15/06 Flashcards
1
Q
tx of orthostatic hypertension
A
> fluid and salt intake
compression stockings
med review
Fludrocortisone or midodrine
2
Q
status epilepticus mx
A
pre-hosp: PR diazepam or buccalmidazolam
hosp:
IV lorazepam, repeat after 5-10 min
levetiracetam, phenytoin or sodium valproate
GA to control airway
3
Q
test pt for hep b
A
hbsag
4
Q
early diastolic murmur
A
aortic regurgitation
5
Q
high fever, rapid onset and herpes labialis
A
strep pneumo
6
Q
pneumonia in COPD
A
haemophilus
7
Q
pneumonia following flu
A
staph aureus
8
Q
dry cough, atypical chest findings, AI haemolytic anaemia, erythema multiforme
A
mycoplasma
9
Q
hyponatreamia, lymphopenia, air conditioning units
A
legionella
10
Q
pneumonia follow up
A
repeat chest X-ray at 6 weeks
11
Q
Varenicline caution
A
patients with a history of depression or self-harm
12
Q
bupronion CI/caution
A
epilepsy, breast feeding/eating disorder
13
Q
pregnancy smoking cessation
A
NRT only
14
Q
upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes
A
silicosis
15
Q
sarcoidosis bloods
A
hypercalcaemia
»ACE levels
»ESR
16
Q
indications for steroids in sarcoid
A
chest x-ray stage 2 or 3 disease who are symptomatic
hypercalcaemia
eye, heart or neuro involvement
17
Q
psoriasis 1st line
A
potent corticosteroid applied once daily plus vitamin D analogue applied at different time
18
Q
severe hyperkalaemia
A
A sinusoidal/sine wave ECG pattern
19
Q
sedative in delirium
A
haloperidol 0.5 mg
20
Q
tx of delirium in parkinsons
A
< of parkinsons meds
atypical antipsychotics quetiapine and clozapine
21
Q
mild to mod alzheimers and Lewy body tx
A
acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine
22
Q
2nd line for alzheimers/Lewy body or severe disease
A
NMDA receptor antagonist - memantine
23
Q
alzheimers pts at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress
A
antipsychotics
24
Q
when is donepezil CI
A
bradycardia
25
donepezil SE
insmonia
26
path changes in alzeheimers
widespread cerebral atrophy, particularly involving the cortex and hippocampus
27
sudden or stepwise deterioration in cognitive function
vascular dementia
28
screen for pts at risk of pressure sores
waterloo score
29
mx of pressure sores
moist wound environment - Hydrocolloid dressings and hydrogels
tissue viability nurse
surgical debridement
30
frailty assessment
gait speed, self reported health status, PRISMA-7 questionaire
31
scan for lewy body
SPECT
32
falls blood screen
FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels
33
vaginal passage of faeces or flatus
colovaginal fistula due to diverticular disease
34
cardiac arrhythmia macrolides
torsades de pointes
35
acromegal invx
first line = serum IGF1
if this is >>, OGTT
36
tx of acromegaly
transphenoidal surgery
2nd line = somatostatin analogue eg ocreotide, GH receptor antagonist pegvisomat
37
commonest cause of addisons uk
AI destruction of adrenal glands
38
diagnosis of addisons
ACTH stimulation test, short synacthen test
if not available, 9am cortisol
39
addisons electrolyte abnormalities
hyperkalaemia
hyponatraemia
hypoglycaemia
metabolic acidosis
40
mx of addisonian crisis
hydrocortisone 100mg im or iv
1 l saline infused over 30-60 mins or with dextrose if hypoglycaemic
continue hydrocortisone 6 hourly until the patient is stable
oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
41
CARBIMAZOLE adverse effect
agranulocytosis
42
congenital adrenal hyperplasia inheritance
autosomal recessive
43
congenital adrenal hyperplasia endocrine
affect adrenal steroid biosynthesis
in response to resultant low cortisol levels the anterior pituitary secretes high levels of ACTH
ACTH stimulates the production of adrenal androgens
44
presentation of congenital adrenal hyperplasia
virilisation in females
precocious puberty in males
salt losing crisis
45
most common cause of congenital adrenal hyperplasia
21-hydroxylase deficiency
46
congenital hypothyroidism
prolonged neonatal jaundice
delayed mental & physical milestones
short stature
puffy face, macroglossia
hypotonia
47
Minimal glucocorticoid activity, very high mineralocorticoid activity
fludrocortisone
48
Glucocorticoid activity, high mineralocorticoid activity
hydrocortisone
49
Predominant glucocorticoid activity, low mineralocorticoid activity
prednisolone
50
Very high glucocorticoid activity, minimal mineralocorticoid activity
dexamethasone
betamethasone
51
sick day rules pt on long term steroids
double dose
52
when to take statins
last thing in evening
53
restless legs syndrome tx
dopamine agonists such as ropinirole
54
salicylate poisoning
iv bicarb
55
hypothermia ECG
J waves
56
afro carribean hypertension
CCB
57
when to co-prescribe in SSRI
when already taking an NSAID, give a PPI
58
valvulae conniventes extending across bowel
small bowel obstruction
59
Bone pain, tenderness and proximal myopathy
?osteomalacia
60
when can pts be tested for coeliac
when they have eaten gluten for 6 wks
61
why is nephrotic syndrome assoc with a hypercoagulable state
loss of antithrombin III by the kidneys
62
Stopping of voluntary movement or staying still in an unusual position
catatonia
63
TLCO in IPF
reduced
64
when is platelet transfusion indicated
platelet count <30 and clinically significant bleeding
65
CLL transformation
richters = non-hodgkins lymphoma
66
severe diverticulitis flare
72 hours, admission to hospital for IV ceftriaxone + metronidazole is indicated
67
critical limb ischaemia
pain at rest for greater than 2 weeks, often at night, not helped by analgesia
68
why is albumin prescribed in large volume ascites paracentesis
reduces paracentesis-induced circulatory dysfunction and mortality
69
parkinsons delerium
lorazepam
70
Rupture of the papillary muscle due to a myocardial infarction ->
mitral regurgitation
71
pH NG tube
safe to use if <5.5 on aspirate
72
what is reccomended after WLE breast cancer
whole breast radiotherapy
73
timolol eyedrops MOA
reduce aqueous secretion
74
gynae disease RF for ectopic
endometriosis
75
which other antidepressent do SSRIs interact with -> serotonin syndrome
MAOs eg phenelzine
76
prophylaxis for contacts of meningitis
Oral ciprofloxacin or rifampicin
77
most common MOA of ankle sprain
inversion
78
what should be checked prior to prescribing EPO in CKD
iron studies
79
when should lithium levels be checked
7 days, 12 hours post-dose
80
vision worse going down stairs
4th nerve palsy - trochlear
81
T1DM antibodies
anti-GAD
islet cell antibodies
insulin autoantibodies
82
symptomatic DM diagnosis
fasting glucose >= 7.0 mmol/l
random glucose >= to 11.1 mmol/l (or after 75g OGTT)
83
asymptomatic DM diagnosis
same applies but must be demonstrated x2
84
atypical features of T1DM - order C peptide or antibodies
age 50 years or above, BMI of 25 kg/m² or above, slow evolution of hyperglycaemia or long prodrome
85
HBA1C T2DM diagnostic
>=48 (repeat test to confirm diagnosis)
86
conditions where HBA1C cannot be diagnostic
haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
suspected GDM
children
HIV
CKD
ptstaking medication that may cause hyperglycaemia (eg steroids)
87
pre-diabetes
HBA1C 42-47
fasting glucose 6.1-6.9
88
metformin MOA
Increases insulin sensitivity
Decreases hepatic gluconeogenesis
89
metformin SEs
lactic acidosis
GI upset
90
metformin CI
eGFR <30
91
sulfonylureas eg gliclazide, glimepiride
Stimulate pancreatic beta cells to secrete insulin
92
sulfonylureas eg gliclazide, glimepiride SEs
hypoglycaemia
wt gain
hyponatramia
93
Thiazolidinediones eg pioglitazone MOA
Activate PPAR-gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake
94
Thiazolidinediones eg pioglitazone SE
weight gain
fluid retention
95
DPP4 inhibitors eg gliptins MOA
Increases incretin levels which inhibit glucagon secretion
96
DPP4 inhibitors eg gliptins potential but rare SE
pancreatitis
97
SGLT-2 inhibitors (-gliflozins) MOA
inhibits reabsorption of glucose in the kidney
98
SGLT-2 inhibitors (-gliflozins) SE
UTIs
99
SGLT-2 inhibitors (-gliflozins) benefit
wt loss
100
GLP-1 agonists (-tides) (SC) MOA
Incretin mimetic which inhibits glucagon secretion
101
GLP-1 agonists (-tides) (SC) SEs
Nausea and vomiting
Pancreatitis
102
how often HBA1C monitored in T1
3-6 monthly
103
blood glucose targets
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
104
hba1c target when taking drug which may cause hypo eg sulfonylureas
53
105
Already on one drug, but HbA1c has risen to 58 mmol/mol target
53
106
DKA path
uncontrolled lipolysis (not proteolysis) which results in an excess of free fatty acids that are ultimately converted to ketone bodies
107
DKA diagnostic criteria
glucose > 11 mmol/l or known DM
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick
108
what electrolyte should be added to fluid in DKA
potassium
109
DKA resolution
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
110
DKA resolution timeframe
should be within 24 hrs -> endocrinologist
111
diabetic peripheral neuropathy
SENSORY loss in a glove and stocking distribution
112
indicator kidney disease is chronic not acute
hypocalcaemia
113
how long do symptoms need to be present for a diagnosis of chronic fatigue syndrome
3 months
114
lower than exptected HBA1C (due to
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
115
higher than expected HBA1C (due to >RBC lifespan)
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
116
graves disease main antibodies
TSH receptor stimulating antibodies
117
CIs radioactive iodine tx
pregnancy
age <16
eye disease
118
hashimotos antibodies
anti-thyroid peroxidase (TPO) and also anti-thyroglobulin (Tg) antibodies
119
cancer assoc with hashimotos
MALT lymphoma
120
key invx for pts with hypercalcaemia
PTH
121
HHS features
hypovolaemia
hyperglycaemia
> serum osmolality
no sig ketones or acidosis
122
insulin in HHS
should not be given unless blood glucose stops falling when fluids given
123
complciations in HHS
vascular eg stroke or MI
124
tx of primary hyPOPTH
alfacalcidol
125
pseudohyperparathyroidism phenotype
low IQ, short stature, shortened 4th and 5th metacarpals
126
psuedohyperparathyroidism features
low calcium, high phosphate, high PTH
127
levothyroxine SEs
hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation
128
levothyroxine interaction
iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart
129
dermatophyte nail infection
terbinafine
130
candida nail infection
itraconazole
131
tx of MODY
sulfonylureas eg gliclazide
132
High uric acid + renal impairment following chemotherapy
tumour lysis syndrome
133
kallman syndrome
lack of smell in a boy with delayed puberty
134
kallman syndrome findings
everything low
135
klinefelters
tall but 2ndary sexual characteristics, small firm testes and infertile
136
klinefelters findings
fsh lh high
testosterone low
137
MEN 1 (MEN 1)
3 Ps
Parathyroid: hyperparathyroidism due to parathyroid hyperplasia
Pituitary
Pancreas: e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
138
MEN IIa (RET oncogene)
1M
Medullary thyroid cancer
2P's
Parathyroid
Phaeochromocytoma
139
MEN IIb (RET oncogene)
2Ms
Medullary thyroid cancer
Marfanoid body habitus
1P
Phaeochromocytoma
Neuromas
140
raised urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels
neuroblastoma (adrenal tumour)
141
what is orlistat
pancreatic lipase inhibitor
142
anti-thyroid drugs in preg
propylthiouracil in first trim
switch back to carbimazole at start of 2nd trim
143
features of primary hyperaldosteronism
hypertension
hypokalaemia
metabolic alkalosis
144
when would starting plasma osmolality be low in water deprivation test
psychogenic polydipsia
145
modifiable RF thyroid eye disease
smoking
146
most common and best prognosis thyroid cancer
papillary
147
Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness
anterior inferior cerebellar artery
148
MSH2/MLH1 gene mutations
HNPCC
149
SAH mx
aneurysm coiling
150
early diastolic murmur
aortic regurgitation
151
when would you choose sputum culture over smear for TB testing
PLWH
152
PSC diagnosis
MRCP
