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A. REVISION FROM QBANKS > 14/10/2024 > Flashcards

14/10/2024 Flashcards

1
Q

What is wellens syndrome?

A

Critical stenosis of the LAD - the pre-infarction state of CAD
Usually has a history of recent chest pain that has nor resolved

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2
Q

ECG findings in wellens syndrome?

A

Deep inverted T waves in V2 and V3 (may extend V1-6)

No/minimal ST elevation
No pre cordial Q waves
Preserved precordial R wave progression

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3
Q

Pathophysiology of bacterial vaginosis?

A

Overgrowth of anaerobic organisms (such as gardnerella vaginosis) which decreases lactobicilli which decreases lactic acid production and leads to an increase in vaginal pH. The more alkaline environment enables anaerobic bacteria to multiply

Not an STI but only occurs in women who are sexually active. Multiple sexual partners seems to be a RF
Can increase risk of STI!

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4
Q

Name of the criteria used to diagnose BV?

A

Amsel’s criteria

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5
Q

Outline Amsel’s criteria for diagnosing BV?

A

3 out of 4 of the following…
1. Thin white homogenous discharge
2. Clue cells on microscopy
3. Vaginal pH >4.5
4, positive whiff test (addition of potassium hydroxide causes fishy odour)

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6
Q

How do you treat bacterial vaginosis?

A

Oral metronidazole 5-7 days (a single dose can be used if adherence might be an issue)
Alternatives include vaginal metronidazole or vaginal clindamycin

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7
Q

What are the important SE to remember for clozapine?

A

Intestinal obstruction, faecal impaction and paralytic ileus
Agranulocytosis & neutropenia
Reduces seizure threshold
Myocarditis and cardiomyopathy
Weight gain and hyperlipidaemia
Hypersalivation

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8
Q

Cardiorenal syndrome management?

A

Diuretics

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9
Q

Investigation of choice for genital herpes?

A

NAAT

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10
Q

Presentation of measles?

A

Prodromal phase - irritable, conjunctivitis, fever
Koplik spots
Maculopapular blotchy & confluent rash that starts behind ears then spreads to whole body
Desquamation that spares palms and soles may occur aftr a week
High fever

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11
Q

Most common complication of measles?

A

Acute otitis media is the most common complication

Others:
Pneumonia is the most common cause of death
Febrile convulsions
Diarrhoea
Keratoconjunctivities or corneal ulcation
Appendicitis
Myocarditis
Encephalitis

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12
Q

Whats the most likely cause of nephrotic syndrome in a pt with sickle cell disease?

A

Focal segmental glomerulosclerosis

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13
Q

Tx of Focal segmental glomerulosclerosis

A

Steroids +/- immunosuppressants such as Cyclophosphamide

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14
Q

Causes of prolonged APTT?

A

Exclusively:
VW disease
Haemophilia A and B
Antiphospholipid syndrome

PT and APTT
Vitamin K deficiency
Heparin
DIC
Liver cirrhosis

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15
Q

Pathophysilogy of Von willebrand disease?

A

In von Willebrand disease, there is a deficiency, absence or malfunctioning of a glycoprotein called von Willebrand factor (VWF). Von Willebrand factor is important in platelet adhesion and aggregation in damaged vessels
VWF is a carrier molecule for factor 8

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16
Q

Incubation period of chicken pox?

A

10-21 days

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17
Q

When is a child with chicken pox infectious?

A

4 days before rash, until 5 days after the rash first appeared

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18
Q

Is crohns or UC more associated with PSC?

A

UC

19
Q

Sx of primary sclerosing cholangitis?

A

Pruritis
Jaundice
RUQ pain
Fatigue

20
Q

What is the triad for boerhaaves syndrome called?

A

Macklers triad

21
Q

Sx of macklers triad?

A

Vomiting
Chest pain
Subcutaneous emphysema

22
Q

What is subcutaneous emphysema?

A

the presence of gas in the subcutaneous soft tissues which may be detected clinically by swelling of the affected area and crepitus on palpation

23
Q

What are the 3 types of altitude sickness?

A

Acute mountain sickness
High altitude pulmonary oedema (HAPE)
High altitude cerebral oedema (HACE)

24
Q

Tx for high altitude cerebral oedema?

A

Descent
Dexamethasone

25
Q

Pathophysiology of tumour lysis syndrome?

A

Usually related to treatment of high-grade lymphomas or leukaemias. Usually triggered by introduction of combination chemotherapy
TLS occurs from the breakdown of the tumour cells and the subsequent release of chemicals from the cell. It leads to a high potassium and high phosphate level in the presence of a low calcium. It should be suspected in any patient presenting with an acute kidney injury in the presence of a high phosphate and high uric acid level

26
Q

What is the problem with tumour lysis syndrome?

A

Can cause cardiac arrhythmias, sudden death and seizures

27
Q

Prophylactic management of tumour lysis syndrome?

A

IV fluids
Allopurinol if low risk or rasburicase if high risk
(Never use them together as this reduces effect of rasburicase!)

28
Q

What causes 85% of primary hyperparathyroidism?

A

Parathyroid adenoma

29
Q

Bone profile results in osteolytic metastatic disease?

A

High Ca
High ALP
Normal phosphate
Normal PTH

30
Q

Which drugs can be a risk factor for idiopathic intracranial hypertension?

A

COCP
Steroids
Tetracyclines
Retinoids
Lithium

31
Q

Management of chicken pox?

A

Analgesia with paracetamol (not NSAIDs as risk of secondary bacterial infection !!)
Keep cool
Trim nails
Encourage adequate fluids
Wear smooth, cotton fabrics
Calamine lotion for pruritis
Can consider chlorphenamine for itch if over 1

Consider prescribing oral aciclobir 800mg 5 times a day for 7 days if immunocompetent or 14 and older

32
Q

Tx of idiopathic intracranial hypertension?

A

Weight loss - exercise, diet and drugs e.g. topiramate is good because it causes weight loss but its also a carbonic anhydrase inhibitor
Carbonic anhydrase inhibitors e.g. acetazolamide

repeated lumbar puncture may be used as a temporary measure but is not suitable for longer-term management
surgery: optic nerve sheath decompression and fenestration may be needed to prevent damage to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure

33
Q

Tx of toxic megacolon?

A

Urgent decompression with NGT
Aggressive fluid resuscitation
IV broad spectrum antibiotics

34
Q

Management of genital herpes?

A

Saline bathing, analgesia
Topical pretroleum jelly or anaesthetic agents may be given e.g. lidocaine - may be used before passing urine if there is dyruria
Avoid tight clothing, increase fluid intake to dilute urine or try urinating with water flowing over area to reduce stinging
Advise about abstaining from sexual activity
Oral aciclovir

35
Q

Investigations for primary sclerosng cholangitis?

A

FBC
PT and APTT
LFTs - raised ALP, ALT, bilirubin, GGT
Immunoglobulins - IgG and IgM
Abdominal USS may show abnormal bile ducts
Autoantibodies e.g. P-ANCA, ANA, smooth muscle antibodies may be raised (not very sensitive!)
MRCP is gold standard - beaded appearance showing multiple biliary structures
May do a colonoscopy to check for UC
Liver biopsy can be done if diagnostic uncertainty

36
Q

Complications of PSC?

A

Cholangiocarcinoma
Increased risk of colorectal cancer

37
Q

What % of pts with PSC have ulcerative colitis?

A

80%

38
Q

What is the scoring system for tumour lysis syndrome called?

A

Cairo-bishop scoring system

39
Q

What is the cairo-bishop scoring system?

A

Laboratory tumor lysis syndrome: abnormality in 2 or more of the following, occurring within 3-7 days after chemotherapy.
- uric acid > 475umol/l or 25% increase
- potassium > 6 mmol/l or 25% increase
- phosphate > 1.125mmol/l or 25% increase
- calcium < 1.75mmol/l or 25% decrease

Clinical tumor lysis syndrome: laboratory tumour lysis syndrome + 1 or more of the following:
- increased serum creatinine (1.5 times upper limit of normal)
- cardiac arrhythmia or sudden death
- seizure

40
Q

What is the cairo-bishop scoring system?

A

Laboratory tumor lysis syndrome: abnormality in 2 or more of the following, occurring within 3-7 days after chemotherapy.
- uric acid > 475umol/l or 25% increase
- potassium > 6 mmol/l or 25% increase
- phosphate > 1.125mmol/l or 25% increase
- calcium < 1.75mmol/l or 25% decrease

Clinical tumor lysis syndrome: laboratory tumour lysis syndrome + 1 or more of the following:
- increased serum creatinine (1.5 times upper limit of normal)
- cardiac arrhythmia or sudden death
- seizure

41
Q

Causes of toxic megacolon?

A

C.diff pseudomembranous colitis
Other infections e.g. salmonella, shigella
IBD
Ischaemic colitis

42
Q

Features of toxic megacolon?

A

abdominal pain
abdominal distension
fever
bloody diarrhoea
shock

Can lead to perf or septic shock

43
Q

How do we diagnose toxic megacolon?

A

abdominal Xray or CT scan — colonic dilation diameter > 6cm, loss of haustra

A. REVISION FROM QBANKS (11 decks)

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