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Year 3 difficult topics > 16/05/22 > Flashcards

16/05/22 Flashcards

1
Q

heart failure management

is oxygen given? if so when/why

A

Iv loop diuretics
only when sats are below 94%
nitrates- ONLY if not aortic stenosed or hypotensive

cpap

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2
Q

HF when in hypotension?
management
why does it happen?

A

drugs like loop diuretics and nitrates can make things worse

give inotropic agents: dobutamine

vasopressor agent: norepinephrine

mechanical assistance: intra aortic balloon

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3
Q

what regular meds can be continued in HF?

A

beta blockers
acei
but beta blockers stop if HR <50

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4
Q

chronic HF mx

1st line
if preserved ejection fraction?

2nd line- what needs to be monitored at this point?

A

1- acei and beta blocker

2- spironolactone - K+ risk of hyperkalaemia

3-digoxin

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5
Q

what can better outcome in heart failure

A

implantable cardioverter device as risk of death from arrythmias

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6
Q

pleural aspiration

A

21g needle and 50ml syringe

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7
Q

lights criteria
exudate?
transudate

A

have a protein level of >30 g/L

25-35 g/L

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8
Q

exudative causes of pleural effusion

these increase the capillary permeability

A

infection such as pneumonia or TB
malignancy: mesothelioma/ lung cancer

inflammatory cause: RA, lupus

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9
Q

if a pneumonia caused a pleural effusion what would the aspiration be
protein?
LDH

A

pleural fluid : protein ratio >0.5
pleural fluid to serum LDH >0.6
ldh >2/3

as this would be an exudative cause of effusion

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10
Q

what is a transudative cause of a pleural effusion?

A

this is when interstitial fluid is imbalanced due to starling forces

like conditions that increase cap hydrostatic pressure
congestive HF

or cap oncotic pressure is reduced like cirrhosis, nephrotic syndrome / coeliac

HF is the most common cause

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11
Q

guidelines for pneumothorax

when can you discharge?

A

rim of air <2cm

and NOT breathless

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12
Q

if a pneumothorax is 3cm on a 25yr old and he is sob ?

A

aspiration attempt

then chest drain

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13
Q

when do you put a chest drain for a pneumothorax straight away?

A

> 50yrs and secondary >2cm and SOB

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14
Q

when do you admit and give oxygen over 24hours if pneumothorax rim is 1cm?

A

if secondary

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15
Q

complications of pneumothorax

A

fitness to fly
2 weeks after a successful

1 week post xray

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16
Q

testicular torsion of appendage

A

Testicular appendage torsion is the twisting of a small piece of tissue above a testicle. The appendage doesn’t have a function in the body. But it can twist and cause pain and swelling that gets worse over time. It is not the same as testicular torsion

blue dot is signifying

tender nodule with blue discoloration on the upper pole of the testis

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17
Q

what drugs are commonly used to treat UTI?

and what are the common side effects?

A

nitrofuntein- pulmonary fibrosis

trimethopram - folate metabolism so avoid in first trimester

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18
Q

lung nodule
diarrhoea
facial flushing
asthma

what Ix ?

A

urinary 5-HIAA excretion

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19
Q

what type of lung nodules does RCC present with?

A

cannon ball mets

in whihc case EPO

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20
Q

nicotine replacement

if pregnant?

A

NRT / varencline/ buproprion

NRT only

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21
Q

prescription for NRt??

A

2 weeks after stop date

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22
Q

prescription for buproprion / varencline

end date ?

A

3-4 weeks

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23
Q

which is most effective smoking cessation drug?

A

varenicline

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24
Q

acute asthma attack what abg finding is most alarming and requires escalation?

A

normal Paco2 as it indicates exhausation

life threateneing asthma

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25
Q

what should you give when giving salbutamol? in an asthma attack?

A

potassium IV 20mmol / 6 hours

as salbutamol drives K+ into cells

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26
Q

how can you treat deteriorating acute asthma patients further?

A

IV magnesium
IV salbutamol/ theophylline
ventillatory support

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27
Q

life threatening asthma?

A 
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
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28
Q

haemopytsis differential

saddle nose/ flat nose

A

granulomatosis with polyangitis

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29
Q

haemoptysis with glomerulonephritis

differentials?

A

good pastures - systemically unwell, nauses

Granulomatois with polyangitis - saddle nose, URT signs

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30
Q

30-49% fev1

copd stage?

A

severe

3

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31
Q

what is very severe stage 4 copd?

A

fev1 <30%

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32
Q

SCLC
associated with which endocrine
with neuro condition?

A

acth and adh
hypokalaemia, hyponatraemia, cushings

lambert eaton syndrome

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33
Q

In MG why is it important to do one imaging?

A

CT
because it presents with thymoma
anterior mediastinal mass.

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34
Q

what causes nephrotic syndrome inchildren - affects eyes; bitemporal periorbital oedema

A

minimal change disease - non proliferative glomerulonephritis

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35
Q

what joints are spared in RA?

what deformaties occur

A

distal interphalangeal joints

radial deviation of wrist
z deformaty thumb swan neck
boutonniere and trigger finger

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36
Q

what causes ataxia?

A

finger to nose ataxia is caused by cerebeller hemisphere lesion

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37
Q

headache dull
fever
down and out eye
with nausea and seizure

on fundoscopy - pappiloedema seen

what mx?

A

brain abscess?
due to focal neurology signs of infection - fever and raised ICP

dexamethasone
cepholosporin and metronidazole

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38
Q

presents with hand weakness and inability to use the fingers on associated hand
24hours

strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule

A

lacunar stroke

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39
Q

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

A

posterior inferior cerebellar artery

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40
Q

what happens with a brainstem stroke?

A

Brainstem infarction

may result in more severe symptoms including quadriplegia and lock-in-syndrome

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41
Q

nause and vomiting
decrease in. conciousness
headache
seizure

is more common in what type of stroke

A

Brainstem infarction

may result in more severe symptoms including quadriplegia and lock-in-syndrome

42
Q

criteria for thrombolysis

A

no haemorrhages - no hyperdensity
>4.5

always give 300mg of aspirin

43
Q

when is an urgent neuro assemenet required within 24 hours

when within 7 days?

TIA

A

if tia within 7 days

is outside of 7 days

44
Q

in a stroke a contrast CT head is done

T/F?

A

false

non contrast

45
Q

typically show areas of hyperdense material (blood) surrounded by low density (oedema)

A

haemorrhagic stroke

46
Q

what is Rosier used for

A

stroke

47
Q

how long after ischaemic stroke can AF medication be started?

A

14 days

48
Q

Offer thrombectomy between 6 hours and 24 hours?

A

confirmed occlusion of anterior. circ

and limited infarct core volume

49
Q

offer thrombectomy - 6 hours

A

with alteplase if within 4.5hrs

or 6 hours alone if proximal anterior circulation
CTA / MRA

50
Q

when can you consider thrombectomy if its within 24 hours

A

basilar / posterior cerebral artery

limied infarct core volume

51
Q

when is a carotid artery endarterectomy recommended

A

should only be considered if carotid stenosis > 70% according ECST** criteria

or > 50% if symptomatic

52
Q

sudden transient loss of vision in one eye

A

(amaurosis fugax)

TIA sign

53
Q

PT has SLE
presents with a DVT
on examination has a mottled lace like appearance of skin
recently had a miscarriage

on blood results there is thrombocytopenia

CLOT

A 
antiphospholipid syndrome 
Clots
Livedo reticularis
Obstetric loss
Thrombocytopenia
54
Q

what IX confirms anti phospholipid syndrome?

A

anti cardiolipin
anti beta2GPI
lupus - anti dsdna , ana

55
Q

Nicotinic acid deficiency
pt presents with dermatitis, diarrhoea, dementia
brown scaly rash on sun-exposed sites - termed Casal’s necklace if around neck

what TB drug can also cause this?

A

pellagra vit b3 deficiency

isoniazid

carcinoid syndrome can also cause this

56
Q

how is carcinoid tumour investigated?

A

urinary 5 HiAA

57
Q

what causes glossitis

A

b12 deficiency - pernicious anaemia

58
Q

embryo sign?
obstructed bowel
defn

A

caecum volvulus

stomach or loop of bowel twist on its own mesentery

59
Q

Coffee bean sign?

A

sigmoid volvulus

stomach or loop of bowel twist on its own mesentery

60
Q

in raised ICP you get cushings reflex what is the criteria?

A

bradycardia
hypertension
weird breathing

61
Q

complete heart block JVP sign?

A

a wave is increased

62
Q

adenosine?

what is the one side effect to warn pt of?

A

to restore rhythm in supraventicular tachycardia
3mg
this is emergency
if haemodynamically stable then vagal moves first

chest pain as they already have it so might think theyre getting worse

63
Q

what is flucloxacillin used for?

A

soft cell and tissue infection
eg cellulitis

treats staph aureus as it is gram +

64
Q

RA spares what part of spine?

A

thoracic and lumbar

it only affects the C part

65
Q

what is the most common se of dialysis ?

A

dialysis induced hypotension

66
Q

how should you image prostate? first line?

A

MRI

67
Q

what electrolyte is an indicator of pancreatitis severity

A

calcium

hypocalcaemia

hypercalcaemia can cause pancreatitis

68
Q

HF medication step wise

A

acei
beta blocker

add hydrazalineif acei not possible

2) loop diuretics furesomided/ bumetanide

3)spironolactone / epelerone
hydrazaline and a nitrate - if afro-caribbean
ivabradine - sinus rhythm and impaired ejection fraction
arb

4) digoxin

69
Q

when is cardiac resynchronistaion indicated?

A 
QRS interval <120ms, high risk sudden cardiac death, NYHA class I-III
QRS interval 120-149ms without LBBB, NYHA class I-III
QRS interval 120-149ms with LBBB, NYHA class I
70
Q

what is medium sized AAA?

what is guideline ?

A

4.5-5.4

repeat ultrasound 3 months

71
Q

high risk of rupture of AAA?

A

> 5.5

surgery within 2 weeks

72
Q

low risk of AAA rupture but repeat ultrasound yearly?

A

3-4.4cm

73
Q

when is there no need to repeat uss for AAA

A

if it is less than 3cm

normal

74
Q

what immune conditions are risk factors for PE?

A

anti phospholipid syndrome

factor V leiden

75
Q

what is a sign of sub massive PE?

A

right heart strain

76
Q

what is a sign of massive PE?

A

hypotension

IV fluids <90

77
Q

mx of massive PE?

when is embolectomy indicated?

A

IV alteplase
DOAC - apixaban

massive PE with thrombolysis contraindicated

78
Q

wells score of 4?

A

PE unlikely
arrange a d dimer
if + CTPA > interim doac

if - consider alternative

79
Q

wells score of 5?

A

PE likely
CTPA
doac in interim

if ctpa - consider DVT uss

80
Q

when is V/Q scan preferred

A

renal impairment and pregnancy

81
Q

what is an insulinoma?

how to Ix?

A

functional neuroendocrine tumour of pancreas

72hour fast
at moment of true hypoglycaemia - measure plasma insulin and pre insulin and ketones

82
Q

has chronically swollen feet and ankles for the last 10 years. X-rays demonstrate destruction and deformities of the joints, mainly affecting the tarsometatarsal joints. The bones are dense and there is limited sensation in a glove and stocking distribution. What is the most common aetiology underlying this presentation?

A

diabetes this is charcots arthropathy

83
Q

sore throat treated in 18yr old presents week later with rash

what is the rash called?
what has happened?

A

amoxicillin given and pt has EBV - morbilliform eruption

84
Q

Autoimmune hepatitis serology?

A

anti smooth muscle ab

and ana

85
Q

lft raised ALT and bilirubin with midly raised alp

igG hypergammaglobulinaemia

14yr pt has PMHx graves?

A 
autoimmune hepatitis
palpable liver edge 
fatigue 
loss of appetite 
splenomegaly
86
Q

PR interval prolongation on ecg
pt has splinter haemorrhage
osler nodes and janeway lesions
and a new murmur

A

in a patient with Infective Endocarditis this is an indication for surgery as it can be secondary to aortic root abscess

87
Q

if a pt with variceal bleed must take an NSAID say for RA which one is best?

A

celocoxib

88
Q

coagulase - staphylococci

which abx?

A

vancomycin - this is nephorgenic however

89
Q

Upper GI series may show the ‘string sign of Kantour

A

crohns

narrowed terminal ileum

90
Q

peri-anal abscess mx?

A

ceftriaxone + metronidazole.

under anaesthetic and incision and drainage.

91
Q

crohns cx
peri-anal fistulae

what complication do you want to avoid?

A

seton drainage trans sphincteris fistuale

division of anal sphincter and incontinence

92
Q

perianal pain and swelling
no bleeding
fluctuant peri anal swelling
PR not tolerated

what is this?
mx?

A

anorectal abscess

early drainage- surgical immediately LA

93
Q

reinfarct MI
diagnostic serum marker?

why?

A

CK MB clear 72hours
more than 3x upper limit indicative
troponin remains high for 2 weeks

94
Q

tall tented t waves and a VBG showing hyperkalaemia

nausea vomiting, disturbance in colour vision and palpitations

how do you manage

A

digoxin toxicity

give digiband

95
Q

what antibodies associated with psoriatic arthritis?

A

none - it is seronegative

96
Q

RA abx?

A

anti ccp

97
Q

causes of a long QT interval?

TIMMES

A 
toxins- anti arrhythmatics tricyclin 
inherited: lange nielson
ischaemia 
myocarditis 
mitral valve prolapse 
electrolyte imbalance :hypokalaemia/hypocalcaemia 
subarachnoid haemorrhage
98
Q

salmonella and shigella treated with?

A

ciprofloxacillin

99
Q

camplylobacter?

A

macrolide - erythromycin

100
Q

cholera mx?

A

tetracycline

101
Q

high SAAG

what does this mean?

A 
cirrhosis 
HF
budd chiari 
constrictive pericarditis 
hepatic failure 
raised portal pressure forcing water into peritoneal cavity whilst albumin remains in vessels = high {difference} between serum and ascitic fluid
102
Q

low saag causes?

A

Causes of a low SAAG (<1.1g/dL)

biliary leak 
Cancer of the peritoneum
Tuberculosis and other infections
Pancreatitis
Nephrotic syndrome

Year 3 difficult topics (22 decks)

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