO 2 weeks
raised levels - specialist assessment ECHO 6 weeks

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14
Q

chronic heart failure first line

A

ACEi and BB

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15
Q

chronic heart failure second line

A

aldosterone antagonist and SGLT2 inhibitor

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16
Q

chronic heart failure third line

A

ivabradine
sacubitril-valsartan
digoxin
hydralazine + nitrate
cardiac resync therapy

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17
Q

coarctation of the aorta features

A

HTN
radio-femoral delay
mid-systolic murmur maximal over the back
apical click from the aortic valve
notching of the inf border of the ribs

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18
Q

acute heart failure mx

A

IV loop diuretics
oxygen
nitrates if heart disease
cpap if resp failure

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19
Q

acute heart failure hypotension

A

ionotropic agents eg dobutamine
vasopressor agents eg norepinephrine
mechanical circulatory assistance

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20
Q

left heart failure

A

pulmonary oedema
dyspnoea
orthopnoea
paroxysmal nocturnal dyspnoea
bibasal fine crackles

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21
Q

right heart failure

A

peripheral oedema
ankle/sacral oedema
raised jugular venous pressure
hepatomegaly
weight gain due to fluid retention
anorexia (‘cardiac cachexia’)

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22
Q

when is s3 normal

A

pts less than 30 (sometimes women up to 50)

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23
Q

path s3

A

left ventricular failure (e.g. dilated cardiomyopathy) constrictive pericarditis (called a pericardial knock)
mitral regurgitation

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24
Q

s4

A

aortic stenosis
HOCM
hypertension

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25
Q

aortic valve

A

right second intercostal space
upper sternal border

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26
Q

pulmonary valve

A

left second intercostal space
upper sternal border

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27
Q

mitral valve

A

Left fifth intercostal space
just medial to mid clavicular line

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28
Q

tricuspid valve

A

left fifth intercostal space
lower left sternal border

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29
Q

most common lymphoma

A

diffuse large b cell

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30
Q

foot drop after hip arthroplasty nerve injury

A

sciatic

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31
Q

crypt abscesses

A

ulcerative colitis

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32
Q

TCA overdose

A

bicarbonate

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33
Q

lateral epicondylitis

A

pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

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34
Q

medial epicondtlitis

A

pain is aggravated by wrist flexion and pronation

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35
Q

SVT mx

A

vagal manouvres
adenosine
electrical cardioversion

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36
Q

contraindications to statins

A

pregnancy
macrolides eg erythromycin, clari

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37
Q

HOCM mx

A

Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

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38
Q

suspected aortic dissection in unstable pt

A

trans OESOPHAGEAL echo

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39
Q

assess severity of liver cirrhosis

A

Child-Pugh classification

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40
Q

head injury lucid interval

A

extradural haematoma

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41
Q

most specific ecg finding in acute pericarditis

A

PR depression

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42
Q

upper GI bleed score

A

glasgow blatchford scoring
after endoscopy - rockall score

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43
Q

tx of alchoholic ketoacidosis

A

IV saline and thiamine infusion

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44
Q

alcoholic liver disease LFTS

A

gamma-GT&raquo_space;»
AST:ALT is normally > 2

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45
Q

alcoholic hepaitis mx

A

steroids eg pred
pentoxyphylline

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46
Q

achalasia diagnosis

A

oesophageal manometry

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47
Q

achalasia tx

A

pneumatic balloon dilatation
heller cardiomyotomy or botox injection

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48
Q

main side effect of 5ASAs

A

haem eg agranulcytosis so monitor FBC

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49
Q

SAAG <11 causes

A

hypoalbuminaemia
malignancy
infections

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50
Q

SAAG >11 causes

A

liver disorders
cardiac disorders
lack of blood flow eg Budd chairi, veno-occlusive disease

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51
Q

what does high saag indicate

A

portal hypertension

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52
Q

mx of ascites

A

reduce dietary sodium
sometimes fluid restrict
aldosterone antagonists
drainage if tense ascites
antibiotic prophylaxis with ciprofloxacin or norfloxacin
TIPS

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53
Q

AI hep antibodies

A

ANA/SMA/LKM1 antibodies, raised IgG levels

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54
Q

bile acid malabsorption presentation

A

chronic diarrhoea

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55
Q

bile acid malabsorption test

A

SeHCAT

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56
Q

bile acid malabsorption tx

A

bile acid sequestrants e.g. cholestyramine

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57
Q

carcinoid tumours invx

A

urinary 5-HIAA
plasma chromogranin A y

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58
Q

carcinoid tumours tx

A

somatostatin analogues e.g. octreotide

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59
Q

coeliac disease gold standard invx

A

Endoscopic intestinal biopsy

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60
Q

inducing remission in crohns

A

glucocorticoids
enteral feeding with elemental diet
2nd line - 5 ASAs
azathioprine or mercaptopurine
infliximab - fistulating disease

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61
Q

crohns isolated peri-anal disease

A

metronidazole

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62
Q

complex fistulae

A

draining seton

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63
Q

diverticulitis mx

A

mild - oral abx
severe - nil by mouth, IV fluids, iv abx

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64
Q

gallstones invx

A

USS and LFTs

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65
Q

acute cholecytitis

A

Right upper quadrant pain
Fever
Murphys sign on examination

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66
Q

gallbladder abscess

A

Usually prodromal illness and right upper quadrant pain
Swinging pyrexia
Patient may be systemically unwell

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67
Q

cholangitis

A

Patient severely septic and unwell
Jaundice
Right upper quadrant pain

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68
Q

cholangitis mx

A

Fluid resuscitation
Broad-spectrum intravenous antibiotics
Correct any coagulopathy
Early ERCP

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69
Q

gallstone ileus

A

known gallstones
Small bowel obstruction (may be intermittent)

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70
Q

gallstone ileus mx

A

Laparotomy and removal of the gallstone from small bowel,

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71
Q

risks of ERCP

A

Bleeding
Duodenal perforation
Cholangitis
Pancreatitis

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72
Q

screen for haemachromatosis

A

general pop - transferrin sat
fam member - genetic testing for HFE mutation

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73
Q

haemachromatosis iron study

A

> > transferrin and ferriting
&laquo_space;TIBC

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74
Q

h pylori eradication

A

PPI + amox + (clarithromycin OR metronidazole)
if pen-allergic: PPI + metronidazole + clarithromycin

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75
Q

hepatic encephalopathy mx

A

lactulose and rifaximin

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76
Q

wilsons disease invx

A

slit lamp examination for Kayser-Fleischer rings
reduced serum caeruloplasmin
reduced total serum copper
free serum copper is increased
increased 24hr urinary copper excretion
ATP7B gene

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77
Q

mx wilsons

A

pencillamine

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78
Q

in controlled drugs what needs to be stated in words and figures

A

quantity

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79
Q

AKI poor response to fluid challenge

A

acute tubular necrosis

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80
Q

dpp4 inhibitors

A

gliptins

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81
Q

IBS tx

A

pain: antispasmodic agents
constipation: laxatives but avoid lactulose
diarrhoea: loperamide is first-line
second line = TCAs

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82
Q

mesenteric ischaemia

A

typically small bowel
due to embolism
sudden onset, severe
urgent surgery
high mortality

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83
Q

ischaemic colitis

A

large bowel
multifactorial
transient less severe symptoms, bloody diarrhoea
thumbprinting
conservative mx

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84
Q

screening for cirrhosis in chronic liver disease

A

transient elastography

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85
Q

screening for cirrhosis in NAFLD

A

enhanced liver fibrosis blood test

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86
Q

pancreatic cancer imaging

A

CT scan
double duct sign

87
Q

peptic ulcer bleeding vessel

A

gastroduodenal artery

88
Q

primary biliary cholangitis bloods

A

anti-mitochondrial antibodies
raised IgM

89
Q

small bowel bacterial overgrowth syndrome tx

90
Q

SBP tx

A

intravenous cefotaxime

91
Q

benzo overdose

A

flumazenil

92
Q

mesothelioma

A

histology, following a thoracoscopy

93
Q

what is ARDS

A

non-cardiogenic pulmonary oedema

94
Q

subacute combined degeneration of the spinal cord

A

Distal sensory loss, tingling
absent ankle jerks/extensor plantars
gait abnormalities/Romberg’s positive

95
Q

hiv, ct brain ring enhancement

A

toxoplasmosis

96
Q

achalasia cancer

A

squamous cell

97
Q

ileostomy

A

right iliac fossa
spouted
liquid output

98
Q

colostomy

A

more likely L side abdo
flushed
solid output

99
Q

loop ileostomy

A

defunction colon

100
Q

loop colostomy

A

defunction distal segment of colon

101
Q

anal cancer risk factor

102
Q

when should anal fissure be further invx for IBD

A

if anterior midline (90% occur in post midline)

103
Q

acute anal fissue tx

A

soften stool - dietary advice and bulk forming laxatives
lubricants
analgesics
regional anaesthetics

104
Q

chronic anal fissue mx

A

continue acute tx
topical GTN
8 wks -> sphincterectomy

105
Q

haemorrhoids tx

A

conservative
rubber band ligation
haemorrhoidectomy

106
Q

anal neoplasm

A

squamous cell carcinoma

107
Q

rectal neoplasm

A

adenocarcinoma

108
Q

Caecal, ascending or proximal transverse colon

A

right hemocolectomy

109
Q

Distal transverse, descending colon

A

left hemicolectomy

110
Q

sigmoid colon

A

high anterior resection

111
Q

upper or lower rectum

A

anterior resection

112
Q

anal verge

A

Abdomino-perineal excision of rectum

113
Q

FIT screening

A

every 2 years aged 50-74
can also be used if pts dont meet 2 week wait criteria

114
Q

usual site of diverticular disease

A

teniae coli

115
Q

large bowel obstruction invx

A

xray first line
CT gold standard

116
Q

large bowel obstruction mx

A

NBM
IV fluids
nasogastric tube with free drainage

117
Q

large bowel obstruction, cause does not require surgery

A

conservative mx for 72 hours

118
Q

when abx in large bowel obstruction

A

if surgery planned or perf suspected

119
Q

emergency surgery large bowel obstruction

A

overt peritonitis or evidence of bowel perforation

120
Q

perianal abscess

A

incision and drainage

121
Q

pt presents with rectal bleeding invx

A

PR exam and procto-sigmoidoscopy

122
Q

volvulus diagnostic invx

123
Q

tx sigmoid volvulus

A

rigid sigmoidoscopy with rectal tube insertion

124
Q

tx caecal volvulus

A

operative with R hemocolectomy

125
Q

thrombosed haemorrhoids mx

A

if present within 72 hours, excision
otherwise stool softeners, ice packs and analgesia

126
Q

anaesthetic with anti-emetic properties

127
Q

kallman syndrome

A

LH FSH low-normal and testosterone low

128
Q

order of structures divided in the abdo midline incision

A

linea alba
transversalis fascia
extraperitoneal fat
peritoneum

129
Q

order of strutures divided in the abdo paramedian incision

A

anterior rectus sheath
rectus (retracted)
posterior rectus sheath
transversalis fascia
extraperitoneal fat
peritoneum

130
Q

most common cause of bowel obstructions

A

small bowel = adhesions
large bowel = tumours

131
Q

Posterior triangle lymph node biopsy

A

accessory nerve

132
Q

lloyd davies stirrups

A

common peroneal nerve

133
Q

thyroidectomy

A

laryngeal nerve

134
Q

anterior resection of rectum

A

hypogastric autonomic nerves

135
Q

axillary node clearance

A

long thoracic nerve
thoracodorsal nerve
intercostobrachial nerve

136
Q

inguinal hernia surgery

A

ilioinguinal nerve

137
Q

varicose vein surgery

A

sural and saphenous nerves

138
Q

post. approach to hip

A

sciatic nerve

139
Q

carotid endaterectomy

A

hypoglossal nerve

140
Q

thyroid peroxidase antibodies

A

hashimotos and graves

141
Q

antibodies to TSH receptor

142
Q

tx of cryptochordism

A

Orchidopexy at 6- 18 months of age

143
Q

hiatus hernia gold standard

A

barium swallow

144
Q

imaging in acute pancreatitis

145
Q

GET SMASHED

A

Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

146
Q

what is ascending chlangitis

A

bacterial infection (usually e coli) of the biliary tree

147
Q

features of ascending cholangitis

A

charcots triad
fever
RUQ pain
jaundice
hypotension + confusion (+ these 2 = reynolds pentad)

148
Q

ascending cholangitis tx

A

iv abx
ERCP after 24-48 hrs to relieve any obstruction

149
Q

boerrhaves syndrome diagnosis

A

CT contrast swallow

150
Q

chronic pancreatitis imaging

151
Q

absolute CIs to laparoscopic surgery

A

haemodynamic instability/shock
raised intracranial pressure
acute intestinal obstruction with dilated bowel loops
uncorrected coagulopathy

152
Q

herceptin

A

trastuzumab

153
Q

mx of uncomplicated descending aorta dissection

A

beta blockade and analgesia

154
Q

when is asthma cough often worse

155
Q

results of FeNO in asthma

A

increased due to inflammation >40 in adults and 35 in kids is diagnostic

156
Q

MART inhaler

A

ICS + LABA

157
Q

pts on a saba + ICS whos asthma is not well controlled

158
Q

asthma diagnostic spriometry

159
Q

asthma diagnostic reversibility testing

A

> 12% improvement in FEV1

160
Q

most common cause of occupational asthma

A

isocyanates

161
Q

mod asthma attack

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

162
Q

severe asthma attack

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

163
Q

life threatening asthma attack

A

PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
normal PCO2

164
Q

near fatal asthma

A

a raised pC02 and/or requiring mechanical ventilation with raised inflation pressures.

165
Q

myeloma without mets bloods

A

hypercalcaemia
normal/high phosphate
normal ALP

166
Q

infant with bilous vomiting and obstruction

A

intestinal malrotation

167
Q

what guides antibiotics in acute bronchitis

A

CRP >100, 20-100 give delayed script

168
Q

abx in acute bronchitis

A

doxycycline

169
Q

invx copd

A

post bronchodilator spirometry
CXR
FBC

170
Q

FBC COPD

A

to exclude 2ndary polycythaemia

171
Q

COPD no asthmatic features

A

add (LABA) + (LAMA)
if already taking a SAMA, discontinue and switch to a SABA

172
Q

copd asthmatic features

A

LABA + ICS
if patients remain breathless or have exacerbations offer triple therapy i.e. LAMA + LABA + ICS
if already taking a SAMA, discontinue and switch to a SABA

173
Q

abx prophylaxis copd

A

azithromycin

174
Q

LTOT COPD requirements

A

pO2 of < 7.3 kPa or a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension

175
Q

when to give abx in COPD exacerbation

A

purulent sputum or clinical signs of pneumonia

176
Q

abx copd exacerbation

A

amox, doxy or clari

177
Q

COPD exacerbation hosp

A

O2
nebs
iv hydrocortisone or oral prednisolone
iv theophylline

178
Q

when to use NIV in COPD exacerbation

A

respiratory acidosis pH 7.25-7.35 (pts who are more acidotic need HDU/more monitoring)

179
Q

NIV in COPD

180
Q

duchenne muscular dystrophy diagnosis

A

genetic analysis

181
Q

juvenile myoclonic epilepsy

A

seizures in the morn/following sleep deprivation

182
Q

hearing loss menieres disease

A

unilateral sensorineural hearing loss

183
Q

2ndary mx of MI - CRABS

A

clopidogrel
ramipril
aspirin
BB
statin

184
Q

lemon tinge to skin

A

pernicious anaemia

185
Q

sleep apnoea diagnosis

A

polysomnography

186
Q

allergic bronchopulmonary aspergillosus features

A

bronchiectasis and eosinophilia (asthma like features)

187
Q

allergic bronchopulmonary aspergillosus mx

A

steroids
itraconazole

188
Q

alpha 1 antitrypsin def features

A

COPD in young non-smokers

189
Q

atelectasis

A

post-op complication where alveolar collapse -> resp difficulty
airways become blocked with secretions

190
Q

atelectasis tx

A

positioning the patient upright
chest physiotherapy: breathing exercises

191
Q

bilateral hilar lymphadenopathy

A

TB or sarcoidosis

192
Q

tramlines and signet ring signs

A

bronchiectasis

193
Q

chest drain position

A

5th intercostal space midaxillary line

194
Q

SAMA

A

ipratropium

195
Q

EGPA

A

asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%

196
Q

extrinsic allergic alveolitis

A

type 3 hypersensitivity

197
Q

GPA

A

upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions

198
Q

red jelly sputum

A

klebsiella

199
Q

red currant jelly sputum

A

klebsiella

200
Q

klebsiella

A

alcoholics and diabetics

201
Q

auscultation in lung cancer

A

fixed, monophonic wheeze

202
Q

when in hoarseness seen in lung cancer

A

Pancoast tumours pressing on the recurrent laryngeal nerve

203
Q

paraneoplastic small cell

A

ADH -> hyponatraemia
ACTH -> cushings
LEMS

204
Q

paraneoplastic squamous cell

A

PTH-rp -> hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthopathy
ectopic TSH -> hyperthyroidism

205
Q

paraneoplastic adenocarcinoma

A

gynaecomastic
HPOA

206
Q

bloods lung cancer

A

raised platelets
thrombocytosis

207
Q

invx lung cancer

208
Q

most common lung cancer

A

adenocarcinoma

209
Q

lower zone fibrosis

A

IPF
SLE
drug induced
asbestosis

210
Q

sleep apnoea mx

A

wt loss
CPAP

211
Q

o2 curve -> left

A

Lower oxygen delivery, caused by
Low [H+] (alkali)
Low pCO2
Low 2,3-DPG
Low temperature

212
Q

o2 curve -> right

A

Raised [H+] (acidic)
Raised pCO2
Raised 2,3-DPG*
Raised temperature

213
Q

transudate (<30 protein)

A

heart failure
hypoalbuminaemia
meigs syndrome
hypothyroidism

214
Q

exudate (>30 protein)

A

infection
CTD
neoplasia
pancreatitis
PE
yellow nail syndrome
dressers

passmed qs (18 decks)

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