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A. REVISION FROM QBANKS > 14/11/2024 > Flashcards

14/11/2024 Flashcards

1
Q

When in pregnancy does fibroid red degeneration typically occur?

A

In the first and second trimesters

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2
Q

What % of testicular Cancer are germ cell tumours?

A

95%

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3
Q

Types of germ cell tumours?

A

Seminomas
Non-Seminomas: embryonal, yolk sac, teratoma, choriocarcinoma

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4
Q

Examples of non-germ cell testicular tumours?

A

Leading cell tumours
Sarcomas

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5
Q

Risk factors for testicular cancer?

A

Infertility
Cryptochordism
FHx
Klinefelters syndrome
Mumps orchitis

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6
Q

Features of testicular Ca?

A

Painless testicular lump - painful in minority of men
Hydrocele
Gynaecomastia
Back pain
Dragging sensation in scrotum

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7
Q

Why can testicular cancer cause gynaecomastia?

A

Increased oestrogen:androgen ratio
In germ cell tumours - they secrete hCG which increases testosterone but oestradiol to an even greater extent
In leading cell tumours they secrete more oestradiol directly

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8
Q

Tumour markers for Seminomas in testicular cancer?

A

HCG
LDH

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9
Q

Tumour markers for non-seminomas in testicular cancer?

A

AFP
Beta-hCG
LDH

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10
Q

Does pregnancy cause hyperthyroidism/

A

In pregnancy, there is an increase in the levels of thyroxine-binding globulin. This causes an increase in the levels of total thyroxine but does not affect the free thyroxine level - so no

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11
Q

Which thyroid drugs are safe in pregnancy?

A

Thyroxine - may required an increased dose in pregnancy
Propylthiouracil - in first trimester
Carbimazole in second & third trimester

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12
Q

Managing UTI in pregnancy?

A

7 day treatment of one of the following:
Cefalexin 500mg TDS
Amoxicillin 500mg TDS
Nitrofurantoin 100mg BD - NOT IN THIRD TRIMESTER
Trimethoprim 200mg BD - NOT IN FIRST TRIMESTER

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13
Q

A MMSE score of what suggests dementia?

A

<24/30

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14
Q

Most common causes of delerium?

A

Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment

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15
Q

How can you confirm a diagnosis of delirium?

A

Do a cognitive assessment - either based on DSM-5, short-CAM or 4As

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16
Q

Investigations for delirium?

A

Urinalysis
Sputum culture
FBC
Folate and B12
U&Es
HbA1c
Calcium
LFTs
ESR and CRP
TFTs
Drug levels if ?toxicity
CXR
ECG

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17
Q

Moa of metochlopramide?

A

D2 receptor antagonist

it is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist
the antiemetic action is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone. At higher doses the 5-HT3 receptor antagonist also has an effect
the gastroprokinetic activity is mediated by D2 receptor antagonist activity and 5-HT4 receptor agonist activity

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18
Q

Adverse effects of metoclopramide?

A

EPS e.g. acute dystonia - esp in children and young adults
Diarrhoea
Hyperprolactinaemia
TD
Parkinsonism

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19
Q

Types of laxatives?

A

Bulk forming
Stimulant
Osmotic
Faecal softeners

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20
Q

Example of bulk-forming laxative?

A

Isphagula husk
Methyl cellulose
Sterculia
Bran

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21
Q

Example of stimulant laxative?

A

Bisacodyl
Sodium picosulfate
Senna
Co-danthramer and co-danthrusate - only in terminally ill pts due to potential carcinogenicity and genotoxicity
Docusate sodium

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22
Q

Example of faecal softeners?

A

Docusate sodium
Glycerol suppositories

23
Q

Example of osmotic laxative?

A

Lactulose
Macro goals

24
Q

Can you use trimethoprim when breast feeding?

A

Yes its present in milk but not known to be harmful

25
Q

which antibiotic has cross sensitivity with penicillin?

A

Cephalosporins - have a 10% cross-reactivity

26
Q

Tx of Ramsay hunt syndrome?

A

Oral aciclovir
Corticosteroids

27
Q

Moa of dobutamine?

A

Beta 1 agonist - its an inotrope

28
Q

Moa of succinylcholine?

A

It’s a depolarising neuromuscular blocking drug - Binds to nicotinic acetylcholine receptors resulting in persistent depolarization of the motor end plate = muscle paralysis necessary for mechanical ventilation

29
Q

Management of testicular torsion?

A

Immediate surgical detorsion & B/L orchidopexy - both testis should be fixed as the condition of bell clapper testis is often bilateral

30
Q

What can trigger otosclerosis if you are genetically predisposed?

A

Pregnancy
Measles virus is thought to trigger it also
Age 20-40

31
Q

What is otosclerosis?

A

the replacement of normal bone by vascular spongy bone causing progressive conductive deafness due to fixation of the stapes at the oval window

32
Q

Sx of otosclerosis?

A

Conductive deafness and tinnitus in a pt 20-40
TM may be normal or have a flamingo tinge in 10%
Likely have positive FHx

33
Q

Management of a suspected PDA?

A

Observe for spontaneous closure in asymptomatic pts - normally in first 24 hours but definitely in first few weeks
Symptomatic babies undergo an echocardiogram a few days after birth. Depending on the echocardiogram findings, the PDA is managed medically or surgically. Medical management involves giving indomethacin or ibuprofen to the newborn.

34
Q

What is bowens disease?

A

Intra-epidermal squamous cell carcinoma, aka carcinoma in situ - precursor to SCC
5-10% chance of developing invasive skin cancer if left untreated

35
Q

How is bowens disease treated?

A

Topical 5-fluorouracil BD for 4 weeks with topical steroids (as it often results in significant inflammation and erythema)
Cryotherapy
Excision

36
Q

What are risk factors for spider naevi?

A

Pregnancy
COCP
Liver disease
Thyrotoxicosis

More common in childhood

37
Q

What is club foot also called? How does it present?

A

Talipes equinovarus

Inverted plantar flexed foot that is not passively correctable

38
Q

Management of subacute thyroiditis?

A

Self-limiting but NSAIDs can be used for thyroid pain
If very severe then steroids can be used

39
Q

What % of pts with SCLC will have metastasis at diagnosis?

A

Up to 70%

40
Q

Moa of thiazide diuretics?

A

Inhibit sodium reabsorption at the beginning of the DCT by blocking the thiazide-sensitive Na+CL- symporter = more Na+ loss = more water loss

41
Q

Management of haemochromatoiss?

A

Venesection regularly
Desferrioxamine may be used second line

42
Q

What is pulses paradoxus?

A

an abnormal drop in systolic blood pressure during inspiration - can manifest as disappearing radial pulse during inspiration
Often caused by pericardial effusions & cardiac tamponade

43
Q

First line drug for generalised tonic-clonic seizures in males and females?

A

Males: sodium valproate
Females: lamotrigine or levetiracetam

44
Q

First line drug for focal seizures in males and females?

A

Lamotrigine or levetiracetam for males and females

45
Q

First line drug for absence seizures in males and females?

A

Ethosuximide in males and females

46
Q

First line drug for myoclonic seizures in males and females?

A

Males: sodium valproate
Females: levetiracetam

47
Q

First line drug for tonic or atonic seizures in males and females?

A

Males: sodium valproate
Females: lamotrigine

48
Q

What paraneoplastic syndrome is SCC lung cancer associated with?

A

PTHrP secretion -> hypercalcaemia

49
Q

Paraneoplastic syndromes of small cell lung cancer?

A

ADH -> hyponatraemia
ACTH -> Cushing sundrome
LES

50
Q

Which type of lung cancer is highly associated with cavitation?

A

squamous cell carcinoma

51
Q

Precipitating events for thyroid storm?

A

Thyroid or other surgery
Trauma
Infection
Acute iodine load e.g. CT contrast media

52
Q

Clinical features of thyroid storm?

A

Fever >38.5
Tachycardia
Confusion & agitation
N&V
Hypertension
HF
Abnormal LFTS & jaundice

53
Q

Management of thyroid storm?

A

Treat precipitating event and Sx Tx e.g. paracetamol
Beta blockers - IV Propanolol
Antithyroid drugs
Steroids - dexamethasone
Lugols iodine

54
Q

Whats the function of dexamethasone in the Tx of thyroid storm?

A

Blocks the conversion of T4 to T3

A. REVISION FROM QBANKS (11 decks)

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