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Finals Revision > 26/05 > Flashcards

26/05 Flashcards

1
Q

Widened QRS or arrhythmia in tricyclic overdose

A

give IV bicarbonate

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2
Q

management of tricyclic overdose

A

Consider gastric lavage only if within one hour of a potentially fatal overdose.

Give 50 grams of charcoal if within one hour of ingestion.

Give sodium bicarbonate (50 ml of 8.4%) if:

  • pH <7.1
  • QRS >160 ms
  • Arrhythmias
  • Hypotension
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3
Q

bilateral hilar lymphadenopathy

A

tuberculosis

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4
Q

Progressively worsening headache with higher cognitive function impaired

A

urgent imaging

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5
Q

headache red flags

A
  • immunocompromise
  • under 20 with history of malingnacy
  • brain mets
  • vomiting
  • worsening headache +fever
  • sudden onset
  • new onset neuro deficit
  • now onset cognitive dysfunction
  • change in personality
  • impaired consciousness
  • head trauma (3/12)
  • obvious pressure trigger
  • changes with posture
  • symptoms of GCA or glaucoma
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6
Q

pharmacological cardioversion for new onset a-fib

A

> flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease

OR

> amiodarone if there is evidence of structural heart disease.’

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7
Q

side effects of standard heparin

A

Bleeding
Heparin-induced thrombocytopaenia (HIT)
Osteoporosis

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8
Q

side effects of LMWH

A

> Bleeding

> Lower risk of HIT and osteoporosis with LMWH

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9
Q

monitoring of LMWH

A

Anti-Factor Xa (although routine monitoring is not required)

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10
Q

monitoring of standard heparin

A

Activated partial thromboplastin time (APTT)

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11
Q

heparin overdose

A

protamine sulphate

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12
Q

massive PE + hypotension

A

thrombolyse - alteplase

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13
Q

persistent pyrexia of unknown origin, lymphadenopathy and high WCC

A

lymphoma

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14
Q

causes of PUO

A

neoplasia

  • lymphoma
  • hypernephroma
  • preleukaemia
  • atrial myxoma

Infections

  • abscess
  • TB

connective tissue disorders

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15
Q

how do SGLT2 inhibitors work?

A

in renal proximal tubule- inhibit sodium-glucose co=transporter to reduce glucose reabsorption and increase urinary glucose excretion

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16
Q

examples of SGLT2 inhibitors

A

canagliflozin
dapaglflozin
empagliflozin

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17
Q

flashers + floaters

A

posterior vitreous detachment

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18
Q

features of lambert eaton

A

> repeated muscle contractions lead to increased muscle strength (in contrast to myasthenia gravis)

> limb-girdle weakness (affects lower limbs first)

> hyporeflexia

> autonomic symptoms: dry mouth, impotence, difficulty micturating

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19
Q

how to differentiate between pseudogout and gout on x-ray

A

chondrocalcinosis

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20
Q

acute hypophosphataemia

A

mild (∼0.64–0.80 mmol/L), moderate (∼0.32–0.64 mmol/L)

severe (<0.32 mmol/L).

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21
Q

acute hypophosphataemia management

A

mild/mod= effervescent tabs

severe/symptomatic= phosphate polyfusor IV

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22
Q

patients on warfarin undergoing emergency surgery

A

> If surgery can wait for 6-8 hours - give 5 mg vitamin K IV

> If surgery can’t wait - 25-50 units/kg four-factor prothrombin complex

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23
Q

digoxin toxicity signs

A

> generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

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24
Q

management of digoxin toxicity

A
  • Digibind
  • correct arrhythmias
  • monitor potassium
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25
Q

chancroid cause

A

Haemophilus ducreyi

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26
Q

people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma.

A

> very urgent protein electrophoresis and a Bence Jones protein urine test (within 48 hours) to assess for myeloma

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27
Q

features of myeloma

A

> bone disease: bone pain, osteoporosis + pathological fractures (typically vertebral), osteolytic lesions

> lethargy

> infection

> hypercalcaemia

> renal failure

other features: amyloidosis e.g. Macroglossia, carpal tunnel syndrome; neuropathy; hyperviscosity

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28
Q

investigations in myeloma

A

> monoclonal proteins (usually IgG or IgA) in the serum and urine (Bence Jones proteins)

> increased plasma cells in the bone marrow

> whole-body MRI

> X-rays: ‘rain-drop skull’ (likened to the pattern rain forms after hitting a surface and splashing, where it leaves a random pattern of dark spots).

Note that a very similar, but subtly different finding is found in primary hyperparathyroidism - ‘pepperpot skull’

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29
Q

diagnostic criteria for myeloma

A

one major and one minor
OR
three minor

Major criteria;
> Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
> 30% plasma cells in a bone marrow sample
> Elevated levels of M protein in the blood or urine

Minor criteria;
> 10% to 30% plasma cells in a bone marrow sample.
> Minor elevations in the level of M protein in the blood or urine.
> Osteolytic lesions (as demonstrated on imaging studies).
> Low levels of antibodies (not produced by the cancer cells) in the blood.

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30
Q

why is there hypercalcaemia in myeloma?

A

1ry- increased osteoclastic bone resorption

other- impaired renal function, increased renal tubular calcium reabsorption and elevated PTH-rP levels

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31
Q

management of hypercalcaemia

A

> rehydration with normal saline, typically 3-4 litres/day.

Following rehydration bisphosphonates may be used.

They typically take 2-3 days to work with maximal effect being seen at 7 days

calcitonin - quicker effect than bisphosphonates

steroids in sarcoidosis

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32
Q

presentation of hep A

A

flu-like symptoms, RUQ pain, tender hepatomegaly and cholestatic LFTs

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33
Q

incubation of hep A

A

2-4 weeks

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34
Q

spread of hep A

A

Faecal-oral

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35
Q

who should get hep A vaccine

A
  • going to endemic areas
  • chronic liver disease
  • haemophilia
  • MSM
  • IVDU
  • occupational risk
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36
Q

what is NHL

A

lymphoma without reed stenberg cells

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37
Q

what cells are affected in NHL

A

B or T cells

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38
Q

NHL is ____ common than HL

A

NHL is much more common than HL

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39
Q

burkitts lymphoma

A

starry sky appearance

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40
Q

most common type of NHL

A

diffuse large b cell lymphoma

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41
Q

who is affected by burkitts lymphoma?

A

young or immunosuppressed

42
Q

management of PR bleeds

A

if haemodynamically stable- supportive

43
Q

common peroneal nerve lesion

A

> foot drop
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles

44
Q

management of haemothorax

A

> Patients should all have a wide bore 36F chest drain.

> Indications for thoracotomy include;

  • loss of more than 1.5L blood initially or
  • ongoing losses of >200ml per hour for >2 hours.
45
Q

untreated hyponatraemia

A

cerebral oedema

46
Q

management of acute hyponatraemia with severe symptoms

A

hypertonic saline (3% NaCl)

47
Q

diagnostic features of kawasaki

A

fever >5d with 4 of the following criteria:
A) Conjunctival injection
B) Mucous membrane changes (dry cracked lips, strawberry tongue)
C) Cervical lymphadenopathy D) Polymorphous rash
E) Red and oedematous palms/soles, peeling of fingers and toes.

48
Q

what is the ciliary ganglion

A

parasympathetic ganglion of the eye

49
Q

anisocoria worse in bright light

A

inability of pupil to constrict

parasympathetic = constriction therefore problem with parasympathetic merves

50
Q

fragile x testes

A

big testes

51
Q

most common form of prostate cancer

A

adenocarcinoma

52
Q

1st line for maintenance remission in chrons

A

azathioprine or mercatopurine

53
Q

management of red man syndrome

A

> cessation of the infusion, and when symptoms have resolved, recommencement at a slower rate.

> In patients who are more symptomatic antihistamines can be administered, and may require intravenous fluids if the syndrome is associated with hypotension.

54
Q

immunisations at birth

A

BCG if risk factors

-Tuberculosis in the family in the past 6 months

55
Q

2 months vaccines

A

> 6-1 vaccine (diptheria, tetanus, whooping cough, polio, Hib and hep B)
oral rotavirus
men B

56
Q

3 months vaccine

A

> 6-1 vaccine
oral rotavirus
PCV

57
Q

4 months vaccine

A

> 6-1 vaccine

> Men B

58
Q

12-13 months vaccine

A

> Hib/MenC
MMR
PCV
Men B

59
Q

2-8 years vaccine

A

flu vaccine (annual)

60
Q

3-4 vaccine

A

4 in 1 pre-school booster (diptheria, tetanus, whooping cough, polio)
MMR

61
Q

12-13 years vaccine

A

HPV

62
Q

13-18 years vaccine

A

3 in 1 teenage booster (tetanus, diptheria and polio)

Men ACWY

63
Q

scintigraphy reveals patchy uptake

A

toxic multinodular goitre

64
Q

investigation of SUFE

A

hip x-ray

65
Q

investigation of breech neonates

A

ultrasound

66
Q

painful limp (perthes) investigation

A

mri

67
Q

normal pCO2 in acute severe asthma

A

life-threatening

68
Q

negative result on spirometry for asthma

A

refer for fractional exhaled nitric oxide testing

69
Q

discharge and vaginal pH <4.5

A

candidiasis

70
Q

AKI criteria

A

> increased creatinine (>26 umol/L in 48hrs)
increased creatinine >50% in 7 days
decreased urine output of <0.5ml/kg/hr for more than 6 hours

71
Q

oesophageal cancer in GORDo

A

oesophageal adenocarcinoma

72
Q

Bell’s palsy is a _____ motor neuron condition. Unlike ___ conditions of the face, in ____ conditions the entire side of the patients face is affected

A

Bell’s palsy is a lower motor neuron condition. Unlike UMN conditions of the face, in LMN conditions the entire side of the patients face is affected

73
Q

maintenance fluid calculation in children

A

100ml/kg for the first 10kg, 50ml/kg for the next 10kg and 20ml/kg for every subsequent kg.

74
Q

side effects of SERM

A

Tamoxifen

> menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

75
Q

side effects of aromatase inhibitors

A

Anastrozole and letrozole

> osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
> hot flushes
>arthralgia, myalgia
>insomnia
76
Q

A 2-week-old infant with a small chin, posterior displacement of the tongue and cleft palate

A

pierre-robin syndrome

77
Q

Supravalvular aortic stenosis is found in a 3-year-old boy with learning difficulties

A

william’s syndrome

78
Q

A 9-week-old is noted to have a small chin and rocker-bottom feet

A

edward’s syndrome

79
Q

rocker-bottom feet without small chin

A

patau’s

80
Q

investigation for PSC

A

ERCP/MRCP

81
Q

marfans mutation

A

fibrillin-1

82
Q

Acute viral labrynthitis

A

sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo

83
Q

In acute testicular pain, a unilateral swollen and retracted testicle, with loss of the cremasteric reflex, is characteristic of…

A

testicular torsion

84
Q

Gestational diabetes: if the fasting plasma glucose is < 7 mmol/l a …..

A

trial of diet and exercise should be offered for 1-2 weeks

85
Q

most common type of breast cancer

A

invasive ductal carcinoma

86
Q

ank spon x-ray findings

A

subchondral erosions, sclerosis

and squaring of lumbar vertebrae

87
Q

Globus, hoarseness and no red flags

A

laryngopharyngeal reflux

88
Q

bilateral grittiness

A

blepharitis

89
Q

Complete heart block following a MI?

A

right coronary artery lesion

90
Q

In suspected SBP- diagnosis ….

A

is by paracentesis. Confirmed by neutrophil count >250 cells/ul

91
Q

carpal tunnel vs C6 entrapment

A

More proximal symptoms would be expected with a C6 entrapment neuropathy e.g. weakness of the biceps muscle or reduced biceps reflex.

92
Q

Pepperpot skull

A

hyperparathyroidism

93
Q

type I hypersensitivity

A
  • Antigen reacts with IgE bound to mast cells •

> Anaphylaxis
Atopy (e.g. asthma, eczema and hayfever)

94
Q

type II hypersensitivity

A

IgG or IgM binds to antigen on cell surface

  • Autoimmune haemolytic anaemia
  • ITP
  • Goodpasture’s syndrome
  • Pernicious anaemia
  • Acute haemolytic transfusion reactions
  • Rheumatic fever
  • Pemphigus vulgaris / bullous pemphigoid
95
Q

Type III hypersensitivity

A

Free antigen and antibody (IgG, IgA) combine

> Serum sickness
Systemic lupus erythematosus
Post-streptococcal glomerulonephritis
Extrinsic allergic alveolitis (especially acute phase)

96
Q

Type IV hypersensitivity

A

T-cell mediated

> Tuberculosis / tuberculin skin reaction
Graft versus host disease
Allergic contact dermatitis
Scabies
Extrinsic allergic alveolitis (especially chronic phase)
Multiple sclerosis
Guillain-Barre syndrome

97
Q

Type V hypersensitivity

A

Antibodies that recognise and bind to the cell surface receptors.

This either stimulating them or blocking ligand binding

> Graves’ disease
Myasthenia gravis

98
Q

encephalopathy, jaundice and coagulopathy

A

liver failure

99
Q

causes of acute liver failure

A

> paracetamol overdose
alcohol
viral hepatitis (usually A or B)
acute fatty liver of pregnancy

100
Q

features of acute liver failure

A 
>jaundice
>coagulopathy: raised prothrombin time
>hypoalbuminaemia
>hepatic encephalopathy
>renal failure is common ('hepatorenal syndrome')
101
Q

The PTH level in primary hyperparathyroidism may be…

A

normal

Finals Revision (29 decks)

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