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__Y6 Finals Revision > __Y6 Passmed Points > Flashcards

__Y6 Passmed Points Flashcards

1
Q

What do these all show?

HBsAg
Anti-HBs
Anti-HBc
HBeAg

A

HBsAg normally implies current acute disease

Anti-HBs implies immunity (either prev exposure or immunisation)

Anti-HBc implies previous (or current) infection

HBeAg is a marker of infectivity as it results from breakdown of core antigen from infected liver cells

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2
Q

What do these results show?

1) Anti-HBs + Anti-HBc
2) Anti-HBs alone

A

1) immune due to prev infection

2) immune due to vaccination

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3
Q

Histology of coeliac disease?

A

Villous atrophy, raised intra-epithelial lymphocytes, crypt hyperplasia, lamina propria infiltration with lymphocytes

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4
Q

Blood marker for Coeliac disease?

A

Diagnosis by TTG abs (also EMA)

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5
Q

Villous atrophy, raised intra-epithelial lymphocytes, crypt hyperplasia, lamina propria infiltration with lymphocytes

A

Coeliac disease

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6
Q

Severity score for UC flares?

A

Truelove and Witts

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7
Q

Markers of severe UC flare?

A

Truelove and Witts severity score

> 6 stools a day, containing blood with evidence of any systemic disturbance (fever, tachy, abdo distension, anaemia, ESR)

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8
Q

Define toxic megacolon

A

transverse colon >6cm in combo with signs of systemic upset

Need to urgency decompress bowel ± surgery if not improved within 24 hrs

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9
Q

Inducing remission in UC flare

A

Oral aminosalicylates e.g. mesalazine
Oral pred 2nd line if no improvement

if severe manage in hosp with IV steroids

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10
Q

Maintaining remission in UC

A

Oral aminosalicylates, azathioprine and mercaptopurine

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11
Q

Inducing remission in Crohn’s flare

A
  • Oral pred if mild
  • IV hydrocort if severe
  • (2nd line 5-ASA e.g. mesalazine, less effective)

If conventional therapy unsuccessful start biologic therapy (anti-TNFα agents e.g. infliximab or adalimumab)

Azathioprine or mercaptopurine as add on therapy

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12
Q

Maintaining remission in Crohn’s disease

A

Azathioprine/mercaptopurine

2nd line methotrexate

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13
Q

Criterea for diagnosis of malnutrition

A

Any one of:

BMI < 18.5kg/m²

Unintentional weight loss > 10% within the last 3-6 months

BMI <20kg/m² + unintentional weight loss > 5% within the last 3-6 months

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14
Q

RF for acute mesenteric ischaemia

A

AF, HTN, T2DM

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15
Q

Acute hx of bloody diarrhoea with intense abdo pain out of proportion to signs

A

Acute mesenteric ischaemia

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16
Q

1st line investigation in suspected acute mesenteric ischamia

A

check for high lactate

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17
Q

Most common site for ischaemic colitis?

A

Watershed areas eg. splenic flexure

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18
Q

Upper GI bleed scores

A

Blatchford score (first assessment) - incl. urea, Hb, sysBP

Rockall score after endoscopy

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19
Q

Upper GI bleed vs lower GI bleed?

A

Check urea

High urea levels suggest upper (breakdown of RBC in stomach act as ‘protein meal’)

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20
Q

1st line intervention to stop variceal bleed

A

Band ligation

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21
Q

Acute pancreatitis cause

A

GET SMASHED

Gallstones
ETOH
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hyper-trig/Ca, hypothermia
ERCP
Drugs - azathiprine, mesalazine, bendroflum, sodium val
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22
Q

Abdo pain with relief on defaction, mucus passage, lethargy, nausea, feeling of incomplete evacuation

A

IBS

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23
Q

Primary biliary cholangitis

Definition and markers

A

AI condition, characterised by damage to intra-lobular bile ducts by chronic inflammation

leads to progressive cholestasis and cirrhosis

IgM, anti-Microbial abs, M2 subtype

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24
Q

Treatment of IBS

A

Loperamide (for diarrhoea), antispasmodic agents (for pain), laxatives (for constipation)

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25
Q

Autoimmune hepatitis abs

A

Anti-nuclear abs (ANA) and anti-smooth muscle abs (SMA)

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26
Q

Most common causes of cirrhosis

A

Alcohol, NAFLD, viral hep (B, C)

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27
Q

Investigation of choice to detect liver cirrhosis?

A

Transient elastography (Fibroscan)

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28
Q

Grading of hepatic encephalopathy

A

I – irritability
II – confusion, inappropriate behaviour
III – incoherent, restless
IV – coma

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29
Q

Define achalasia

Key signs

A

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter
Due to degenerative loss of ganglia from Auerbach’s plexus

Key signs -
Dysphagia (both solids and liquids), heartburn, regurgitation of food

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30
Q

Melanosis coli

A

Seen with laxative abuse

Disorder of pigmentation of the bowel

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31
Q

Hepatorenal syndrome types

A

Type 1 – rapidly progressive, rapid onset (<2 weeks), usually due to acute event e.g. upper GI bleed

Type 2 – slowly progressive, gradual decline in renal function, assoc ascites

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32
Q

Colon cancer genetic cause

and mode of inheritance

A

95% sporadic

Most common inherited:
HNPCC - hereditary non-polyposis colorectal carcinoma (auto dom)

Rarer:
FAP - familial adenomatous polyposis (auto dom)

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33
Q

Diagnostic marker of carcinoid syndrome

A

5 HIAA diagnostic marker – measure in 24 urine collection

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34
Q

Numerous harmartomatous polyps in GI tract + pigmented freckles on lips, face, palms, soles

A

Peutz-Jeghers

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35
Q

Spontaneous rupture of the oesophagus due to +++vomiting

→ Vomiting, thoracic pain, subcutaneous emphysema (crepitus)

A

Boerhaave syndrome

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36
Q

Persistent ST elevation after previous MI?

A

Very suggestive of a left ventricle aneurysm

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37
Q

Most common cause of drug-induced angioedema?

A

ACE inhibitors

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38
Q

What are varenicline and bupropion?

A

Varenicline (nicotine receptor partial agonist) or bupropion (NA and DA reuptake inhibitor and nicotinic antagonist) for smoking cessation

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39
Q

P mitrale

A

Bifid p wave with LA enlargement/hypertrophy

Enlarged LA makes a greater contribution to P wave contour

Most commonly due to mitral stenosis

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40
Q

ASD murmur

A

Ejection systolic, radiates through to back, fixed splitting of S2, beware paradoxical embolisms (→ stroke)

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41
Q

Aortic stenosis common causes:

A

Young pts <65 years – bicuspid aortic valve

Older pts >65 years – calcification

Also: post-rheumatic disease, HOCM

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42
Q

At what QRISK2 score are statins recommended?

A

Statins should be given to all pts with QRISK2 (10yr CV risk score) of ≥ 10%

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43
Q

Doses of statin for primary and secondary prevention?

A 
Primary prevention (QRISK2 >10%, most T1DM, CKD if eGFR<60)
→ 20mg Atorvastatin 
Secondary prevention (known IHD, CVD, peripheral artery disease)
→ 80mg Atorvastatin
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44
Q

When should Warfarin be stopped presurgery and what INR should be aimed for?

A

Warfarin pre-surgery - usually stopped 5 days before

Surgery can proceed once INR is <1.5

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45
Q

Warfarin and bleeding

Management of a bleed

A

Any major bleed → stop warfarin, give IV vit K, give prothrombin complex concentrate

If minor bleeding but INR >8 → stop warfarin, give IV vit K

If INR 5-8 → withhold next warfarin and reduce maintenance dose

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46
Q

ALS protcol for CPR

After three defib attempts what can be given?

A

Give amiodarone 300mg IV and adrenaline 1mg after three defib attempts
(Can give further adrenaline 1mg IV after alternate shocks)

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47
Q

Post-MI treatment to send pt home on

A 
ACE-i
BB
Statin
Aspirin
Clopidogrel (for 1st month, can continue)
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48
Q

Side effects of BB

A

Bronchospasm, cold peripheries, fatigue, sleep disturbance (nightmares)

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49
Q

Contraindictions for BB

A

Asthma, SSS, uncontrolled HF

Cannot be given alongside non-dihydropyridine e.g. verampamil or diltiazem

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50
Q

Pulsus alternans

Definition and condition seen in?

A

Alternation of the force of arterial pulse, seen in severe LVF

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51
Q

Bisferens pulse

Definition and condition seen in?

A

Double pulse with two systolic peaks seen in mixed aortic valve disease and occ HOCM

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52
Q

‘Jerky’ pulse seen in:

A

seen in HOCM

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53
Q

Pulsus paradoxus

Definition and condition seen in?

A

Greater than normal (>10mmHg) fall in sys BP with inspiration (fainter pulse with insp)

Seen in severe asthma or cardiac tamponade

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54
Q

Conditions to consider of ↑JVP, persistent hypotension and +++tachy despite fluid resus in pt with chest wall trauma

A

Cardiac tamponade

Tension pneumothorax

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55
Q

Most common valvuar abnormality in PKD?

A

Mitral valve prolapse

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56
Q

Most common cause of mitral stenosis?

A

Rheumatic fever

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57
Q

Marker for Churg Strauss disaese

A

p-ANCA

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58
Q

Hx asthma and nasal polyps, ↑eosinophilia, impaired kidney function, petechial rash

A

Churg Strauss disaese

Aka eosinophilic granulomatosis with polyangiitis

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59
Q

Marker for Wegener’s granulomatosis

A

cANCA

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60
Q

Affects upper resp tract and kidneys

Nose bleeds, rhinitis, conjunctivitis, saddle nose, rapidly progressing glomerulonephritis, pulm nodules, arthritis

A

Wegener’s granulomatosis aka granulomatosis with polyangiitis

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61
Q

ECG features of hypokalaemia

A
  • U waves
  • Small or absent T waves (occasionally inversion)
  • Prolong PR interval
  • ST depression
  • Long QT (>600ms)
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62
Q

J wave (Osborn wave)

A

Seen in hypothermia

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63
Q

Hypothermia ECG findings

A 
J waves (Osborn waves)
Bradycardia, 1st degree HB, long QT, other arrythmias
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64
Q

Inheritance pattern of HOCM

A

Auto dom

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65
Q

Acute pericarditis ECG findings

A

Saddle-shaped ST elevation (‘concave) and PR depression on ECG

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66
Q

Causes of acute pericarditis

A

Viral infection, TB, uraemia, trauma, post MI, CTD, hypothyroid

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67
Q

Notching of the inferior border of the ribs on CXR

A

Coarctation of the aorta

Aortic obstruction → dilated intercostal collateral vessels (allow sufficient blood flow to descending aorta) → increased pressure of these vessels erodes the inf margin of ribs

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68
Q

Tx for pt with bradycardia and signs of shock

A

500micrograms of atropine (repeated up to max 3mg)

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69
Q

Management of AF

When to use rate vs rhythm

A

NICE say offer RATE as 1st line, unless AF due to reversible cause, presence of HF (due to AF), new-onset AF
Or if rhythm more suitable based on clinical judgement

–

Rate control with BB (e.g. bisoprolol)
If required can add diltiazem or digoxin

Rate favoured if >65 years, or hx IHD

–

Rhythm control with amiodarone + flecainide (to cardiovert to sinus)

Sotalol also used to maintain sinus rhythm

Favoured if <65years, symptomatic, first pres, lone AF, CHF
Also if AF due to a reversible cause (e.g. infection)

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70
Q

Management of AF post-stroke

A

Aspirin for 2 weeks then start life-long anticoag

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71
Q

Normal QT intervals

How is it measured?

A

Normal QT should be <430ms in males, <450ms in females

QT interval between START of Q wave and END of T wave

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72
Q

Causes of Long QT syndrome

A

Causes:

  • Congenital
  • Drugs – amiodarone, sotalol, TCAs, SSRIs, methadone, erythromycin, haloperidol, chloroquine
  • Hypo-Ca/K/Mg, acute MI, myocarditis, hypothermia, SAH
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73
Q

Management of long QT syndrome

A

Avoid precipitants (e.g. strenuous exercise, swimming, stress)

Beta-blockers ± ICD in high risk cases (if QTc >500ms or prev cardiac arrest)

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74
Q

Management of SVT

A

Acute management:
1. Vagal manoeuvres e.g. Valsalva
2. IV adenosine 6mg → 12mg → 12mg (verapamil in asthmatics)
Adenosine has a 10s half-life so must be given fast through a central route or large calibre vein (16G cannula)
3. Electrical cardioversion

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75
Q

Management of VT

A

Give amiodarone 300mg over 10-20mins
Then 900mg over 24 hrs

If this fails or adverse signs (BP<90, CP, HF, syncope) then shock

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76
Q

Management of torsades des pointes

A

IV magnesium sulphate

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77
Q

Define pathological Q wave

A

Older but simpler definition of pathological Q wave:

Q wave ≥0.04 s and amplitude ≥25% R wave in that lead

Now newer definition with parameters dependent on lead

Assoc with prev MI

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78
Q

Poor prognostic factors in ACS (GRACE)

A

Age, HF hx or development, PVD, ↓sys BP, initial creatinine conc, ↑cardiac markers, cardiac arrest on admission

79
Q

Killip class for Acute Coronary Syndrome mortality

A

I: no signs of HF (6% mortality)
II: lung crackles, S3
III: frank pulm oedema
IV: cardiogenic shock (80% mortality)

80
Q

Management of HF

A

1st line: ACE-I and BB (bisoprolol, carvedilol)

2nd line: [ARB] or [aldosterone antagonist] or [hydralazine + nitrate]

If sx persist: consider CRT or digoxin (ivabradine in some cases)

Plus diuretics for fluid overload

Consider statins if indicated
Annual influenza vaccine and one-off pneumococcal

81
Q

Orthostatic hypotension criterea

A

Diagnosed when there is one of:

  1. A drop in systolic BP of ≥20mmHg (with or without sx)
  2. A drop to <90mmHg on standing (with or without sx)
  3. A drop in diastolic BP of 10mmHg with symptoms (less clinically sig)
82
Q

Stages of HTN

A

Stage 1 - clinic BP ≥ 140/90 (or Home BP average or ABPM ≥ 135/85)

Stage 2 - clinic BP ≥ 160/100 (Home ≥ 150/95)

Severe HTN - clinic systolic BP >180 or clinic diastolic >110)

83
Q

BP targets

A

Age <80 - clinic BP <140/90

Age >80 - clinic BP <150/90

84
Q

HTN guidelines

A
  1. ACE-I or CCB
  2. ACE-I and CCB
  3. Then add in thiazide-like diuretic (indapamide and chlortalidone recommended).
  4. Spiro can be used as a fourth agent in resistant HTN if K is <4.5
    (if K >4.5 then add higher dose thiazide-like)
85
Q

Aortic dissection management

A

Type A – ASS
Surgery and systolic management (control BP to 100-120 systolic)

Type B – BooBs
Bed rest and BBs (labetalol)

86
Q

Infective endocarditis

A

The vast majority caused by gram positive cocci

Strep viridians, staph aureus (IVDU), staph epidermis (prosthetic)

87
Q

DUKES criteria – infective endocarditis

A 
Pathological criteria (1 to diagnose)
\+ve histology or microbiology of pathological material obtained at cardiac surgery/autopsy

Major criteria (need 2)
• x2 +ve blood cultures showing orgs consistnet with IE (S viridians and HACEK group)
Or persistent bacteraemia from x2 cutlures taken >12 hrs apart or ≥x3 where pathogen is less specific

• Evidence of endocardial involvement
+ve echo or new valvular regurg

Minor criteria (need 1 major 3 minor, or 5 minor)
• Predisp heart condtion or IVDU
• Microbiological evidence that does not meet major criteria
• Fever >38
• Vasc phenom – major embolic, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae
• Immunological phenomena – glomerulonephritis, Osler nodes, Roth spots

88
Q

Scoring system: ABCD2

What condition?

A

TIA prognosis

89
Q

Scoring system: NYHA

What condition?

A

HF severity

90
Q

Scoring system: DAS28

What condition?

A

Rheumatoid arthritis disease activity (28 joints examined)

91
Q

Scoring system: Child Pugh

What condition?

A

Severity of liver cirrhosis

92
Q

Scoring system: HAD, PHQ9, GAD-7

What condition?

A

Depression and anxiety

93
Q

Scoring system: IPSS

What condition?

A

International prostate symptom score

94
Q

Scoring system: Gleason

What condition?

A

Prognosis in prostate cancer

95
Q

Scoring system: Waterlow score

What condition?

A

Pressure sores

96
Q

Scoring system: FRAX

What condition?

A

10 year risk of osteoporosis related fracture

97
Q

Scoring system: Ranson Criterea

What condition?

A

Acute pancreatitis

98
Q

Scoring system: MUST

What condition?

A

Malnutrition

Malnutrition Universal Screening Tool

99
Q

MOA: Aspirin

A

Antiplatelet

Inhibits produciton of thromboxane A2

100
Q

MOA: Clopidogrel

A

Antiplatelet

Inhibits ADP binding to platelet receptor

101
Q

MOA: Enoxaparin

A

Activates anti-thrombin III

Which potentiates inhibition of FXa

102
Q

MOA: Fondaparinux

A

Activates anti-thrombin III

Which potentiates inhibition of FXa

103
Q

Abciximab, tirofiban, eptifibatide

A

Glycoprotein IIb/IIIa receptor antatgonist

104
Q

P450 inducer or inhibitor?

Antiepileptics
Barbituates
Rifampacin

A

Inducer

105
Q

P450 inducer or inhibitor?

Chronic alcohol intake
Smoking
St Johns wort

A

Inducers

106
Q

P450 inducer or inhibitor?

Antibiotics - cipro, erythro
Isoniazid
Omeprazole

A

Inhibitors

107
Q

P450 inducer or inhibitor?

Amiodarine
Allopurinol

A

Inhibitors

108
Q

P450 inducer or inhibitor?

SSRIs
Sodium valproate
Fluconazole

A

Inhibitor

109
Q

Painful 3rd nerve palsy differentials?

A

Posterior communicating artery aneurysm

Stroke

110
Q

Ophthalmalgia, proptosis, absent corneal reflex, trigeminal nerve lesion (multiple cranial nerves involved)

A

Consider cavernous sinus thrombosis

111
Q

Hoffman’s sign?

A

flick nail of middle finger, +ve if flexion and adduction of thumb also

Demonstrates an issue with the corticospinal tract (UMN)

112
Q

Which movement is limited with adhesive capsulitis (frozen shoulder)

A

Classically limited external rotation of the shoulder seen

113
Q

Essential tremor

Diagnostic features and management?

A

classically a tremor present with sustained muscle tone (i.e. postural tremor) in hands, can also affect vocal cords

Absent when relaxed (improved by alcohol and rest)
Most common cause of head tremor

Propranolol as 1st line tx

114
Q

Treatment of Myesthenia Gravis

Management of myesthenic crisis?

A

1st line tx: pyridostigmine (cholinesterase inhibitor)
Add in prednisolone if required
± Thymectomy

Management of myasthenic crisis – plasmapheresis, IV Ig

115
Q

Multiple sclerosis CSF findings?

A

Oligoclonal bodies in CSF

116
Q

Features of multiple sclerosis

A

Visual – optic neuritis (common), optic atrophy
Internuclear ophthalmoplegia
Uhthoff’s phenomenon – worsening of vision with ↑temp

Sensory – pins and needles, numbness, trigeminal neuralgia
Lhermitte’s sign – tingling in hands when neck is flexed

Motor – spastic weakness

Cerebellar – ataxia, tremor

Others – urinary incontinence, sexual dysfunction

117
Q

Multiple sclerosis - worsening of vision with ↑temp

A

Uhthoff’s phenomenon

118
Q

Both upper and lower motor neurone signs
Fasciculations

Absence of sensory signs/symptoms
Wasting of small muscles of hand
Muscle cramps and spasm

A

Motor neurone disease

119
Q

Features of pseudo-seizures

What can you use to differentiate true from pseudo?

A

More common in females
Gradual onset
Crying after seizure
pelvic thrusting

Use PROLACTIN to differentiate from true seizure

(true if prolactin elevated 10-20 mins post seizure)

120
Q

General epilepsy management

A

Generalised seizures – sodium valproate 1st line

Partial seizures – carbamazepine 1st line

121
Q

Generalised tonic clonic management (1st and 2nd line)

A

1st line: sodium val
2nd line: carbamazepine, lamotrigine

(sodium val avoided in women of childbearing age)

122
Q

Absence seizure treatment options

A

Sodium val or ethosuximide

123
Q

Myoclonic seizure treatment options

A

Sodium val, 2nd line: clonazepam, lamotrigine

124
Q

Facial nerve functions

A

Face, ear, taste, tear

Face – motor
Ear – nerve to stapedius
Taste – ant 2/3 tongue
Tear – parasympathetic fibres to lacrimal and salivary glands

125
Q

Dermatome for:

Thumb and index fingers

A

C6

put thumb and index finger together to make a 6

126
Q

Dermatome for:

Nipples

A

T4

127
Q

Dermatome for:

Umbilicus

A

T10

bellybuTEN

128
Q

Dermatome for:

Kneecap

A

L4

down on all FOURS

129
Q

Dermatome for:

Big toe

A

L5

“largest of 5 toes”

130
Q

Dermatome for:

Little toe and lateral foot

A

S1

“small one”

131
Q

Dorsal columns

Direction, parts and what info they carry

A

Ascending

Fine touch, proprioception, vibration, pressure

  • Fasciculus gracilis (lower trunk and legs)
  • Fasciculus cuneatus (upper trunk and arms)
132
Q

Corticospinal tract

Direction and info carried

A

Descending

Voluntary muscle movement

133
Q

Spinothalamic

Direction and info carried

A

Ascending
Sensory pain and temp (lateral)
Crude touch (anterior)

134
Q

Management of migraine

Acute tx and prophylaxis

A

Acute tx → triptan ± NSAID/paracetamol

Prophylaxis (if ≥2 a month) → topiramate or propranolol

Propranolol if female child-bearing age (topiramate is teratogenic)

Topiramate if asthmatic

135
Q

Severe unilateral pain (sharp, shooting, electric shocks)

Pain commonly evoked by light touch (washing, shaving, brushing)

A

Trigeminal neuralgia

136
Q

Management of trigeminal neuralgia

A

Carbamazepine

137
Q

Management of cluster headaches

Acute tx and prophylaxis

A

Acute: 100% O2, subcut triptan

Prophylaxis: verapamil

138
Q

Stroke

Different arteries that can be affected and resulting clinical signs of each

A

Anterior cerebral artery – contralateral hemiparesis and sensory loss

Middle cerebral artery of the dominant side supplies Wernicke’s and Broca’s areas – hence MCA strokes cause aphasia
Plus contralateral hemiparesis and sensory loss
Contralateral homonymous hemianopia

Posterior cerebral artery – visual agnosia, contralateral homonymous hemianopia

Retinal artery – amaurosis fugax

Basilar artery – locked in

139
Q

Anterior cerebral artery stroke signs

A

Contralateral hemiparesis and sensory loss

140
Q

Middle cerebral artery stroke signs

A

Aphasia (Wernicke’s and Broca’s areas supplied by MCA)

Plus contralateral hemiparesis and sensory loss

Contralateral homonymous hemianopia

141
Q

Posterior cerebral artery stroke

A

Visual agnosia

Contralateral homonymous hemianopia

142
Q

Stroke with aphasia

Which artery affected?

A

Middle cerebral artery

143
Q

Stroke follow up

What do you send pt home on?

A

Aspirin 300mg daily for 2 weeks
Then clopidogrel 75mg daily long term
Plus statin therapy

144
Q

Spinothalamic sensory loss

‘Cape-like’ (neck and arms) loss of sensation to temp – but preservation of light touch, proprioception, vib

A

Syringomyelia

Collection of CSF in SC

145
Q

Idiopathic intracranial hypertension management

A

Management is with repeated therapeutic lumbar punctures
→ pressure is lowered by draining off CSF until symptoms settle and with acetazolamide

± a lumboperitoneal or ventriculoperitoneal shunt in resistant cases

Look for assoc causative medications (tetracycline abx, contraceptives, steroids, levothyroxine, lithium)

146
Q

Which vessel is affected subdural hemorrhage?

A

Bridging veins between cortex and venous sinus

147
Q

Which vessel is affected in an epidural haemorhage

A

Middle menigeal artery

148
Q

Berry aneurysm rupture leads to a:

A

Subarachnoid haemorrhage

149
Q

Triad of progressive cognitive impairment, Parkinsonism, Visual hallucinations

A

Lewy Body Dementia

150
Q

Wernicke’s encephalopathy caused by:

+ features:

A

Thiamine (B1) deficiency

Opthalmoplegia/nystagmus, ataxia, confusion

151
Q

Features of Korsakoff syndrome

A

Amnesia and confabulation

152
Q

Urinary incontinence, dementia, ataxia (falls, gait abnormality)

A

Normal pressure hydrocephalus

Wet, Wobbly, Wacky

153
Q

Management of normal pressure hydrocephalus

A

Management with ventriculoperitoneal shunt

A reversible cause of dementia seen in elderly pts
2ndary to ↓CSF absorption at arachnoid villi

154
Q

Parkinsonism + postural HTN + ataxia (early falls)

A

Mutisystem atrophy

Parkinsons plus disorder with autnomic instability, earlier falls and faster progression than parkinsons

155
Q

Ataxia, bradykinesia, dementia

Difficulty moving eyes, particularly vertically (difficulty reading)

A

Progressive supranuclear palsy

156
Q

Causes of Parkinsonism

A 
Parkinson’s disease
Drug induced e.g. antipsychotics, phenothiazines, metoclopramide
Progressive supranuclear palsy
Multiple system atrophy
Wilson’s disease 
Toxins – e.g. CO
157
Q

Liver and neuro disease

Hepatitis, cirrhosis, dementia, speech/behaviour change, chorea

A

Wilson’s disease

158
Q

Wilsons disease inheritance pattern

A

Auto recessive (Chr 13)

159
Q

Eye signs in Wilson’s disease

A

Kayser-Fleischer rings

160
Q

Test for Wilson’s disease

Management for Wilson’s disease

A

Test with copper studies (serum copper, serum caeruloplasmin, urine copper)

Management – penicillamine (chelates copper)

161
Q

Lethargy, erectile dysfunction, arthalgia, bronze skin

Chronic liver disease, cardiac failure

A

Haemochromatosis

162
Q

Haemochromatosis inheritance pattern

A

Auto recessive (Ch 6)

163
Q

Medical Alzheimer’s management

A

Mild to mod – manage with acetylcholinesterase inhibitors: donepezil, galantamine, rivastigmine

Memantine (NMDA-R antagonist) used 2nd line

164
Q

Bitemporal hemianopia

Upper vs lower quadrant defects

A

Upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

Lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

165
Q

Erb-Duchenne brachial plxus injury

Which nerves and what signs?

A

C5, C6 – winged scapula

Commonly seen with breech presentation

166
Q

Klumpke’s paralysis

Which nerve and what signs?

A

T1
Loss of intrinsic hand muscles, due to traction pulling arm up

(Klumpky monkey)

167
Q

Most common complication of menigitis

A

Sensorineural hearing loss

168
Q

SC lung cancer, weakness worse in legs

Weakness improves with muscle use

A

Lambert-Eaton syndrome

169
Q

Hereditary sensory and motor peripheral neuropathy

↓Power, LMN signs (↓reflexes, wasting) and reduced sensation
May see foot drop, distal muscle wasting

A

Charcot Marie Tooth

170
Q

GCS

A

M6 V5 E4

MOTOR

6) obeys commands
5) localises to pain
4) withdraws from pain
3) abnormal flexion to pain (decoritcate posture)
2) extending to pain
1) none

VERBAL

5) orientated
4) disoreintated
3) words
2) sounds
1) none

EYE OPENING

4) spontaneous
3) to speech
2) to pain
1) none

171
Q

Nerve roots for reflexes

Ankle
Knee
Biceps
Triceps

A

Ankle S1-S2
Knee L3-L4
Biceps C5-C6
Triceps C7-C8

172
Q

Which nerve is most likely to be affected in a midshaft humeral fracture?

What deformity, sensory loss and weakness will be present?

A

Radial

Deformity - wrist drop
Sensory - dorsal aspect of thumb
Weakness - wrist extensors

173
Q

Which nerve is most likely to be affected in a medial epicondyle fracture fracture?

What deformity, sensory loss and weakness will be present?

A

Ulnar

Deformity: claw hand (hyperext MCP, flex at D/PIP of 4+5th digits)
Hypothenar wasting

Sensory loss - medial palmar surface, medial 1 and 1/2 digits

Weakness - Medial 2 lumbricles, interossei, aDductor pollicis, hypothenar muscles (digiti minimi), flex carpi ulnaris

174
Q

Which nerve is most likely to be affected in a supracondylar fracture or wrist laceration?

What deformity, sensory loss and weakness will be present?

A

Median

Deformity - thenar wasting
Sensory loss - lateral 2 and 1/2 digits

Weakness -

  • Above elbow: reduced wrist flex and forearm pronation
  • In hand: LOAF
175
Q

Nerve injured in axillary dissection eg. post masectomy

Loss of sensation to axilla

A

Intercosto-brachial

176
Q

Foot drop and loss of sensation to dorsum of foot?

A

Common peroneal nerve

177
Q

Anaphylaxis management

How to confirm it was anaphylaxis and how long to keep in hospital?

A

500 mcg (0.5 ml 1 in 1000) Adrenaline

200mg hydrocortisone, 10mg chlorphenamine

Can repeat adrenaline every 5 mins
Back to back salbutamol inhalers as long as resp sx continue

Following anaphylaxis emergency tx, pts must be observed for 6-12 hours from the onset of sx before discharge is allowed
→ Risk of biphasic reaction

Test whether rxn was anaphylaxis – serum tryptase
Can remain elevated for up to 12 hours post-acute episode

178
Q

Cancers that metastasise to the lung

A

Breast, bladder, kidney, prostate, rectum

BBBBB
Breast, Bladder, Bidney, Brostate, Brectum

179
Q

Post op resp difficulty
Fine crackles, areas of collapse with resonant percussion note

Plus management

A

Atelectasis

Management: chest physio with mobilisation and deep breathing exercises

180
Q

COPD treatment

A

Smoking cessation, annual influenza, one-off pneumococcal

  1. SABA or SAMA first line
  2. 2nd line:
    - FEV1 >50% - LABA or LAMA
    - FEV1 <50% - [LABA and ICS] combo or [LAMA]
  3. If persistent SOB or exacerbations
    - If taking LABA switch to [LABA + ICS] combo
    - Or give triple therapy: LAMA and [LABA + ICS]

Note: discontinue SAMA when starting LAMA

Consider theophylline if above therapies ineffective
Consider mucolytics if chronic productive cough

Smoking cessation and long term O2 only factors that improve survival

181
Q

COPD severity stages

Based on FEV1

A

All have FEV1/FVC ratio <0.7

Stage 1 Mild - FEV1 >80%
Stage 2 Moderate - FEV1 50-79%
Stage 3 Severe - FEV1 30-49%
Stage 4 Very Severe - <30%

182
Q

Investigations to confirm asthma

A

Adults with suspected asthma should have both a FeNO test and spirometry with reversibility

183
Q

Causes of CXR mediastinal widening

A

Technical factors (rotation), vascular (thoracic AA), lymphoma, retrosternal goitre

184
Q

Pneumothorax management

A

Primary (no underlying disease)
 <2cm and no SOB – consider discharge
 If >2cm and/or persistent SOB – aspirate
Chest drain if this fails, review OP 2-4 weeks if success

Secondary (underlying resp disease)
 If >50 years and >2cm and/or SOB – chest drain
 If 1-2cm – aspirate first, if no success then chest drain
 If <1cm – give O2 and observe 24 hrs
 All secondary penumo should be admitted and observed for at least 24 hours

185
Q

Indication for surgery in bronchiectasis

A 
Uncontrollable haemoptysis
Localised disease (e.g. to one lobe)
186
Q

Pleural effusion

Chest drain indicated if:

A

Purulent or cloudy fluid on sample

Presence of organisms shown by G stain or culture of sample

Pleural fluid pH <7.2 in suspected pleural infection

187
Q

Pleural effusion

Exudate vs transudate

A

Exudates if protein level >30 g/L, transudate if <30
Use Light’s criteria if between 25-35

Exudate likely if ≥1 of:
• Pleural fluid protein/serum protein >0.5
• Plural fluid LDH/serum LDH >0.6
• Pleural fluid LDH >2/3 upper limit of normal serum LDH

188
Q

Features of

Kartagener’s syndrome

A

Primary ciliary dyskinesia

Features → dextrocardia/sinus inversus, bronchiectasis, recurrent sinusitis, subfertility

189
Q

CENTOR criteria

For Strep pharyngitis

A 
	Age 
	Presence of tonsillar exudate
	Tender ant cervical lymphadenopathy
	Hx of fever
	Absence of cough
190
Q

Pulmonary fibrosis causes

Affecting upper vs lower lobes

A

Idiopathic pulmonary fibrosis, CTD (e.g. SLE), drugs – tend to predom affect lower zones

Hypersensitivity pneumonitis, sarcoid, TB – upper zones

191
Q

Features of sarcoidosis

A

Multisystem disorder of unknown aetiology characterised by non-caseating granulomas

Features:
• Acute – erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
• Insidious – dyspnoea, cough, malaise, weight loss
• Skin – lupus pernio (raised indurated purple lesion on face)
• Hypercalcaemia (macrophages in granulomas cause ↑conversion of Vit D to active form

192
Q

Diseases caused by asbestos

A

Cause a variety of diseases:
• Benign pleural plaques
• Pleural thickening
• Asbestosis (lower lobe fibrosis, severity = length exposed)
• Malignant mesothelioma (v limited exposure can cause disease, v poor prognosis)
• Risk factor for lung cancer

193
Q

Scoring scale and management of obstructive sleep apnoea

A

Screen using Epworth scale
Definitive diagnosis with sleep studies

Tx: ↓weight, ↓alcohol, sleep on side ± CPAP

194
Q

ALS protocol for choking

A

First ask “are you choking?”

If pt can answer ‘yes’ → mild airway obstruction
Encourage pt to cough

If unable to answer → severe airway obstruction
Other sings: wheezing, silent cough, LOC

  1. Give up to 5 back-blows (sharp blow between shoulder blades with heel of hand)
  2. Give up to 5 abdominal thrusts (fist between umbilicu and ribcage, pull sharply inwards and upwards)
  3. If unsuccessful continue above cycle

If unconscious – call for ambulance, start CPR

__Y6 Finals Revision (14 decks)

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