26/05 Flashcards
1
Q
Widened QRS or arrhythmia in tricyclic overdose
A
give IV bicarbonate
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
3
Q
bilateral hilar lymphadenopathy
A
tuberculosis
4
Q
Progressively worsening headache with higher cognitive function impaired
A
urgent imaging
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
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.’
7
Q
side effects of standard heparin
A
Bleeding
Heparin-induced thrombocytopaenia (HIT)
Osteoporosis
8
Q
side effects of LMWH
A
> Bleeding
> Lower risk of HIT and osteoporosis with LMWH
9
Q
monitoring of LMWH
A
Anti-Factor Xa (although routine monitoring is not required)
10
Q
monitoring of standard heparin
A
Activated partial thromboplastin time (APTT)
11
Q
heparin overdose
A
protamine sulphate
12
Q
massive PE + hypotension
A
thrombolyse - alteplase
13
Q
persistent pyrexia of unknown origin, lymphadenopathy and high WCC
A
lymphoma
14
Q
causes of PUO
A
neoplasia
- lymphoma
- hypernephroma
- preleukaemia
- atrial myxoma
Infections
- abscess
- TB
connective tissue disorders
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
16
Q
examples of SGLT2 inhibitors
A
canagliflozin
dapaglflozin
empagliflozin
17
Q
flashers + floaters
A
posterior vitreous detachment
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
19
Q
how to differentiate between pseudogout and gout on x-ray
A
chondrocalcinosis
20
Q
acute hypophosphataemia
A
mild (∼0.64–0.80 mmol/L), moderate (∼0.32–0.64 mmol/L)
severe (<0.32 mmol/L).
21
Q
acute hypophosphataemia management
A
mild/mod= effervescent tabs
severe/symptomatic= phosphate polyfusor IV
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
23
Q
digoxin toxicity signs
A
> generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
24
Q
management of digoxin toxicity
A
- Digibind
- correct arrhythmias
- monitor potassium
25
chancroid cause
Haemophilus ducreyi
26
people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma.
> very urgent protein electrophoresis and a Bence Jones protein urine test (within 48 hours) to assess for myeloma
27
features of myeloma
> 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
28
investigations in myeloma
> 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'
29
diagnostic criteria for myeloma
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.
30
why is there hypercalcaemia in myeloma?
1ry- increased osteoclastic bone resorption
other- impaired renal function, increased renal tubular calcium reabsorption and elevated PTH-rP levels
31
management of hypercalcaemia
> 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
32
presentation of hep A
flu-like symptoms, RUQ pain, tender hepatomegaly and cholestatic LFTs
33
incubation of hep A
2-4 weeks
34
spread of hep A
Faecal-oral
35
who should get hep A vaccine
- going to endemic areas
- chronic liver disease
- haemophilia
- MSM
- IVDU
- occupational risk
36
what is NHL
lymphoma without reed stenberg cells
37
what cells are affected in NHL
B or T cells
38
NHL is ____ common than HL
NHL is much more common than HL
39
burkitts lymphoma
starry sky appearance
40
most common type of NHL
diffuse large b cell lymphoma
41
who is affected by burkitts lymphoma?
young or immunosuppressed
42
management of PR bleeds
if haemodynamically stable- supportive
43
common peroneal nerve lesion
> 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
management of haemothorax
> 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
untreated hyponatraemia
cerebral oedema
46
management of acute hyponatraemia with severe symptoms
hypertonic saline (3% NaCl)
47
diagnostic features of kawasaki
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
what is the ciliary ganglion
parasympathetic ganglion of the eye
49
anisocoria worse in bright light
inability of pupil to constrict
| parasympathetic = constriction therefore problem with parasympathetic merves
50
fragile x testes
big testes
51
most common form of prostate cancer
adenocarcinoma
52
1st line for maintenance remission in chrons
azathioprine or mercatopurine
53
management of red man syndrome
> 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
immunisations at birth
BCG if risk factors
| -Tuberculosis in the family in the past 6 months
55
2 months vaccines
> 6-1 vaccine (diptheria, tetanus, whooping cough, polio, Hib and hep B)
> oral rotavirus
> men B
56
3 months vaccine
> 6-1 vaccine
> oral rotavirus
> PCV
57
4 months vaccine
> 6-1 vaccine
| > Men B
58
12-13 months vaccine
> Hib/MenC
> MMR
> PCV
> Men B
59
2-8 years vaccine
flu vaccine (annual)
60
3-4 vaccine
4 in 1 pre-school booster (diptheria, tetanus, whooping cough, polio)
MMR
61
12-13 years vaccine
HPV
62
13-18 years vaccine
3 in 1 teenage booster (tetanus, diptheria and polio)
Men ACWY
63
scintigraphy reveals patchy uptake
toxic multinodular goitre
64
investigation of SUFE
hip x-ray
65
investigation of breech neonates
ultrasound
66
painful limp (perthes) investigation
mri
67
normal pCO2 in acute severe asthma
life-threatening
68
negative result on spirometry for asthma
refer for fractional exhaled nitric oxide testing
69
discharge and vaginal pH <4.5
candidiasis
70
AKI criteria
> 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
oesophageal cancer in GORDo
oesophageal adenocarcinoma
72
Bell's palsy is a _____ motor neuron condition. Unlike ___ conditions of the face, in ____ conditions the entire side of the patients face is affected
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
maintenance fluid calculation in children
100ml/kg for the first 10kg, 50ml/kg for the next 10kg and 20ml/kg for every subsequent kg.
74
side effects of SERM
Tamoxifen
> menstrual disturbance: vaginal bleeding, amenorrhoea
> hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
> venous thromboembolism
> endometrial cancer
75
side effects of aromatase inhibitors
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
A 2-week-old infant with a small chin, posterior displacement of the tongue and cleft palate
pierre-robin syndrome
77
Supravalvular aortic stenosis is found in a 3-year-old boy with learning difficulties
william's syndrome
78
A 9-week-old is noted to have a small chin and rocker-bottom feet
edward's syndrome
79
rocker-bottom feet without small chin
patau's
80
investigation for PSC
ERCP/MRCP
81
marfans mutation
fibrillin-1
82
Acute viral labrynthitis
sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo
83
In acute testicular pain, a unilateral swollen and retracted testicle, with loss of the cremasteric reflex, is characteristic of...
testicular torsion
84
Gestational diabetes: if the fasting plasma glucose is < 7 mmol/l a .....
trial of diet and exercise should be offered for 1-2 weeks
85
most common type of breast cancer
invasive ductal carcinoma
86
ank spon x-ray findings
subchondral erosions, sclerosis
| and squaring of lumbar vertebrae
87
Globus, hoarseness and no red flags
laryngopharyngeal reflux
88
bilateral grittiness
blepharitis
89
Complete heart block following a MI?
right coronary artery lesion
90
In suspected SBP- diagnosis ....
is by paracentesis. Confirmed by neutrophil count >250 cells/ul
91
carpal tunnel vs C6 entrapment
More proximal symptoms would be expected with a C6 entrapment neuropathy e.g. weakness of the biceps muscle or reduced biceps reflex.
92
Pepperpot skull
hyperparathyroidism
93
type I hypersensitivity
- Antigen reacts with IgE bound to mast cells •
> Anaphylaxis
> Atopy (e.g. asthma, eczema and hayfever)
94
type II hypersensitivity
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
Type III hypersensitivity
Free antigen and antibody (IgG, IgA) combine
>Serum sickness
> Systemic lupus erythematosus
> Post-streptococcal glomerulonephritis
> Extrinsic allergic alveolitis (especially acute phase)
96
Type IV hypersensitivity
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
Type V hypersensitivity
Antibodies that recognise and bind to the cell surface receptors.
This either stimulating them or blocking ligand binding
> Graves' disease
>Myasthenia gravis
98
encephalopathy, jaundice and coagulopathy
liver failure
99
causes of acute liver failure
>paracetamol overdose
>alcohol
>viral hepatitis (usually A or B)
>acute fatty liver of pregnancy
100
features of acute liver failure
```
>jaundice
>coagulopathy: raised prothrombin time
>hypoalbuminaemia
>hepatic encephalopathy
>renal failure is common ('hepatorenal syndrome')
```
101
The PTH level in primary hyperparathyroidism may be...
normal
