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3A/3B Deck Flashcards

1
Q

Wet, Wacky, Wobbly?

A

Normal Pressure Hydrocephalus

  • Urinary incontinence
  • Dementia
  • Gait disturbance
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2
Q

Normal Pressure Hydrocephalus

A

Wet, Wacky, Wobbly:

  • Urinary incontinence
  • Dementia
  • Gait disturbance
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3
Q

Delirium Causes

A

PINCH ME
Pain

Infection / intoxication:
UTI, pneumonia, sepsis, meningitis, encephalitis, malaria

Nutrition
Vitamin deficiency - Thiamine, nicotinic acid, B12/Folate

Constipation

Hypoxia / hydration

Medication / drugs / substance abuse
Benzodiazepines, anticholinergics, anaesthetics, opiates, anticonvulsants, alcohol

Environmental

Others:
Surgical post op
Vascular -Stroke, HF, SAH, SDH, vasculitis, migraines
Metabolic - Hypoxia, electrolyte imbalance, renal/hepatic impairment, hypoglycaemia
Endocrine pathology -Hypo/hyperthyroid, Cushings, porphyria
Head trauma
Epilepsy

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4
Q

Osteoporosis risk factors

A 
SHATTERED
Steroids 
hyperthyroidism, hyperparathyroid, hypocalcaemia 
Alcohol / tobacco 
Thin 
Testosterone - low 
Early menopause - oestrogen deficiency 
Renal / liver disease
Erosive / IBD
Dietary intake - low Calcium / T1DM
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5
Q

Tonsilitis Tx

A

Symptomatic - paracetamol

Abx - Penicillin

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6
Q

Otitis Media Tx

A

Pain relief

Abx - amoxicillin

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7
Q

Sinusitis

A

98% viral - self limiting
Often secondary bacterial infection - (SAME ORGANISMS as OM)
Abx - amoxicillin

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8
Q

Croup Tx

A

Oral Dexamethasone +/- ABC+Oxygen +/- nebulised adrenaline

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9
Q

Acute epiglottitis Tx + organism

A

Haemophilus influenza tybe B

Intubation
Possible tracheostomy
Cefotaxime

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10
Q

Whooping Cough Tx + Organism

School leave?

A

Bordatella Pertussis
Azithromycin / clarithromycin / erythromycin

48hrs after Abx start - Abx do not alter course of disease - just infectivity

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11
Q

Pneumonia Tx

A

Amoxicillin
OR: clarithromycin, co-amoxiclav, azithromycin
Drainage of empyema - if unwell after period of improvement

Infants - GBS
Kids - Strep. Pneu / H.Influ / TB

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12
Q

ToF Features

A 
PROVE
Pulmonary stenosis 
RV Hypertrophy 
Overriding Aorta 
VSD
Ejection systolic murmur
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13
Q

Infective endocarditis Tx

A

BLIND - after 3 cultures - Benpen + gentamicin

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14
Q

Rheumatic Fever Tx + Organism

Diagnostic Criteria?

A 
Group A B-haemolytic Strep - PYOGENES
JONES criteria - 2major / 1major+2minor - (JONES PEACE)
Joints - large joint arthritis 
O - carditis 
N - nodules - painless + subcutaneous 
E - erythema marginatum 
S - syndenham's chorea

P - PR interval prolongation 
E - ESR v raised
A - arthralgia 
C - CRP raised 
E - elevated temp

Aspirin
Benpen - help strep throat
Prednisolone - for Syndenhams chorea (consider haloperidol)

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15
Q

Measles Organism + features

A

Paramyxovirus - RNA morbillivirus
4C’s - cough, coryza, conjunctivitis, Cranky
Koplik spots
RASH

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16
Q

Scarlet Fever Tx

A

Penicillin + azithromycin

Ibuprofen + paracetamol

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17
Q

Imetigo Tx

A

Fusidic acid + oral flucloxacillin

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18
Q

Complications of meningitis

A 
SHAPD
Sepsis 
Hydrocephalus / encephalitis
Abcess
Paralysis
Deafness - serineuonal hearing loss - MOST COMMON
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19
Q

Toxic shock syndrome Tx + Organisms

A

Toxin = producing s.aureus + group A strep

Clindamycin + ceftriaxone

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20
Q

Complications of preterm?

A

Heads - intraventricular haemorrhage, hypoxic ischaemic damage
Hearts - Patent ductus
and Lungs - respiratory distress syndrome
and Guts - NEC
and Retinitis drives me nuts!

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21
Q

TB Tx?

A 
RIPE
Rifampicin 
Isoniazide 
pyrazinomaide 
Ethambutol
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22
Q

5 stages of chemo

A 
Induction 
Consolidation 
Interim Maintenance 
Delayed intensification 
Maintenance
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23
Q

Histo finding of dermoid cyst?

A

Rokitansky’s protuberance

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24
Q

Signs of shock?

A 
I-SHOCKS
Increased RR
Sinus Tachycardia
hypotension 
Oliguria 
Cold 
Klammy 
Slow capillary refill
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25
Q

SIRS criteria

A 
3 T's white with sugar:
-Tachycardia
Tachypnoea 
Temp (low or high)
WBC low or high
Sugar >7.7 - in absence of DM
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26
Q

Depression symptoms?

A 
DEADSWAMP
Depression 
Energy low 
Anhedonia 
Death thoughts

Sleep disturbance (insomnia / early morning waking)
Worthlessness/Guilt
Appetite / Weight change
Mentation change - lack of concentration
Psychomotor retardation / agitation

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27
Q

Who should you tell about a never event?

A

NRLS + StEIS

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28
Q

Key Wernicke’s / Korsakoff features?

A

werNICkes
Nystagmus
Incoordination / ataxia
Confusion - i.e. delirium

KorSAKoffs

  • pSychosis
  • Anterograde amnesia + hallucinations (lilliputlin / formication)
  • (K)Confabulation
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29
Q

Cerebellar signs?

A 
DANISH:
Dysdiadochokinesia
Ataxia 
Nystagmus 
Intention tremor
Slurred staccato speech 
Hypotonia
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30
Q

Vasculitis screen? 5 domains

A

[FUEL CAB]

FBC - think EOSINOPHILS (churg-strauss)
Urine
ESR/CRP
Liver - clotting

CXR / CT pulmonary
ANCA
Biopsy

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31
Q

Post vasculitis screen - further Ix

A

[EM…III]

EMG - neuropathy
Myeloma screen

Imaging - MRI, PET
Infection - sepsis, HepB (in PAN)
Imunology - RF/ACCP, ANCA, ANA, dsDNA

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32
Q

FRAX - mad formation

A

3-3-3-2
[estimate of 10 year fracture risk with low BMD)

3 person - Age, sex, BMI
3 fracture - previous?, parent hip fracture, low femoral neck BMD
3 put in - Alcohol, smoking, glucocorticoids
2 conditions - RA, secondary osteoporosis

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33
Q

How to tell #NOF on X-ray

A

Shenton’s line broken

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34
Q

Secondary risk factors of osteoporosis?

A

SHATTERED

Steroids + Cushings
H - HyperTh, hyperPTh, Hypercalciuria
A - Alcohol + tobacco
T - thin (BMI<19)
T - testosterone decreased - primary hypogonadism / anti-androgens
E - Early menopause (<45)
R - renal/liver function - chronic liver disease/ renal osteodystrophy in CKD
E - erosive/inflam disease - RA, myeloma, mets
D - diet - Ca/T1DM, malabsorption, malnutrition

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35
Q

Common sites for osteoprotic #

A

Sheffield Wednesday Protects Hillsborough

Spine - crush
Wrist - distal radius
Pelvis
Hip

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36
Q

What’s covered in bony profile bloods?

A 
Ca
Vit D
Phos
PTH
ALP
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37
Q

XR OA?

A 
LOSS
loss of joint space
osteophytes 
subchondral/subarticular sclerosis
subchondral cysts
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38
Q

XR RA?

A 
LESS
Loss of joint space 
Erosions 
Softening of bones (periarticular osteopenia)
Soft tissue swelling
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39
Q

Common co-infection with polyarteritis nodosa?

A

Hep B

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40
Q

Pres of SLE?

A

Criteria + systemic: fatigue, fever, weight loss, lymphadenopathy

4/11 of DOPAMINE RASH:

  • Discoid rash
  • Oral ulcers - usually painless
  • photosensitive rash - skin rash from sunlight
  • Arthritis - deforming BUT non-erosive 2+ joints (similar deformities to RA)
  • Malar Rash
  • Immunological phenomena - dsDNA, anti-smith
  • Neuro symps - seizures/psychosis/autonomic disorder/headache - literally anything
  • ESR raised (*NOT CRP) + LOW COMPLEMENT
  • Renal disorder - proteinuria >0.5g/day or +++ (lupus nephritis)
  • ANA +ve
  • Serositis - pleuritis (pleural rub on ausc or pleural effusion) / pericarditis (ECG, pericardial rub)
  • Haematological - haemolytic anaemia (Coombs +ve), Neutropenia, thrombocytopenia, lymphopenia
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41
Q

Reiter’s syndrome

A

Can’t see (uveitis)
Can’t pee (urethritis)
Can’t climb a tree (arthritis)

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42
Q

Associations with ankylosing spondylitis?

A

The 6 A’s:

Apical Lung Fibrosis
Anterior uveitis
Aortic regurg
Achilles tendonitis 
Aortic incompetence - dissection/regurg
Amyloidosis
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43
Q

Muscle blood tests/screen?

A

CK
LDH
Aldolase

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44
Q

Signs of compartment syndrome?

A

6 P’s!!!

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45
Q

Kawasaki’s age + symptoms?

Major complication?

A

6months-5years
CRASH and BURN (MyHEART as well ;) )

Conjunctivitis (bilateral + non-purulent)
Rash - non-vesicular
Adenopathy (cervical + unilateral)
Strawberry tongue + inflammation of mouth + lips (cracked lips)
Hands/feet - palmer erythema/swelling/desquamation (2-5days after onset)

Fever > 5days (BURN)

Comp - coronary artery aneurysm!! (do ECHO) –> deaths+signif. morbidity

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46
Q

Red Flags of Back pain?

A

TUNA FISH:
Trauma
Unexpected weight loss/loss of appetite
Neuro symps - CAUDA EQUINA
Age: >50 , <20
Fever/night sweats - osteomyelitis/cancer
Immunosuppression/IVDU - osteomyelitis
Steroid use - immunocomprimise/osteoporotic #
History of cancer: Prostate, breast, lung, renal

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47
Q

Felty syndrome

A 
SANTA:
Splenomegaly
Anaemia
Neutropenia - low WCC
Thrombocytopenia 
Arthritis - RA

(also leg ulcers + brown pigmentation of legs)

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48
Q

ECG of RBBB vs LBBB (v basically)

A

Broad QRS > 0.12ms

MarroW - RBBB
V1 - rSR’
V6 - deep wide slurred S

WilliaM - LBBB
V1 - rS - deep S wave
V6 - Broad R (may look like m) + absent Q waves

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49
Q

Digoxin drug interations? - i.e. induce toxicity

A

SAC those drugs, if you’re gonna use them with digoxin you must be LOOPY

S - spironalactone
A - amiodarone
C - CCB

LOOPY - loop diuretics/thiazides - hypokalaemia - toxicity

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50
Q

X-ray signs of HF?

A 
ABCDE:
alveolar oedema 
Kerley B-lines
cardiomegaly
dilated pulmonary vessels
effusion
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51
Q

Infective endocarditis:
Most common symps?
Signs

A

*Most common - fever, chills, weight loss, poor appetite

FROM JANE:
Fever>38 + tachycardia
Roth spots - eyes, retinal haemorrhage with pale centre
Osler’s nodes - painful red blisters @ terminal phalanges + toes
Murmur - tricuspid w/ s.aureus

Janeway lesions - painless red maculae on thenar eminence
Anaemia/arthritis: subacute - >3 joints (asymmetrical). acute: 1 joint septic
Nail splinter haemorrhages
Embolic phenomena - e.g. stroke

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52
Q

Given post-MI (not acute)

A

ABSeeD

ACE-I
BB
Statin
Dual antiplatelet - aspirin, clopidogrel

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53
Q

Complication of MI

A 
DEPARTS + Fail
Death, dresslers 
Electrical activity - arrhythmias - tachy/brady 
Pericarditis (acute), papillary muscle rupture 
Aneurysm --> persistent ST elevation 
Re-MI / rupture - tamponade 
Thrombus
Shock - cardiogenic

Heart Failure - pulmonary oedema –> give B-BLOCKER! - bisoprolol

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54
Q

What is beck’s triad?

A

Cardiac tamponade:

  • Decreased heart sounds
  • distended jugular veins
  • decreased arterial blood pressure
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55
Q

Triad in cardiac tamponade?

A

Beck’s triad:

  • Decreased heart sounds
  • distended jugular veins
  • decreased arterial blood pressure
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56
Q

Key signs of sepsis? (score)

A 
SOFA score (2+ is not good)
HAT:
Hypotension < 100
Altered mental state GCS<15
Tachypnoea >=22
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57
Q

Normal CAP / HAP pneumonia organisms?

A

CAP:
S.pneumoniae, H.Influenza (*esp in COPD)

HAP:
(Gram-ve bacilli)
E.coli, klebsiella, pseudomonas aeruginosa, MRSA

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58
Q

Atypical CAP organisms?

A

Mycoplasm pneumonia - common in young adults
Legionella pneumonia - air con!
Chlamydia pneumoniae
Chlamydia psitacci - bird fanciers

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59
Q

Mx of TB?

A

RIPE DOTS:
Rifampicin 6M - liver tox, orange secretions
Isoniazid 6M - liver tox, peripheral neuropathy
Pyrazinamide 2M - liver tox, hepatitis
Ethambutol 2M - visual disturbance, optic neuritis

DOTS - directly observed therapy 3x/week

Check LFTs before
Check vision with Snellen

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60
Q

O/E of pulmonary fibrosis?

A 
4 D's: 
Digital clubbing 
Dry cough 
Dyspnoea 
Diffuse inspiratory crackles
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61
Q

Upper vs Lower lung fibrosis diseases/causes?

A 
Upper - ESCHART (granulomatous disease)
Extrinsic allergic alveolitis 
Sarcoidosis/silicosis
Coal worker's pneumoconiosis
Histiocytosis X
Ankylosing spondylitis 
Radiotherapy
TB

Lower - RASCO (systemic disease)
RA
Asbestosis 
Systemic sclerosis/SLE
Cryptogenic fibrosing alveolitis
Other (drugs) - amiodarone, methotrexate, bleomycin
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62
Q

Causes of BHL (bilateral hilar lymphadenopathy)

A 
TIMES
TB
Inorganic dust - Silicosis
Malignancy - carcinoma, lymphoma, mediastinal
EAA
Sarcoidosis
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63
Q

Red flags for dyspepsia?

A

Weight loss, recurrent vomiting, dysphagia, chronic bleeding

ALARMS:
Anaemia, Loss of wt, Anorexia, Recent onset (if >55), Melaena, swallowing difficulty

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64
Q

H pylori mx?

A

PAM/PAC:

PPI + amox + metron/clarith

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65
Q

Antibodies in CD / UC?

A

UC - pANCA

CD - ASCA

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66
Q

Types (+examples) of laxatives? 4 types!

A

Bulk forming - increase faecal mass, improve peristalsis - e.g. isphagula husk

Stool softener - for impacted faeces - e.g. docusate

Stimulant - increase motility - e.g. senna

Osmotic - retain water in bowel - e.g. lactulose

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67
Q

Foods containing copper (i.e. to avoid in Wilson’s)

A

Chocolate
nuts
mushrooms
liver

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68
Q

Drugs affecting liver/hepatotoxic?

A

Paracetamol
Alcohol
Meds: Ciproflox, Methotrexate, Amox, flucolox, diclofenac

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69
Q

Signs of chronic liver disease?

A 
FLAPSS
Finger clubbing
Leukonychia 
Asterixis (liver flap)
Palmar erythema 
Shifting dullness
Spider naevi/scratch marks (pruritis)

Bleeding
(+ caput medusae)

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70
Q

Alcoholic Hepatitis triad?

A

Fever
Mallory bodies
Steatosis

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71
Q

Hepatitis B serology?

A 
Surface antigen (HBsAg) – active infection
E antigen (HBeAg) – marker of viral replication and implies high infectivity

Core antibodies (HBcAb) – implies past or current infection - IgM (current), IgG (past infection)
Surface antibody (HBsAb) – implies vaccination or past or current infection
E antibody (HBeAb) = immune response

Hepatitis B virus DNA (HBV DNA) – this is a direct count of the viral load

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72
Q

Causes of acute pancreatitis?

A 
GET SMASHED 
Gallstones 
Ethanol (alcohol)
Trauma 
Scorpions 
mumps
AI
Steroids 
Hyperlipidaemia/hypothermia/hypercalcaemia
ERCP
Drugs
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73
Q

Score for pacreatitis severity? (also good for remembering some Ix)

A 
Glasgow score
PANCREAS
PaO2 < 8kPa (remember sepsis+pancreatitis = main cause of ARDS)
Age > 55
Neutrophillia (WCC>15)
Calcium <2mmol/L
Renal, urea >16mmol/L
Enzymes:
-AST/ALT >200units
-Albumin <32g/L
-Sugar > 10mmol/L
74
Q

Retroperitoneal structures?

A 
SADPUCKER
SVC
Aorta/IVC
Duodenum (2+3)
Pancreas
Ureters
Colon
Kidneys
Esophagus 
Rectum
75
Q

Who gets gallstones?

A

Fair, fat, female, fertile, forty, family history

76
Q

Antibodies of PSC / PBC?

A

p-ANCA - PSC - primary sclerosing cholangitis

AMA - PBC - primary billiary cirrhosis

77
Q

Management of Hep B / Hep C

A

Pegylated interferon alpha

Hep B - tenofovir (2nd line)

Hep C - ribavarin w/ interferon

78
Q

What causes activation of RAAS (i.e. release of renin) - where exactly??

A

Reduced perfusion to afferent arteriole –> juxtaglomerular apparatus

79
Q

Nephrotoxic drugs?

A 
CANT DAMAG
Contrast
Antibiotics (penicillin/ceph)
NSAIDs
Trimethoprim
Diuretics
ACE-I
Metformin
ARBs
gentamicin!!!!
80
Q

Indications for dialysis in severe AKI?

A

AEIOU (VOWELS)
Acidosis (severe + unresponsive to treatment)
Electrolyte imbalance (Hyperkalaemia + not responding to treatment)
Intoxication (overdose of certain meds)
Oedema (severe and unresponsive pulmonary oedema)
Uraemia (seizures + reduced consciousness)

81
Q

Why potential hyperglycaemia in peritoneal dialysis?

Other complications?

A

As dialysate = dextrose

Infection - peritonitis
Blockage/infection/leak of catheter 
Fluid retention/weight gain
Constipation
Hernia
82
Q

Nephritic vs Nephrotic BASICS?

A

Nephritic: - PROLIFERATIVE
HTN –> glomerular inflam –> oliguria
Haemturia - Dark urine - like coca-cola
Main cause - IgA Berger’s disease

Nephrotic: - NON_PROLIFERATIVE
Main cause - FSG (focal segmental glomerular nephritis) [also main cause of glomerularnephrtitis in general]
Triad:
Hypoalbuminaemia 
Proteinuria 
Oedema
(hyperlipidaemia)
83
Q

Management of mod-severe Glomerulonephritis? (haematuria, proteinuria, low GFR)

If nephrotic?

A

FAAP
Furosemide, ACE-I/ARB, ABx, Pred

nephrotic - immunosuppressant - cyclophosphamide

84
Q

PKD characteristics?

A

Renal + extra-renal cysts
Intracranial aneurysms

(aortic root dilatation and aneurysms)

85
Q

BPH symptoms? (urinary symptoms in general really)

A

Storage symptoms [FUN]
Frequency, urgency, nocturia

Voiding symptoms [HIIPP]
hesitency, intermittent/incomplete emptying, poor flow /post-void dribbling

86
Q

Very low risk prostate cancer scores (PSA + gleason + T-score)?

A

PSA<10
Gleason =< 6
T1/T2

87
Q

Opioids in kidney disease? Why not morphine/codeine?

A

tramadol + oxycodone

Morphine + codeine = accumulate in kidney disease

88
Q

AKI - define

A

Rise in serum creatinine of 26+ µmol/L in 48 hours.

=>50% rise in serum creatinine in last 7 days

A drop in urine output to 0.5 ml/kg/hour for:

  • 6 hours in adults
  • 8 hours in children and young people
89
Q

Acute COPD exacerbation?

A 
SHONA
Steroids - oral pred
Heparin
Oxygen (88-92%)
Neb bronchodilators - SABA+SAMA (Salbutamol + Ipratropium)
Abx
90
Q

Foods that contain oxalate?

A

Chocolate
Tea
Nuts

91
Q

Testicular swellings?

  1. Separate and cystic?
  2. Separate and solid?
  3. Testicular and cystic?
  4. Testicular and solid?
  5. Can’t get above?
A

Epidydimal cyst

Epididymitis / varicocele

Hydrocele

Tumour/orchitis

Inguinal hernia

92
Q

Testie torsion pres? Mx?

Ddx?

A

TENDER, SWOLLEN, RED, HOT, HIGH, TRANSVERSE LIE
Absent cremasteric reflex
N+V

Mx:
orchidectomy + bilateral fixation

Ddx:
Testie appendix torsion (hydatid of morgagni)
Epididymo-orchitis

93
Q

Testicular Ca Ix?

A

BALUC (like bollock)
B-hCG -
AFP
LDH

USS

CT abdo pelvis - LNs

94
Q

Psychological therapies (for psych)?

A

Primary care:
Counselling
Psychoeducation (group/individual)
CBT

Secondary care:
Group therapy
Family therapy 
Psychoanalytic psychotherapy
Referral to CMHT
95
Q

Examples for Bio-Psych-Social managment approach in psych?

A

Bio - DRUGS
Psych - CBT, Psychoeducation, Counselling, Group therapy
Social - Support (family/carer), Work/Education, Support with engagement/benefits

96
Q

Clinical features of Dementia? (4 A’s)

A

Aphasia
Apraxia
Agnosia
Amnesia - anterograde (can’t create new memories)

97
Q

First rank schneiderlain symptoms (schiz)

A

PETER TAKES DINNER HOME

Passivity phenoma
Thought disorder
Delusional perception
Hallucinations - 3rd person auditory

98
Q

Psychiatric assessment

A

Risk to self
Risk to others
Risk from others
Risk of criminal damage to property

99
Q

Suicide risk assessment? Mx for each score (4 sets)?

A 
SAD PERSONS
Sex (M>F)
Age (peaks in young/old)
Depression
Previous attempts
Ethanol - alcohol 
Rational thinking loss - e.g. schiz / severe depression
Support network lost
Organised? - note/ avoid detection/ planned or impulsive
No significant other 
Sickness - e.g. physical disease

Scores:
0-2 = keep watch
3-4 = check frequently
5-6 = consider hospital - involuntary/voluntary
7-10 - definite hospital - involuntary/voluntary

100
Q

Causes of polyhydramnias?

A

DITCH
Diabetes - causes fetal polyuria = ^AM
Idiopathic/infection (parvovirus/CMV)
Twins - (+TTTS)
Congen abnormalties (e.g. fetal duodenal atresia-swallow difficulty)
Heart failure (due to VSD/Down’s) - causes fetal polyuria (due to ^BNP)= ^AF

101
Q

Risks of polyhydramnios? (6 Ps)

A 
Placental abruption 
Pretty unusual lie
Premature labour 
Prolapse cord
Post partum haemorrhage
Perinatal mortality
102
Q

4 main indications for induction? (4 Ps)

A

Post dates
Pre-labour rupture of membranes
Pre-Eclampsia
Plus Diabetes

103
Q

Diabetes risks in pregnancy?

A 
SMASH
Shoulder dystocia 
Macrosomia 
Amniotic fluid excess - polyhydramnios 
Stillbirth 
Hypertension + neonatal hypoglycaemia

+Miscarriages + congenital malformations = if preceding diabetes

104
Q

Gestational diabetes levels?

A

5, 6, 7, 8
Fasting >5.6
2hours post glucose >7.8

105
Q

When to give Aspirin 75mg as prophylaxis for pre-eclampsia?

A 
ECLAMPT
Existing hypertension
CKD
Lupus
Anti-phospholipid
Maternal diabetes - pre-existing
Previous hypertension in pregnancy
Twins

(+nulliparity + obesity + Fam Hx)

106
Q

Complications of pre-eclampsia? Fetal + Maternal

A

FIP (fetal) SHAME (maternal)
Fetal growth restriction
Intrauterine death
Premature delivery

Stroke 
HELLP
Abruption of placenta 
Multi-organ failure (+DIC +/- death)
Eclampsia
107
Q

Types of Small for gestational age - which is IUGR?

A

SWAN
Starved small (IUGR) - pre-eclampsia, drug/alcohol abuse
Wrong small - i.e. wrong dates
Abnormal small - congentital/chromosomal things
Normal small - genetic (growth velocity ok)

108
Q

Complications of prematurity

What reduces risk of these? Drug!

A

Heads, hearts, lungs, and guts (lungs and guts) x2
..and Retinitis drives me nuts

Resp distress
Interventricular haemorrhage
necrotising enterocolitis
(retinitis)
congenital heart abnormalities - patent ductus!

Maternal steroids!!! - IM dexa

109
Q

High risk factors for IUGR?

A 
SHITS (common) CRAP (rare)
Smoking 
Hypertension &amp; pre-eclampsia
IUGR previous
Twins
Previous stillbirth

Cocaine use
Renal disease
Antiphospholipid
PAPPA levels low

110
Q

Hyperkalaemia management?

A

C BIG K DRopS
Calcium gluconate - cardioprotective - IV (up to 4 doses)

Bicarbonates - sodium bicarb
Insulin - IV Actrapid
Glucose - IV - 250ml 10% glucose (15-30mins)

Kayexalate - binds K+ in GI tract (Calcium resonium)

Diuretics - if kidneys GOOD
Renal Dialysis - if kidneys BAD (either HD / PD)
Salbutamol - Nebs

111
Q

Hyperkalaemia causes

A

Drugs:
ACE-I/ARBs
Diuretics - K+sparing - spironolactone, amilliride
Beta-blockers

Conditions:
AKI

Rhabdomyolysis (causes AKI aswell - myoglobin deposits in kidneys and forms casts) K+ predominantly intracellular

CKD

Addison’s - K+ ^ in renal addison’s (as driven by ACTH - which is high in renal, low in central)

112
Q

Hyperkalaemia ECG

A

Tall tented T-waves
Small/absent p waves
Broad QRS

113
Q

APTT measures what drug?

PT measures what drug?

A

APTT - heparin/LMWH

PT - warfarin - extrinsic pathway

114
Q

Quick trick for hepatically excreted drugs? Why?

A

blood brain barrier drugs (i.e. neuro/nerve shit) - as need to be fat soluble to cross BBB

115
Q

What renal patients does ACE-I not work?

A

if renovascular disease / hypovolaemia is the cause of AKI

USED IF PROTEINURIA!
Use as happy to accept small dip in GFR for benefits

116
Q

Extra Mx for STI? (sex)

A

SEX
Screen for other STIs
Education - e.g. condom use
Explain about partner education

117
Q

PCOS criteria (i.e. signs and symptoms). Hint - where did Villa win the european cup??

A

ROTTERDAM

SHOP 
string of pearls
hyperandrogenism - acne+hirsutism
Oligomenorrhea - irregular + heavy
Prolactin normal
(also insulin resistance)
118
Q

Risk factors for Ectopic? (kate middleton’s sister)

A 
PIPPA (1/3rd have no risk factors)
Previous ectopic 
IUD - (if got pregnant with it in)
Pelvic/tubal surgery 
PID
Assisted reproduction
119
Q

Common types of HPV + associations? (nursery rhyme)

A

1 and 2, do up my shoe (veruccas)
11 and 6, warts on pricks (genital warts)
Please beware sweet little 16
Like number 18, she’s an oncogene (Cervical cancer)

120
Q

Causes of cerebellar signs?

A

PASTIES

P - Posterior fossa tumour
A - Alcohol
S - Multiple sclerosis
T - Trauma
I - Inherited (e.g. Friedreich's ataxia)
E - Epilepsy treatments
S - Stroke
121
Q

What triggers a sickle cell crisis?

A

CHIDS:

Cold
Hypoxia (extreme exercise)
Infection
Dehydration
Stress
122
Q

Common cytokines amongst seronegative arthropathies?

A

TNF + IL-17 (why they have linked features)

123
Q

Nail changes psoriatic arthritis

A

Pitting

Oncholysis - nail separates from bed

124
Q

COMMON EXAM QUESTIONS -‘YOUNG PERSON GOING ABROAD’

A 
REACTIVE ARTHRITIS (?i.e. because of STI?)
 - ITS CHLAYMDIA BRUV

or a GI infection - Campylobacter/salmonella/shigella

125
Q

Organs / Features of MM?

Protein present in Urine?
Blood film finding?

A 
CRAB
Calcium elevation 
Renal impariment 
Anaemia 
Bone disease - lytic / osteoporotic

Bence Jones Protein
rouleaux formation - stacking of RBCs

126
Q

Philadelphia chromosome?

127
Q

TTP = EMERGENCY. Pentad of symps?

A

Fuck Renal HTN

Fever
Renal failure 
Haemolytic anaemia 
Thrombocytopenia 
Neuro change
128
Q

TTP absence of what? Gene mutation?

A

VWF cleaving protein [ADAMTS-13]

129
Q

Rituximab indications - EXAM QUESTION!

it is an example of a biologic drug

A

RA, lymphoma, ANCA associated vasculitis, SLE

130
Q

Used in HyperThy instead of Carbimazole if pregnant????

A

Propylthiouracil

131
Q

Symptoms of hypercalcaemia?

QT length? Muscles?

A

Bones, stones, abdominal moans, thrones, psychic overtones

  • Painful bones (osteitis fibrosa cystica)
  • thrones - polyuria
  • psychic - depression, psychosis, memory loss

Short QT
Muscle weakness/fatigue

132
Q

Hypercalcaemia long term complication - after penia+porosis

A

Osteitis fibrosa cystica - pepperpot skull + subperiostal resorption (phalanges)

133
Q

What stimulates prolactin release at ant. pit?

A

TRH - so think about primary hypothyroid in prolactinaemia causes

134
Q

Difference between acromegaly and gigantism?

A

Gigantism = before closure of epiphyseal plates! I.e. when young!

135
Q

Layers of adrenals?

A

GFR - Salt, Sugar, Sex (the lower you go the sweeter it gets!)

Zone glomerulosa - mineralocorticoids - aldosterone
Zona fasiculata - glucocorticoid - cortisol
Zona reticularis - androgens - DHEA

136
Q

Effects of cortisol?

A

RIDGE

Reproduction SUPPRESSION
Immunity SUPPRESSION
Digestion SUPPRESSION
Growth SUPPRESSION 
Energy MOBILISATION
137
Q

Addison’s features?

A

5 Ts

Tearful - depression, confusion, 
Thin - anorexia, weight loss, N+V
Tanned - skin pigmentation 
Tired - fatigue + muscle weakness
Tumbling - faintness due to hypotenison
138
Q

Bronchiolitis poem

A

In kids under 1, there’s a common disease
With cough, snotty nose, crackles and wheeze
Always record the respiratory rate
If it’s severe, they’ll desaturate

139
Q

ToF features? Embryology

A 
PROVE
Pulmonary stenosis...causing:
RVH
over-riding aorta
VSD - R-->L shunt (due to pulmonary stenosis)
Ejection systolic murmur

UNEQUAL PARTITIONING OF TRUNCUS ARTERIOSUS

140
Q

Down’s syndrome face / head features?

Others?

A

ROSEOLA (n.b. roseola not more common in down’s)
Round face
Occipital flattening (&nasal flattening)
Speckled iris (Brushfield spots) + Squint
Epicanthic folds
Open mouth + protruding tongue
Low set ears
Almond (oval) up-slanted eyes

Others:
Hand - single transverse palmar crease, short fingers, curved little finger
Feet - sandal gap

141
Q

AVPU score meaning?

A

Alert?
responds to voice?
responds to pain?
Unresponsive?

142
Q

Status epilepticus management!

A

Oh My Lord Phone the Anaesthetist

Oxygen (after ABC)
Midazolam (buccal / rectal diazepam / IV lorazepam)
Lorazepam IV (after 10mins)
Phenytoin IV
Rapid induction of anaethesia - risk of aspiration!!

143
Q

What prompts admission for bronchiolitis?

A

DRAMAS

Dehydration 
Resp rate >70 / marked increased WOB - recession/grunting
Apnoeic episodes 
Milk/fluid intake <50% of normal
Appearance - ill / exhausted 
Sats <92%
144
Q

Asthma Ix + signs of severe asthma?

A

5 PROPS

Peak flow - <50% best/predicted
RR >30
O2 sats <92%
Pulse >125/min
Sentances - too breathless to talk
145
Q

Life threatening asthma?

A

33, 92 CHEST

PEF < 33% best/predicted
Sats < 92% .... and any one of: 
 - Cyanosis
 - Hypotension 
 - Exhausation w/ poor resp effort
 - Silent chest
 - Tired / confused (i.e. reduced conscious level)
146
Q

What to give with methotrexate in Rheumatoid, why here and not in anti-cancer?

A

FOLIC ACID - as in rheumatoid = not using this function to treat. Using another methotrexate function

147
Q

Examples of anti-TNF
What is rituximanb?
What is tocilizumab? What effect does this have on what inflam marker? significance?

A

Infliximab
Etanercept
Golimumab
Adalimumab

Ritux = anti CD20 - anti-B cells
Tocilizumab (anti IL-6) - this is a pre-cursor for CRP - so will have low CRP - issue if expecting high CRP - need to know if taking this drug - i.e. in septic arthritis will not see ^CRP

148
Q

What is the epidermis made out of?

4 layers pls

A

Keratinocytes (at different levels of maturation

BROWN SLUGS GRAB COCKS
Stratum:
 - Basale 
 - Spinosum
 - Granulosum
 - Corneum
149
Q

SEs of oral corticosteroids?

A

SHIP DOC

Syndrome (Cushing's)
HTN
Immunosuppresion 
Psychosis
Diabetes
Osteoporosis
Cataracts
150
Q

What not to give in Acne (may give it in other skin conditions)

A

Oral/Systemic STEROIDS!! - Causes acne!!!
- e.g. Cushing’s

?topical ok?

151
Q

investigation for alopecia?

A

Positive hair pull test (>5)

152
Q

How does urticaria present?

A

WHEALS (think about nettle sting!!)

153
Q

Other than Topical retinoids + ABx / Oral retinoids, what can you give in mod/severe acne?

A

COCP - in females!!!

154
Q

Path salivary gland swelling?

A

Infection, inflammation, obstruction, tumour

155
Q

Autonomic comps of tricyclics?

A

TURD MOUTH + constipation
Tachycardia
Urinary retention
Dry mouth

156
Q

Endoderm, ectoderm, mesoderm - what do they form?

A

Endo - Liver, pancreas
Ecto - brain, spinal cord, skin
Meso - muscles, bones, heart + circulation

157
Q

Tonsilitis - bug. Scoring system? Mx?

A 
Viral - coxsackie, EBV, HSV
Strep Pyogenes - FeverPAIN
 - Fever >38 in last 24hours 
 - Purulent tonsils 
 - Absence of cough 
 - Inflammed tonsils 
 - New onset (<=3days)

3 or 4 = 40-60% chance bacterial

Mx:
Antipyretics - NSAIDs/paracetamol
Abx - penicillin V

158
Q

Quinsy also known as? What is it?

A

Peritonsilar abcess. Comp of tonsilitis - pus trapped between tonsil + pharyngeal wall

159
Q

Otitis media - comps?

A

common: OME, CSOM, perforation

MASTOIDITIS, facial nerve palsy, meningitis

160
Q

GCS score?

161
Q

Cushings triad (in ^ICP)

A

Bradycardia, hypotension, apnoea

162
Q

4 stages of HIV?

A

Seroconversion / primary

  • short illness soon after infection (highest infectivity)
  • ABs detectable, antigens not!
  • BLOTCHY RED RASH

Asymptomatic HIV infection

  • can last years
  • progressive CD4 depletion + lymphadenopathy

Symptomatic HIV
- Opportunistic infections + some cancers

Late stage HIV +/- AIDS

  • Further opportunistic infections
  • AIDs related complex
163
Q

When to consider viral haemorhagic fever?

NOTIFY PUBLIC HEALTH ENGLAND

A

unexplained pyrexia
hypovolaemia, bleeding, ^vascular permeability, organ failure

-essentially just lose everything - all clotting prolonged, leukocytopenia, thrombocytopaenia

164
Q

Sleeping sickness also known as?

A

Trypanosomiasis

165
Q

3 malaria species pls?

A

Plasmodium Falciparum
P. Vivax
P. Ovale

166
Q

Brain stem death signs?

A 
No resp effort in reaction to turning off ventilator 
No response to pain
REFLEXES: 
 - No pupil light refex 
 - No corneal reflex
 - No cough reflex 
 - no response to supra-orbital pressure
167
Q

Zoledronic acid SEs?

A

Osteonecrosis of jaw
Gastritis
Oesophagitis

168
Q

Drug causes of reduced sodium?

A 
Steroids 
PPI (change it to ranitidine)
SSRI 
Carbamazepine 
Fluids
Thiazide diuretics
169
Q

Complications of malaria?

A 
CHARD
Cerebral malaria 
Hypoglycaemia 
ARDS
Renal impairment 
DIC

(pre-hepatic jaundice (haem anaemia) + hepatitis)

170
Q

Risk with chemo induced myelosuppression?

A

Neutropenic sepsis

171
Q

Meds that worsen hypercalcaemia?

A

Thiazide diuretics
Lithium
Calcium supplements

172
Q

What is tumour lysis syndrome?

Most common Ca to get it in?

Why do you get AKI?

A

Excessive cell lysis
Metabolic + electrolyte imbalances = upon starting cytotoxic treatment –> ^Uric acid mainly

Lymphoma

AKI = due to uric acid nephropathy

173
Q

Lab findings tumour lysis syndrome?

A

Hyperuracaemia, hyperkalaemia, hyperphosphataemia - arrhythmia

Hypo calcaemia - muscle cramps, tetany

174
Q

Management of tumour lysis syndrome?

A 
allopurinol
rasburicase
Mx of hyperkalaemia 
Fluids 
consider dialysis
175
Q

Comps/symps of liver disease?

A

JEBA (JABBA THE HUT)

Jaundice
encephalopathy
bleeding
ascites

176
Q

Features of mania?

A

I DIG FAST

Insight lost 
Distractibility 
Impulsivity 
Grandiosity 
Flight of ideas 
Activty increase
Sleep deficit 
Talkitiveness
177
Q

Charcot’s triad? (For ascending cholangitis)

A

RUQ pain
Fever
Jaundice

178
Q

How to assess Abdo Xray?

A

Big Cuddly Spanish Giants

Bones, Calcium, Soft Tissue, Gas

179
Q

Ages for Leukaemias?

A

ALL CeLL mates have CoMmon AMbitions
(ages 45-75 = go up in 10s)

ALL - < 5 + > 45years
CLL - >55yrs
CML - >65yrs
AML - >75yrs

180
Q

4 strengths of topical steroid cream (getting stronger)

A

Harvey Elliot Beats Defenders

Hydrocortisone

Clobetasone butyrate (Eumovate)

Betamethasone valerate (Betnovate)

Clobetasol propionate (Dermovate)

Mnemonics / quick learn (7 decks)

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