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Year 3 difficult topics > 30/05/22 > Flashcards

30/05/22 Flashcards

1
Q

how to look for bundle branch block?

A

look at leads v1 and v6

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2
Q

RBBB

Marrow

A

v1 - is there an M?
v6 - QRS looks normal then it is RBBB

R maRRow

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3
Q

LBBB on ECG

A

look at v1, V6
v1- is there W?
lead V6 - is there an M?
LBBB

WiLLiaM

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4
Q

causes of LBBB

A 
aortic stenosis
IHD
hyperkalaemia 
Digoxin 
MI
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5
Q

RBBB

causes?

A

M-V1
V6 usually normal

pulmonary embolism
right ventricular hypertrophy
IHD
normal variant

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6
Q

right ventricular strain pattern

A

(ST depression and T wave inversion in right ventricle and inferior leads)

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7
Q

ALS
if there are only upper motor neurone signs?
late onset

A

primary lateral sclerosis

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8
Q

bamford criteria

TACI

A

unilateral hemiparesis
dysphasia or hemispatial neglect
homonymous hemianopia

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9
Q

LACI

A

pure motor stoke
or pure sensory stroke mixed sensorimotor
ataxic hemiparesis

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10
Q

lateral medullary syndrome

A 
contraletral loss of pain sensation 
ipsilateral facial numbness 
danvah 
dysphagia 
ataxia - ipsilateral 
nystagmus - ipsi
vertigo 
horners
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11
Q

what commonly occurs after an URTI

and presents with vertigo?

A

vestibular neuritis

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12
Q

vertigo
tinnitus
hearing loss

A

labyrinthitis

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13
Q

They usually present with unilateral hearing loss and progress to involve cranial nerves 5, 6, 9, 10, and the ipsilateral cerebellum

A

acoustic neuroma

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14
Q

what antibiotic can cause DI and is used to treat SIADH?

A

demeclocycline

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15
Q

prostate cancer signs

A

blood in semen
discomfort in pelvic area
clot retention

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16
Q

prostate cancer risk factors?

A

african ethnicity
BRCA mutation
family history
increasing age

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17
Q

prostate cancer gleeson

A

1 Normal tissue, well differentiated cells that are small and uniform
2 Increased stroma between glands
3 Distinctly infiltrative margins, moderately differentiated cells
4 Irregular masses of neoplastic glands. Poorly differentiated
5 Occasional gland formation seen. Very poorly differentiated

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18
Q

symptomatic mx of prostate cancer

A

GnRH analogues -
goserelin
leuprolide

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19
Q

androgen antagonists -

A

Bicalutamide and Enzalutamide

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20
Q

Degarelix

A

GnRH antagonists

prostate cancer

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21
Q

hypotension and tachycardia post MI PCi with a pansystolic murmur
mx?

A

mitral regurgitation- needs valve repair or replacement

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22
Q

t2n0m0 renal carcinoma management?

A

radical nephrectomy

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23
Q

hallmark diagnostic test for GBS?

A

lumbar puncture

albuminocytologic dissociation - raised protein with a normal white cell count

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24
Q

which antibodies are present with GBS?

A

antiganglioside antibodies

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25
Q

A sigmoid colectomy

Hartmann’s procedure

A

emergency surgery - obstruction , toxic megacolon, perforation

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26
Q

Panproctocolectomy indications

A

Typically carried out as an elective procedure in medically-refractory ulcerative colitis. The patient will have a permanent end ileostomy.

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27
Q

large-right sided pleural effusion
Pleural fluid protein: 29 g/L

Pleural fluid protein : serum protein ratio 0.78

Pleural fluid LDH : serum LDH ratio 0.81

worsening sob and decrease in exercise tolerance but no other symptoms?

A

malignancy cause of pleural effusion must be considered

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28
Q

pseudogout mx?

A

naproxen

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29
Q

beta thalassaemia major

features

A

microcytic anaemia
HBa2 and HBf raised
HbA absent

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30
Q

management of beta thalaseamia major

A

repeat transfusion

iron overload > iron chelation therapy- desferrioaxamine

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31
Q

ototoxicity causes?

A

gentamicin
vancomycin
loop diuertics

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32
Q

thromboangitis obliterans - buergers

A 
strong association with smoking
> intermittent caudication
> raynauds 
> ulcers 
>superficial thombophlebitis
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33
Q

xray findings of ankylosing spondylitis

A

subchondral erosions
sclerosis
squaring of lumbar vertebrae

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34
Q

subchondral cysts and osteophyte formation at joint margins

A

osteoarthritis

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35
Q

periarticular erosions

juxta-articular osteopenia

A

RA

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36
Q

does of adrenaline in anaphylaxis?

how soon can you give a second dose?

A

IM adrenaline 500mcg
0.5ml 1 in 1000

5 mins

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37
Q

what measures anaphylaxis acutely?

A

serum tryptase

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38
Q

if patient has pneumonia 2 days after being in hospital what indicates aspiration > HAP?

A

risk factors- neuro injury, feeding tube and tracheostomy
right base of pneumonia indicates aspiration as the anatomy of tract makes it more likely to fall down straighter right main bronchi

apyrexia also indicates aspiration

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39
Q

recurrent episode of pseudomonas coilitus
but stable patient
if within 12 weeks of vancomycin

A

fidaxomin

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40
Q

when is Faecal microbiota transplant used in c diff infection

A

2 or more previous episodes

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41
Q

familial hypercholesterolaemia
which gene
what inheritance pattern
how does it present?

A

LDL is mutated

automsomal dominant

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42
Q

what is the extrinsic pathway?
and how does it correlate to clotting screen ?
which common drug targets the extrinsic pathway
what would be the clotting screen results here?

A

,VII TF
this is measured by the prothrombin time
warfarin

PT ABNORMAL APTT normal

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43
Q

mechanism of warfarin

A

inhibits carboxylation of 1972

factor 10
factor 9
factor 7
and factor 2

and protein c

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44
Q

warfarin INR target after a recurrent VTE?

A

3.5

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45
Q

warfarin INR in VTE

A

2.5

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46
Q

atrial fibrillation target warfin inr?

A

2.5

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47
Q

what is a common side effect pf thiazide diuretics affecting big toe?

A

gout

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48
Q

root canal surgery prophylaxis NICE guidelines?

A

no treatment

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49
Q

TIPS connects which two vessels

A

hepatic vein and portal vein \
although can connect the portal vein to the IVC. It aims to treat portal hypertension by making route for blood to flow from the portal circulation to the systemic circulation, bypassing the liver

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50
Q

unfractionated heparin reversal?

A

protamine sulphate

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51
Q

dabitran - direct thrombin inhibitor
if bleeding and want to reverse?

contra

A

Idarucizumab

Doses should be reduced in chronic kidney disease and dabigatran should not be prescribed if the creatinine clearance is < 30 ml/min

52
Q

blood film results resemble stack of coins
what condition?

hb low
calcium high
urea and creatinine high

A

multiple myeloma shows rouleaux fomration

53
Q

Offer platelet transfusions to patients with a platelet count of <30 x 10 9 with clinically significant bleeding

A

prolonged epistaxis
melaena
haematemesis

54
Q

platelet transfusion

A

Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia, or
Thrombotic thrombocytopenic purpura.

55
Q

Thiazides SE

A

HyperGLUC

  • hyperGlycemia
  • hyperLipidemia
  • hyperUricemia
  • hyperCalcemia
56
Q

empyema pleural fluid results

A

low ph <7.2
HIGHHHH LDH
low glucose

57
Q

poor prognosis in hodgekins lymphoma

A

signs of poor prognosis: B-symptoms, increasing age, male sex, stage IV disease and lymphocyte depleted subtype

58
Q

zollinger elison syndrome presents with?

what is associated with- genetic condition?

A

gastrinoma - bening growth of pancreas
high levels of gastrin and high levels of acid so you get erosion of stomach
so leads to ulceration

59
Q

curling ulcers

A

ischaemia or hypervolaemia

60
Q

how does a hiatus hernia present?

A

asymptomatic
GORD worse when lying flat
plapitations or hiccups indicate pericardial irritation

61
Q

Hiatus hernia

gold standard

A

barium swallow is the most sensitive test

given the nature of the symptoms many patients have an endoscopy first-line, with a hiatus hernia being found incidentally

62
Q

what is the most common form of hiatus hernia

what is the more serious concerning hiatus hernia?

A

sliding with GORd

rolling hernia as it can result in volvulus and ischaemia

63
Q

Barrets oesophagus what cells changes after metaplasia?

A

squamous epithelium to columnar epithelium

64
Q

gold standard for barrets

A

upper GI endoscopy with biopsy

65
Q

what does barrest oesophagus risk a progression into?

A

oesophageal adenocarcinoma

66
Q

what type of oesopahgeal cancer is most common

A

Squamous cell carcinoma is the most prevalent esophageal cancer worldwide

67
Q

Patients with low-grade dysplasia

Barrett’s oesophagus

A

high dose PPI and followed up with endoscopic surveillance at six monthly intervals

68
Q

Patients with high-grade dysplasia - barrets

A

Patients with high-grade dysplasia or early adenocarcinoma usually undergo endoscopic resection of the abnormal areas; methods include radiofrequency ablation, photodynamic ablation, or laser. Patients who are fit for surgery may undergo oesophagectomy.

69
Q

squamous cell cancer of oesophagus risk factors

A

alcohol smoking
strictures
achalasia
nitrosamines

70
Q

gastric cancer aetiology

RF

A

2 types intestinal - H pylori associated
diffuse : e -cadherin

RF
pernicious anaemia 
H pylori 
nitrosamine 
smoking 
high salt/low vit C blood type A
71
Q

gastric cancer presentation

A

vague epigastric abdo pain
weight loss
lymphadenopathy

72
Q

gastric cancer lymphadenopathy where?

A

Virchows node - palpable in neck

sister mary joseph nodule - gastric ublicus

73
Q

krukenburg tumour

A

bilaterally on ovaries which is a met of gastric cancer

74
Q

herpes simplex keratitis

what is it

A

painful
watering
light sensitive red eye
It most commonly presents in adult men many years after primary infection with the herpes simplex virus, where the virus lays dormant in the trigeminal nerve

75
Q

On examination, the cornea
is injected and examination under cobalt-blue light after the instillation of fluorescein, reveals a branch-like corneal lesion.

what is this pathogenomic for?

A

herpes simplex keratitis

76
Q

management of herpes simplex keratitis

A

Herpes simplex keratitis is treated with topical aciclovir until the ulcer has healed. There is a risk of corneal scarring and blindness so this condition warrants urgent ophthalmological assessment. Steroids are contraindicated as immuno- suppression can lead to increased viral replication and the formation of a larger ulcer

77
Q

MEN i

A

MEN type I (Wermer syndrome) includes the presence of

para- thyroid adenomas,
pancreatic islet-cell tumours
pituitary adenomas

so central?

78
Q

MEN type IIa

A

parathyroid adenomas,
medullary carcinoma of the thyroid
phaeochromocytoma

79
Q

MEN type III

A

presence of the tumours of MEN type IIa but with the addition of multiple mucosal neuromas of the gastrointestinal tract and a marfanoid phenotype

80
Q

histology of coeliac disease?

A

villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia

81
Q

abdominal pain
bloating and change in bowel habits
what condition most likely

A

Abdominal pain, Bloating and Change in bowel habit are classic features of irritable bowel syndrome

82
Q

what abx given for SBP?

neutrophil count >250?

A

ciprofloxacin

83
Q

what is used to induce remission in CROHNs?

A

prednisolone 300mg

300mg prednisolone. This can be done alongside a polymeric diet, which is especially successful in younger children

84
Q

what drug is used to induce remission in UC

A

Mesalazine is an aminosalicylate and can be trialled to induce remission on failure of steroids. Aminosalicylates are generally first-line for reducing remission in ulcerative colitis

85
Q

how does a transjugular intraheptic portosystemic shunt cause hepatic encephalopathy

A

Transjugular Intrahepatic Portosystemic Shunt causes blood from the portal system to bypass the liver and enter the systemic circulation without the metabolism of nitrogenous waste products such as ammonia. As these build up in the systemic circulation, increased ammonia is able to cross the blood brain barrier resulting in hepatic encephalopathy. Hence, Transjugular Intrahepatic Portosystemic Shunt can precipitate hepatic encephalopathy due to inadequate metabolism of nitrogenous waste products by the liver

86
Q

patient has pin point eyes and reduced respiratory rate how should you manage assuming haemodynamically stable

A

naloxone boluses 0.8-2mg IV every 2 mins

aiming for gcs 13-14

87
Q

Drugs that are known to potentiate the action of warfarin

A

antibiotics (including erythromycin), thyroxine, alcohol, antidepressants, aspirin, amioderone and quinine.

88
Q

if INR is raised and there is associated active bleeding, what shouold you do?

A

oral / IV vit K
prothrombin complex concentrate II, VII,IX and X
if not available FFP

89
Q

in thalassaemia trait if a patient has microcytic hypochromic anaemia how should you treat

how does thalassaemia trait present on electrophresis

A

no treatment needed

a2 increased on electrophoresis
normal ferritin and serum iron

90
Q

Mx of HIV

A

<200 cells/mm3 is when AIDs becomes likely
HAART should be started, typically involving two nucleoside analogue reverse transcriptase inhibitors (NRTIs), such as zidovudine and didanosine, and one of either a protease inhibitor such as indinavir or a

91
Q

Mx of HIV what is in HAART

A

2 nucleoside analogue reverse transcriptase inhibitors

and 1 of protease inhibitor/ non-nucleoside reverse transcriptase inhibitor

92
Q

non-nucleoside reverse transcriptase inhibitor

A

efavirenz

93
Q

zidovudine and didanosine examples of?

A

nucleoside analogue reverse transcriptase inhibitors (NRTIs)

94
Q

protease inhibitor example

A

indinavir

95
Q

what is a scleroderma renal crisis

A

fibrinoid thickening
and vessel narrowing

affects afferent arterioles causing a renal hypoperfusion

96
Q

management of asthma- life threatening
what is not used in acute management

A High-flow oxygen
B High-dose nebulised beta-2 agonists C Intravenous magnesium sulphate
D Leukotriene receptor antagonists
E Steroids

A

D. Leukotriene receptor antagonists

97
Q

rheumatic fever signs?

mx?

A 
fever 
swollen red tongue 
rash on trunk 
pan systolic murmur loudest at apex 
CRP elevated
98
Q

if SBP is suspected what is the next measure?

A

ascitic tap in 8 hours

99
Q

thyroid crisis mx?

what is the role of steroids in this?

A

high dose anti thyroid meds
potassium iodide
beta blockers and high dose steroids which block t4>t3

100
Q

what are the bony hand swellings in osteoarthritis called?

A

bouchards

heberdens

101
Q

what is the surgical management of osteoarthritis?

A

Joint replacement (arthroplasty) may be required in severe cases (providing that they are fit enough for the procedure). It usually provides excellent pain relief, but will not improve the function of the joint

102
Q

SLE and RA pleural effusion is it transudate or exudate?

what would the complement level be

A

exudate
raised ANA
and low complement

103
Q

if septic arthritis suspected in a knee that has undergone knee replacement surgery ?

A

prostehtic joints should be admitted and urgently reviewed by ortho

104
Q

malignant hypertension defn?

A

fibrinoid necrosis affecting small blood vessels
BP over 180/120 and symptomatic
end organ damage - intracranial haemorrhage > raised ICP and aortic dissection and AKI

105
Q

malignant hypertension management ?

A

controlled drop in bp 160/100 over 24 hours

oral drugs preffered ccb - nifedipine

106
Q

subdural haemorrhage surgical mx?

A

burr hole

107
Q

subarachnoid haemorrhage surgical mx options?

A

endovascular coiling

surgical clipping

108
Q

pattern of bleeding in haemophilia?

A

deep bruising into muscles

109
Q

pattern of bleeding in VWF?

A

light bleeds - nose bleeds etc

110
Q

polyarteritis nodosa

features?

A

skin lesions- ulcverate
orchitis
systemic upset
necrotising medium vessel non granuloma vascultis

hep b association

111
Q

lhermitte sign?

A

pain on neck flexion - cervical spondylosis

112
Q

management of osetomyelitis

A

flucloxacillin 6 weeks

clindamycin in penincillin allergic

113
Q

osteomyelitis causes?

A

Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate

114
Q

osteoporosis

A 
S – Steroid use
H – Hyperthyroidism, hyperparathyroidism
A – Alcohol and smoking
T – Thin (BMI<22)
T – Testosterone deficiency
E – Early menopause
R – Renal/liver failure
E – Erosive/inflammatory bone disease
D – Diabetes
FAMILY HISTORY
115
Q

side effects of corticosteroids

A 
CORTICOSTEROID
Cushing's syndrome
Osteoporosis
Retardation of growth
Thin skin, easy bruising
Immunosuppression
Cataracts and glaucoma
Oedema
Suppression of HPA axis
Teratogenic
Emotional disturbance (including psychosis
Rise in BP
Obesity (truncal)
Increased hair growth (hirsutism)
Diabetes mellitus
Striae
116
Q

felt syndrome?

A

highly active rheumatoid arthritis (often with extrarticular disease), splenomegaly and neutropenia

117
Q

severity score fo RA?

A

das28 score

crp /esr

118
Q

when are DMARDs indicated for RA?

A

das28 is >5.1

eg methotrexate, sulfasalazine, hydroxychloroquine and leflunomide

119
Q

what biologic is used for RA

A

infliximab anti-tnf

120
Q

in renal failure what is the pattern of
ca2+
phosphate
PTH

A

ca2+ is low
vit D is low
phosphate is high - due to failure of excretion
pth is high

121
Q

Biochemical and radiological findings

Typical findings in osteomalacia

A 
↓Calcium
↓Phosphate
↑ALP
↑Parathyroid hormone
X-rays: Looser lines (or zones) which are lucencies going part of the way through the bone
122
Q

vancomycin provides?

A

gram positive cover

123
Q

gentamicin ?

A

gram negative cover

124
Q

nephrotic syndrome ascitic albumin gradient

A

gives rise to a low saag due to loss of albumin in urine - resulting in low serum albumin ration

125
Q

SAAG less than 11?

A

exudative
peritoneal mass
infection
pancreatitis

Year 3 difficult topics (22 decks)

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