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P4 > Qus > Flashcards

Qus Flashcards

1
Q

carbimazipine mech of action + side effect

A

sodium channel blocker

folate deficiency –> macrocystic anaemia

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2
Q

phenytoin mech of action + SE

A

sodium channel blocker

profound folate deficiency –> macrocystic anaemia

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3
Q

types of neuro tumours (3) + which are most common

A

60% gliomas
20% meningiomas
10% pituary tumours

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4
Q

how to treat increased ICP due to tumour mass

A

dexamethasone

vasogenic oedema caused by the breakdown of the BBB

swelling reduction

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5
Q

young female, obese - what you thinking?

A

idiopathic intracranial pressure

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6
Q

post herpatic neuralgia - what is your treatment for neuropathic pain?

A

duloxetine - SNRI
amytrypiline - TCA
gabapentin - GABA analogue
pregabalin - GABA analogue

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7
Q

how can you treat a child who is unresponsive to anti-epiletics?

A

ketogenic diet

high fat
low carb
controlled protein diet

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8
Q

oxygen is used as treatment for what kind of headache?

A

cluster

100% oxygen (80% response rate within 15 minutes)

SC triptans (75% response rate with 15 minutes)

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9
Q

cluster headache prophylaxis

A

verampiril - CCB

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10
Q

what drugs can exacerbate trigger mysthenia gravis?

A 
penicillamine - Wilson's disease
quinidine - anti-arrhythmic agent 
beta blocker
lithium
phenytoin
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11
Q

what do heinz’s bodies in a blood film signify?

A

Glucose 6 Phosphate Deficiency

a predisposition of RBC breakdown

G6PD is needed to protect RBC from oxidative stress

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12
Q

hyaline casts seen in urine - what does it mean?

A

patients taking loop diuretics

also healthy people after strenuous exercise

from distal convoluted tubule

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13
Q

brown granular cast in urine

A

acute tubular necrosis

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14
Q

what is a vesicucreteric reflex + imaging

A

back flow of urine from the bladder into the ureters + kidneys

diagnosed by micturating cystourethogram

common in kids –> can develop UTI

35% develop scarring

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15
Q

what immunisation is given at birth?

A

bcg

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16
Q

what can give a false-negative mantoux result

A

immunosuppression (AIDs)
sarcoidosis - reduced immunity
lymphona

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17
Q

roseola infantum

A

Human herpes virus 6 (HHV6)

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18
Q

measles

A

RNA parvmyxovirus

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19
Q

mumps

A

RNA parvmyxovirus

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20
Q

rubella / german measles

A

toga virus

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21
Q

chicken pox

A

varicella zoster virus

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22
Q

scarlet fever

A

group A haemolytic strept (strept pyogenes)

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23
Q

hand, foot + mouth

A

coxsackie A16

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24
Q

reasons for <24 jaundice

A

rhesus haemolytic disease
ABO heamolytic disease
hereditary spherocytics
G6P deficiency

measure bilirubin urgently <2hrs

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25
Q

At what timeframe should you refer for undescended testis ?

A

3 months

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26
Q

what is reflex anoxic seizures (RAS)?

A

non-epiletic seziures due to excessive stimulation of vagus nerve

quick post-ict recovery

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27
Q

Causes of widened mediastinum?

A

vascular problems - thoracic aneurysms
lymphoma
retrosternal goitre
thymus tumour

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28
Q

Infective COPD - most common organisms (3)

A

h.influenza
strept pneumonia
morexella catahhalis

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29
Q

NG tube is inserted. At what pH is it safe to feed??

A

<5.5

if >5.5 CXR is needed to confirm

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30
Q

What should you see on CXR to confirm correct NG placement?

A

NG tip is below the diaphragm

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31
Q

what is aspergillioma?

A

infection due to mould / fungi –> spore inhalation

commonly affects immunosuppressed

severe haemoptysis
PHx of TB
CXR shows rounded opacity

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32
Q

describe sarcoidosis

A

multisystem, chronic disease with granulatous inflammation

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33
Q

diagnostic asthma parameters (4)

A

FeNO >40 parts / billion

post bronchodilator >12% FEV1

post bronchodilator > 200ml lung volume

FEV1 / FVC ratio < 70%

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34
Q

diagnostic asthma parameters (5)

A

FeNO >40 parts / billion

post bronchodilator >12% FEV1

post bronchodilator > 200ml lung volume

FEV1 / FVC ratio < 70%

peak expiratory flow rate variability >20%

FEV1 / FVC ratio <70% (asthma is an obstructive disease)

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35
Q

what are the risk factors + features of transient tachypnoea of the newborn

A

c-section
- fluid in the lungs as they weren’t squeeze out as baby hasn’t gone through birth canal

settles in 1-2 days

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36
Q

what drugs are associated with cleft platelet when taken in pregnancy

A

anti-epileptics

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37
Q

loperimide

A

long-acting synthetic antidiarrheals

antagonize histamine and interfere with acetylcholine release locally.

brand name - imodium

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38
Q

tacrolimus

A

immunosuppresant

calcineurin inhibitor

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39
Q

irbesartan

A

angiotension receptor blocker

HTN tx

block the formation of angiotension II

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40
Q

dipyridamiole

A

platelet inhibitor

given in combo with aspirin

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41
Q

venlafaxine

A

Serotonin-Noradrenaline Reuptake Inhibitor

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42
Q

obstructive + restrictive lung conditions

A

OBSTRUCTIVE

  • asthma
  • COPD
  • bronchietasis
  • A1AT

RESTRICTIVE

  • interstitial lung disease (fibrosis, coal miner, asbestos)
  • neuromuscular (GBS)
  • structural (scoliosis, ank spon, obesity)
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43
Q

high ACE levels signify?

A

acute sarcoidosis

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44
Q

how to certify for death?

A

A –> E assessment (minimium of 5 minutes)

Respiratory effort
Verbral stimuli
Painul stimuli
Carotid pulse

Pupils - fixed + dilated

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45
Q

end of life drugs (4)

A

sedation (midazolam)
analgesia (morphine)
anti-secretory (hyoscine)
anti-emetic (ondansatron)

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46
Q

what test should you do before starting azthromycin ?

A 
LFTs
ECG (long QT)
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47
Q

what is churgg strauss?

Mx

A

eosinophillia + vasculitis (p-ANCA)

  1. Allergic (asthma)
  2. Eosinophilia infilitrates to the tissue
  3. Vascultis

Mainstay of treatment is corticosteroids

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48
Q

what is granulomatosis with polyangitis?

A

systemic vasculitis (small + medium vessels)

triad

   1. Upper RTI
   2. Lower RTI
   3. Glomerolonephritis
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49
Q

what is flail chest?

most common comp?

A

detached ribs moving separately of the rib cage
inspiration - moves in
expiration - moves out

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50
Q

asthma admission –> what are looking out for on ABG and what does it signify?

A

CO2 retention
pH <7.35 (due to the CO2 retention)

means that patient is tiring –> escalate quick

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51
Q

4 types of markers of disease from asbestos

A

pleural plaques

  • benign + don’t undergo maligancy
  • most common / calcification

pleural thickening
- similar pattern seen in empyema / haemothorax

asbestosis

  • severity = length of time
  • LOWER LOBE fib

mesothelioma

  • malginant form of asbestos exposure
  • very limited exposure can cause mesothelioma
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52
Q

what is a lesion in optic nerve (II) called and features (2)

A

marcus-gunn pupil

  1. deafferent pupil
  2. constricts to consensual light but not direct
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53
Q

name the eye muscles and their innervations ?

A

oculomotor (III)

  • medial rectus
  • inferior rectus
  • superior rectus
  • inferior oblique

trochlear (IV)
- superior oblique

abducens (VI)
- lateral rectus

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54
Q

whats the limit of Hb1Ac for adding 1st diabetes drug and 2nd diabetes drug?

A

1st - 48mmol

2nd - 58mmol

55
Q

what is the criteria for giving fluids for burns?

A

fluids are not given for 1st degree burns

Given only for 2nd/3rd, covering >15% BSA

56
Q

Chart used for most accurate burns?

A

lund and browder

57
Q

two skin conditions caused by maslasseai furfur?

A

Pityriasis versicolor

seborrhatic dermatitis

58
Q

describe features acne rosacea

A 
flushing
pustules + papules
telangiestais 
nasal liabial sparing
rhinophyma
59
Q

how do you treat ance rosacea

A

metronidazole / tetracycline

60
Q

Mx lichen planus

A

clobetsol propionate - steroid

61
Q

describe features of ance vulagaris

A

pustules + papules
oilly skin
comodomes (closed + open)

62
Q

complication of draining effusion too quickly

A

re-expansion of pulmonary oedema

63
Q

Mx actinic keratoses

A

Fluorouracil

binds to uracil –> RNA –> destroys malignant cells

64
Q

Mx seborrhatic dermatitis

A

ketoconazole

65
Q

antibodies for Graves

A

TSH receptor antibodies (90%)

Anti-thyroid perioxidase (75%)

66
Q

hashimoto’s

A

chronic immune thyroiditis

non-painful goitre

67
Q

de quervain

A
  1. hyperthyroidism
  2. hypothyroidism

painful- gotire

68
Q

what scores signify impaired fasting glucose?

A

Fasting Glucose 6.1 - 7.0 mmol/l

69
Q

what scores signify impaired glucose tolerance?

A

fasting plasma glucose <7.0 mmol/l

OGTT 2-hour value greater than 7.8 to 11.1mmol/l

70
Q

post surgery stress response

A

insulin
oestrogen
testosterone

71
Q

what is the first treatment regime for newly diagnosed T1DM?

A

basal bolus insulin regimen

w/ twice daily insulin detemir

72
Q

what is buerger’s disease

A

small / medium vessel disease

strong association with smoking

73
Q

statins mech of action

what test is used to monitor statins?

A

HMG-CoA reductase –> rate limiting enzyme in hepatic cholesterol synthesis

LFT measured baseline, 3 months, 12 months

stop in pregnancy

74
Q

cardiac tamponade

features

A

large drop in BP in inspiration = pulsus paradoxus

75
Q

what is kussmaul’s sign?

where is it seen?

A

raise JVP with inspiration

constrictive pericarditis

76
Q

side effects of statins

A

myopathy

liver impairment

77
Q

Nicorandil

A

potassium channel activator

vasodilator –> angina

78
Q

long QT syndrome mx

A
  1. long QT drug avoidance
  2. beta blockers
  3. impantable cardioverter debib (if >500ms)
79
Q

what drug gives you angioedema ?

A

ACE-i

80
Q

Mx torsades de pointes

A

magnesium sulphate

81
Q

orthostatic hypertenson mx

A

fludrocortisone - steroid

increases renal sodium reabsorption and increases plasma volume

82
Q

what is doxazosin?

A

selective a1 - blocker

treats HTN

83
Q

pathophysiology of HHS

A

hyperglycaemia >30mmol
hyperosmolality >320
in the absence of lipolysis (small enough insulin production to suppress this

reduced insulin results in increased gluconeogenesis

  1. hyperglycaemia –> osmotic diuresis
  2. hypernatraemia along with hypovolaemia
  3. leads to progressive decline in eGFR –> aggrevates the hyperglycaemic state
84
Q

pathophysiology of DKA

A

complication of T1DM

due to the lack of insulin –> glucolysis stops
body uses fatty acids for energy –> lipolysis

resulting in the production of ketones

85
Q

diagnostic criteria for HHS

A

hypovolaemic
hyperglycaemia >30mmol
w/o ketoanaemia / acidosis
serum osmolality >320 mosmol/kg

86
Q

Mx HHS

A
  1. monitor osmolality
  2. replace fluid / electrolytes –> potassium
  3. normalise blood glucose

aim to replace 3-6L within first 12 hours
IV 0.9 sodium chloride
already relievely hypotonic compared to blood os

correct potassium levels
AKI = causes hyperkal
Diuretics = causes hypokal

87
Q

what are the indications for insulin in HHS?

A

presence of ketonaemia (mixed DKA/HSS picture)

then the recommended insulin dose is a fixed rate intravenous insulin infusion given at 0.05 units per kg per hour.

if NO ketonaemia then don’t give insulin

88
Q

describe and explain the effects of hyper / hypo / isotonic fluids?

A

hyper - higher osmolality in order to draw fluid out from cells (intra –> extra)

iso - same osmolality for extravascular volume expansion

hypo - lower osmolaity in order to shift fluid into cells (intra –> extra)

89
Q

how dehydrated are patients with HHS?

A

100 - 220ml/kg

so 70kg pt has lost 7 to 15.4L

develops over several days so is more profound than DKA

90
Q

Mx of DKA (5)

A 
1. fluids (isotonic) 
            pts have usually lost 5-8 litres
2. short acting insulin (0.1units/kg/hr)
3. 5% dextrose (once glucose <15)
4. correction of hypokalaemia
5. switch short insulin --> long insulin
91
Q

what kind of patients more at risk of developing cerebral oedema?

A

younger patients (18-25)

92
Q

diagnostic criteria for DKA (4)

A
  1. glucose > 11mmol / known diabetic
  2. pH < 3.5
  3. bicarb <15 (high anion gap)
  4. ketones > 3mol
93
Q

most common precipating factor for DKA

A

infection
missed insulin dose
MI

94
Q

complications of DKA

A
  • gastric stasis
  • thromboembolism
  • arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia
  • iatrogenic due to incorrect fluid therapy: cerebral oedema*, hypokalaemia, hypoglycaemia
  • acute respiratory distress syndrome
  • acute kidney injury
95
Q

administering vancomycin - what are concerns?

A

allergic reaction
red man syndrome (significant release of histamine)

pruritus, erythema
burning sensation of the upper chest

96
Q

dengue fever

A

viral haemorrhagic fever

a form of DIC called dengue haemorrhagiv fever may develop

low plateletts
raised ALT

myalgia
maculopapular rash

97
Q

HIV risk needle stick injury

A

encourage bleed
run under water

may start treatment 72 hours following exposure

refer to ED + oral antiretroviral therapy for 4 weeks

serological testing at 12 weeks following completion of post exposure

98
Q

painful genital ulcer

more common

A

herpes simplex virus (more common)
- HSV type 2 (type 1 cold sores)

chancroid

  • painful genital ulcers
  • inguinal node enlargement
99
Q

painless genital ulcers

A

syphilis (more common)

lymphogranuloma
- chlamydia trachomatis

–> Mx Doxycyline

100
Q

Extensive otitis externa Mx

A

flucloxacillin

101
Q

PID Mx

A

Doxycycline + metronidazole + ceftriaxone

102
Q

atypical pneumonia

A

clarithromycin

103
Q

Acute pyelonephritis

A

Broad-spectrum cephalosporin or quinolone

104
Q

typhoid

A

salmonella typhi

  1. pea green diarrhoea
  2. fever >39
  3. relative bradycardia for level of infection

ciprofloxacin

105
Q

what pneumonia causes:

  • deranged LFTs
  • hyponatriemia
A

legionella pneumophilia

106
Q

erythema multiforme

A

mycoplasma pneumoniae

107
Q

pneumonia following influenza

A

staph aureus

108
Q

erythema migrans / lymes disease

A

Borrelia

109
Q

test for lymes disease

A

ELISA antibodies

then if positive

immunoblot test for lymes

110
Q

Mx for lymes

A

doxycycline (tetragenic)

ceftrixone if disseminated

111
Q

Mx genital warts

A

HPV 6 / 11

multiple / non-keratinised
- topical podophyllum

solitary, keratinised
- cryotherapy

112
Q

herpes simplex infection

A

HSV 1 - cold sores
HSV 2 - genital herpes

primary infection:

  1. gingivostomatitis (gum + mouth infection)
  2. cold sores
  3. painful gential ulceration

Mx
- oral / topical aciclovir

113
Q

herpes simplex infection in pregnancy –> what is advised

A

if infected post-28 weeks

–> c-section advised

114
Q

erythema infectiosum

A

parvovirus b19

IgM - recent infection
IgG - immunity

115
Q

organism most associated with gangrene

A

staph aureus
- type 1 nec fas

strept pyogenes
- type 2 nec fas

clostridium perfringens
- type 3 nec fas

116
Q

lactational mastitis

A

staph aureus

117
Q

sewage worker

A

leptosporosis

  1. bilateral conjuctivits
  2. bilateral calf pains
  3. high fevers
118
Q

most common CAP

A

strept pneumonia

119
Q

most common infective COPD

A

H.influenza

120
Q

bacterial vagionsis

A

gardenerella vaginalis

Mx - oral metronidazole

121
Q

syphilis investigations

A

EIA - detects acute igM antiobody to syphilis

TPPA - remains positive for people who have been previously infected

Rapid plasma reagin (RPR) - used to monitor activity + reinfection

  • –> the number of times a sample needs to be diluted to be come undetectable
  • –> higher diluation means greater infection
122
Q

Mx syphilis

A

IM benzathine penicillin G

123
Q

3 types of pathogen for viral encepthalitis

A

herpes simplex virus (most common)
enterovirus
vericella zoster virus

124
Q

Mx for MRSA from carrier once identified

A 
mupirocin (nose)
chlorhexidine gluconate (skin --> creases)
125
Q

Chagas disease

A

95% patients are asymptomatic

african + american origin

concerned about cardiomyopathy = echocardiogram

126
Q

how many tetanus jabs needed for lifelong immunity?

A

5

127
Q

bupropion

A

anti-depressant

used to aid smoking cessation

lowers epilepsy threshold - bad

128
Q

which pneumonia is associated with neurological symptoms?

A

mycoplasma pneumonia

129
Q

how do you treat PID?

A

doxycycline + ceftriaxone

+ metronidazole

130
Q

lymes disease pathogen + effects

A

borrelia

facial nerve involvement

131
Q

post-splenectomy what organisms are patients at risk from?

A

pneumococcus
Haemophilus
meningococcus

132
Q

what vaccines are given to patients undergone splenectomy?

A

annual influenza vaccine

pneumococcal vaccine every 5 years

133
Q

what is given for post-splenectomy sepsis

A

Penicillin V or amoxicillin

P4 (11 decks)

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