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passmed qs > 16/06 > Flashcards

16/06 Flashcards

1
Q

acanthosis nigricans sinister cause

A

GI cancer

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2
Q

drug induced acne

A

monomorphic eg just pustules due to steroids

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3
Q

mucosal involvement blisters

A

pemphigus vulgaris

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4
Q

Superficial epidermal

A

Red and painful, dry, no blisters

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5
Q

Partial thickness (superficial dermal)

A

Pale pink, painful, blistered. Slow capillary refill

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6
Q

Partial thickness (deep dermal)

A

Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure

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7
Q

full thickness

A

White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain

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8
Q

when to refer burns to 2ndary care

A

superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children

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9
Q

curlings ulcer

A

acute peptic stress ulcer

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10
Q

mild steroid

A

hydrocortisone

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11
Q

mod steroids

A

betametasone valerate 0.025 (betnovate)
Clobetasone butyrate 0.05% (Eumovate)

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12
Q

potent steroids

A

Fluticasone propionate 0.05% (Cutivate)
Betamethasone valerate 0.1% (Betnovate)

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13
Q

very potent steroid

A

Clobetasol propionate 0.05% (Dermovate)

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14
Q

erysipelas

A

localised skin infection caused by Streptococcus pyogenes (localised cellulitis)

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15
Q

tx of erysipelas

A

flucloxacilllin

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16
Q

target lesions

A

erythema multiforme

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17
Q

erythrasma

A

groin or axillae
overgrowth of the diphtheroid Corynebacterium minutissimum

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18
Q

erythrasma invx

A

Wood’s light reveals a coral-red fluorescence.

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19
Q

erythrasma mx

A

Topical miconazole or antibacterial

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20
Q

guttate psoriasis preciptant

A

strep infection

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21
Q

hirsutism

A

androgen dependant

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22
Q

hypertrichosis

A

androgen independant

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23
Q

assessment of hirsutism

A

Ferriman-Gallwey scoring system

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24
Q

tx of hirsutism wide spread

A

co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin)

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25
Q

tx of hirsutism face

A

topical eflornithine (CI in preg and breast feeding)

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26
Q

impetigo cause

A

staph aureus or strep pyogenes

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27
Q

mx of localised impetigo

A

hydrogen peroxide 1%
topical fusidic acid
if resistance suspected -> topical mupirocin

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28
Q

extensive impetigo mx

A

fluclox
pen allergic -> erythromycin

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29
Q

leukoplakia

A

premalignant condition which presents as white, hard spots on the mucous membranes of the mouth
more common in smokers

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30
Q

Lesions 0-1mm thick

A

1cm

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31
Q

Lesions 1-2mm thick

A

1-2cm

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32
Q

Lesions 2-4mm thick

A

2-3cm

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33
Q

Lesions >4 mm thick

A

3cm

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34
Q

tx of venoux ulceration

A

compression bandaging
oral pentoxifylline

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35
Q

shingles vaccine

A

all patients aged 70-79 years

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36
Q

tinea capitis cause

A

Trichophyton tonsurans

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37
Q

tinea corporis (ringworm) causes

A

Trichophyton rubrum and Trichophyton verrucosum

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38
Q

atopic eruption of pregnancy

A

commonest skin disorder
eczematous, itchy red rash

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39
Q

polymorphic eruption of pregnancy

A

3rd trim
abdo striae
periumbilical area often spared
emollients, steroids

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40
Q

Pemphigoid gestationis

A

pruritic blistering lesions
peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required

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41
Q

pretibial myoxedema

A

symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin

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42
Q

sebhorreic dermatitis cause

A

Malassezia furfur

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43
Q

punctum

A

sebaceous cyst

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44
Q

scabies mx

A

permethrim 5%

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45
Q

rosacea predominant erythema/flushing

A

topical brimonidine gel

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46
Q

psoriasis mx

A

potent corticosteroid + vitamin D analogue OD
vit D analogue twice daily
steroid twice daily or coal tar
dithranol
phototherapy or systemic therapy

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47
Q

psoriasis genetic assocs

A

HLA-B13, -B17, and -Cw6

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48
Q

pityriasis versicolour cause

A

Malassezia furfur

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49
Q

nickel dermatitis

A

type 4 hypersensitivity

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50
Q

rare t cell lymphoma affecting skin

A

Mycosis fungoides

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51
Q

chemotherapy nausea mx

A

5-HT3 antagonists eg ondansetron

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52
Q

wernickes aphasia lesion

A

superior temporal gyrus supplied by the inferior division of the left MCA

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53
Q

brocas aphasia lesion

A

inferior frontal gyrus supplied by the superior division of the left MCA

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54
Q

wernickes aphasia

A

receptive
sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’

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55
Q

comprehension aphasia

A

wernickes - impaired
brocas - normal
conduction - normal

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56
Q

brocas aphasia

A

expressive
Speech is non-fluent, laboured, and halting
Repetition is impaired

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57
Q

conduction aphasia lesion

A

stroke affecting the arcuate fasiculus - the connection between Wernicke’s and Broca’s area

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58
Q

conduction aphasia

A

Speech is fluent but repetition is poor. Aware of the errors they are makin

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59
Q

global aphasia

A

Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia

May still be able to communicate using gestures

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60
Q

peripheral (finger to nose) ataxia

A

cerebellar hemisphere lesions

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61
Q

gait ataxia

A

cerebellar vermis

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62
Q

when to refer bells palsy to ENT

A

3 wks no improvement

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63
Q

erb Duchenne paralysis loc of damage

A

C5, C6 roots that may be caused by breech presentation

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64
Q

erb Duchenne paralysis

A

winged scapula

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65
Q

klumpkes palsy loc of damage

A

T1 due to tracion

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66
Q

klumpkes palsy

A

loss of intrinsic hand muscles

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67
Q

brain abscess mx

A

surgery
IV 3rd-generation cephalosporin + metronidazole
dex

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68
Q

tumour to bone

A

prostate/breast

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69
Q

tumour to brain

A

lung

70
Q

craniopharyngioma

A

Most common paediatric supratentorial tumour
Derived from remnants of Rathke pouch

71
Q

brown sequard syndrome cause

A

lateral hemisection of the spinal cord

72
Q

brown sequard syndrome features

A

ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation

73
Q

cerebellar syndrome

A

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

74
Q

CSF circulation

A
  1. Lateral ventricles (via foramen of Munro)
  2. 3rd ventricle
  3. Cerebral aqueduct (aqueduct of Sylvius)
  4. 4th ventricle (via foramina of Magendie and Luschka)
  5. Subarachnoid space
  6. Reabsorbed into the venous system via arachnoid granulations into superior sagittal sinus
75
Q

charcot marie tooth disease

A

hereditary peripheral neuropathy -> motor loss
hx of sprained ankles, foot drop etc

76
Q

first unprovoked/isolated seizure DVLA

A

6 mo off driving

77
Q

benign rolandic epilepsy

A

M
paraesthesia (e.g. unilateral face), usually on waking up

78
Q

juvenile myoclonic epilepsy

A

F
infrequent generalized seizures, often in morning/following sleep deprivation

79
Q

infantile spasms (West syndrome)

A

brief spasms beginning in the first few months of life (salam attacks)
EEG: hypsarrhythmia
serious neuro abnormality

80
Q

Lennox-Gastaut syndrome

A

may be extension of infantile spasms
ketongenic diet may help

81
Q

frontal lobe

A

motor seizures

82
Q

parietal lobe

A

sensory seizures

83
Q

occipital lobe

A

visual seizures

84
Q

essential tremor tx

A

propranolol

85
Q

extradural haematoma cause

A

temporal region - fracture of pterion -> middle meningeal artery

86
Q

foot drop

A

common peroneal nerve injury
L5 ridiculopathy
sciatic nerve injury eg post hip surgery

87
Q

4th nerve palsy

A

eye deviated upwards and outwards
vision worse on going downstairs/reading book

88
Q

ipsilateral CN III palsy and contralateral hemiparesis

A

weber syndrome - posterior cerebral artery

89
Q

ejection systolic murmur loudest on INSPIRATION

A

pulmonary stenosis

90
Q

mirror image nuclei

A

reedsternburg cells/hodgkins lymphoma

91
Q

herpes simplex encephalitis affected lobe

A

usually temporal and inferior frontal lobes

92
Q

LEMS (SCLC)

A

repeated muscle contractions lead to increased muscle strength

93
Q

lateral medullary syndrome

A

posterior inferior cerebellar artery

94
Q

lateral medullary syndrome feautures

A

ataxia
nystagmus
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

95
Q

levodopa prescribing

A

combined with decarboxylase inhibitor (e.g. carbidopa or benserazide) to prevent peripheral metabolism of L-dopa to dopamine

96
Q

CSF polymorphs

A

bacterial

97
Q

CSF lymphocytes

A

viral or TB

98
Q

ALS drug tx

A

Riluzole

99
Q

AML

A

LMN signs in arms and UMN signs in legs

100
Q

Primary lateral sclerosis

A

UMN signs only

101
Q

Progressive muscular atrophy

A

LMN signs only
affects distal muscles before proximal
carries best prognosis

102
Q

worst prognosis MND

A

progressive bulbar palsy

103
Q

dawson fingers on FLAIR images

A

MS

104
Q

indications for disease modifying drugs in MS

A

relapsing-remitting disease + 2 relapses in past 2 years + able to walk 100m unaided
secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)

105
Q

drugs MS

A

natalizumab
ocrelizumab

106
Q

fatigue MS

A

amantadine

107
Q

spasticity MS

A

baclofen or gabapentin

108
Q

bladder dysfunction MS

A

residual volume - self-catheterisation
no residual volume - anticholinergics

109
Q

oscillopia MS

A

gabapentin

110
Q

multiple system atrophy features

A

parkinsonism
autonomic disturbance
cerebellar signs

111
Q

MG

A

muscle fatigueability

112
Q

narcolepsy diagnosis

A

multiple sleep latency EEG

113
Q

narcolepsy mx

A

daytime stimulants (e.g. modafinil) and nighttime sodium oxybate

114
Q

NF1

A

Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas

115
Q

NF2

A

Bilateral vestibular schwannomas
Multiple intracranial schwannomas, mengiomas and ependymomas

116
Q

neuroleptic malignant syndrome mx

A

stop antipsychotic
fludis
dantrolene/bromocriptine

117
Q

neuropathic pain first lines

A

amitriptyline, duloxetine, gabapentin or pregabalin

118
Q

neuropathic pain rescue med

A

tramadol

119
Q

normal pressure hydrocephalus mx

A

ventriculoperitoneal shunting

120
Q

parkinsons path

A

degeneration of dopaminergic neurons in the substantia nigra

121
Q

parkinsons tremor

A

worse when stressed or tired, improves with voluntary movement

122
Q

dopamine receptor agonists issues

A

impulse control disorders and excessive daytime somnolence

123
Q

paroysmal hemicrania tx

A

indomethacin

124
Q

pituitary apoplexy

A

Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction

125
Q

pituitary apoplexy mx

A

urgent steroid replacement due to loss of ACTH
fluid balance
surgery

126
Q

factors favouring true epileptic seizures

A

raised serum prolactin
tongue biting

127
Q

wrist drop

A

radial nerve

128
Q

cushings triad of raised ICP

A

widening pulse pressure
bradycardia
irregular breathing

129
Q

thrombylysis with alteplase conditions

A

administered within 4.5 hours of onset of stroke symptoms
haemorrhage has been definitively excluded

130
Q

thrombylysis + thrombectomy

A

within 6 hours of onset
confirmed occlusion of the proximal anterior circulation

131
Q

antiplatelets stroke

A

aspirin 300mg as soon as haemorrhage excluded
2ndary prevention = clopidogrel or aspirin + MR dipyridamole

132
Q

crescenteric collection not limited by suture lines

A

subdural haematoma

133
Q

cause of chronic subdural haematoma

A

rupture of small bridging veins

134
Q

elderly and alcoholic brain bleed

A

chronic subdural haematoma

135
Q

trigeminal neuralgia tx

A

carbamazepine

136
Q

which cardiac drug may precipitate digoxin toxicity

A

thiazides

137
Q

role of benzos

A

enhance the effect of GABA

138
Q

testing for brain death

A

fixed pupils
no corneal reflex
absent oculo-vestibular reflexes
no response to supraorbital pressure
no cough reflex
no obsered resp effort

139
Q

suspected SAH, if CT head is done within 6 hours of symptom onset and is normal

A

no LP

140
Q

suspected SAH, if CT head is done more than 6 hours after symptom onset and is normal

A

do a LP

141
Q

when should LP be performed in suspected SAH

A

12 hours following the onset of symptoms to allow the development of xanthochromia

142
Q

SAH LP findings

A

xanthochromia
normal or raised opening pressure

143
Q

after SAH is confirmed, what invx

A

CT intracranial angiogram to determine cause

144
Q

tx of intracranial aneurysms

A

coiling

145
Q

predictive factors in SAH

A

conscious level on admission
age
amount of blood visible on CT head

146
Q

acute severe hydrocephalus initial mx

A

external ventricular drain into right ventricle and bag at bedside

147
Q

long term CSF diversion technique for hydrocephalus

A

ventriculoperitoneal shunt

148
Q

electrolyte abnormality leading to long QT

A

hypokalaemia

149
Q

hydrocephalus eye sign in child

A

impaired upward gaze (sunsetting of the eyes)

150
Q

painful mouth end of life

A

Benzydamine hydrochloride mouthwash or spray

151
Q

which cardiac meds can worsen glucose tolerance

A

THIAZIDES

152
Q

which antihypertensives should be avoided in pts with HOCM

A

ACEi

153
Q

what cancer does myelodysplasia progess to

A

AML

154
Q

key about advance directives

A

refer to a specific tx in a specific circumstance

155
Q

confirmation of death after cardiac arrest when cpr has been attempted

A

observe for signs of life for 5 mins
no palpable central pulse
no HS
cardiac monitor confirming 5 mins of asytole
absence of pupillary light reflex, corneal reflex and no response to supraorbital pressure

156
Q

confirmation of death after cardiac arrest when DNACPR in place

A

absence of pupillary light reflex, corneal reflex and no response to supraorbital pressure
no palpable central pulse and no HS for 2 mins
no chest wall movements or breath sounds for 2 mins
no additional monitoring required in these pts

157
Q

GP confirmation of expected death

A

temp <35
No spontaneous movements.
No respiratory effort (examine for at least one minute).
No heart sounds or palpable pulses (examine for at least one minute).
No corneal reflex.
Pupils are fixed and dilated.

158
Q

capacity

A

a. understand the information relevant to the decision
b. retain that information
c. use or weigh that information as part of the process of making the decision
d. communicate the decision made by talking, sign language or other means

159
Q

what is used to treat pts in emergency scenarios

A

common law

160
Q

what is used to treat pts for physical disorders that dont have capacity and refuse

A

Mental Capacity Act

161
Q

what is used to treat pts for mental disorders that does have capacity and refuse

A

mental health act

162
Q

non urgent transfer of RBCs time

A

90-120 mins

163
Q

SSRI in children and adolescents

A

fluoxetine

164
Q

too much NaCl

A

hyperchloraemia metabolic acidosis

165
Q

APS

A

prolonged APTT and low platelets

166
Q

chronic alcoholism electrolyte abnormality

A

hypomagnesaemia

167
Q

how to reduce hypercalciuria to prevent renal stones

A

thiazides

168
Q

how to reduce hypercalciuria to prevent renal stones

A

thiazides

169
Q

how to reduce hypercalciuria to prevent renal stones

A

thiazides

170
Q

what does parvovirus exposure cause in sickle cell disease

A

aplastic crisis

passmed qs (18 decks)

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