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MRCP 2 > Acute / General > Flashcards

Acute / General Flashcards

1
Q

Patient with EColi 0157.
Slightly raised WCC, PT, AKI, slightly low Plt (123)
Management

A

Majority recover spontaneously w best supportive care

Diarrhoea positive: supportive care
Diarrhoea negative: urgent plasma exchange

Eculizumab may have role in mx of atypical HUS

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2
Q

How does multifocal motor neuropathy present

A

MMN is autoimmune, progressive weakness in limb.
Normal sensation
Fasciculation

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3
Q

I’m the stomach, maltomas (aka marginal zone lymphomas) are associated with….

A

H pylori

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4
Q

I’m the eyes, maltomas (aka marginal zone lymphomas) are associated with….

A

Sjogren syndrome

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5
Q

I’m the thyroid, maltomas (aka marginal zone lymphomas) are associated with….

A

Hashimotos thyroiditis

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6
Q

I’m the bowel, maltomas (aka marginal zone lymphomas) are associated with….

A

Crohn’s or coeliac disease

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7
Q

Most common cause of ARDS

A

Sepsis… Causes increased permeability of pulmonary micro circulation, due inflammation causing leakage of fluid to lungs

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8
Q

Causes of acquired factor VIII deficiency

A

Assx with Psoriasis, Pemphigus, Pencillins, cePhalosporins and malignancy

Increased APTT

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9
Q

40yr old hpertensive patients despite max amlodipine and ramipril. What test?

A

? Primary hyperaldosteronism

So plasma Renin, aldosterone and cortisol levels after two weeks without antihypertensive. ACEi can increase renin, CA antag can reduce aldosterone

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10
Q

Features of niacin deficiency

A

Aka pellagra… Rare but can be seen in alcohol dependence/eating disorders

Dementia, dermatitis and diarrhoea……. But constipation not uncommon

Dermatitis is predominantly sun exposed areas

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11
Q

What gender and age are most likely to get malignant melanoma

A

Men over 50

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12
Q

Patient with absence of smell, and hypogonadotrophic hypogonadism diagnosis

A

Kallmans

Absent olfactory bulb in 75%

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13
Q

Management for idiopathic intracranial hypertension

A

Mainstay is weight loss, although not great evidence

Acetazolamide
topiramate(esp if migraine too)

Corticosteroids generally not recommended because of steroid withdrawal headaches

Serial LPs

1/3 relapse
Half have long-term visual problems
10% signif visual problems

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14
Q

Prognosis of idiopathic intracranial hypertension

A

Good response to meds but:

1/3 relapse
Half have long-term visual problems
10% signif visual problems

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15
Q

Features of brucellosis

A

Chronic granulomatous disease
Weight loss, splenomegaly, bone pain(in 55%)
PUO
Neutropenia & thrombocytopenia

Bone marrow aspiration and culture

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16
Q

Young patient with testicular tumour develops anxiety, tenor, diarrhoea. Why?

A

Raised bHCG, serum AFP and LDH can all be raised in germ cell tumors

bHCG is similar to TSH so can cause hyperthyroid state

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17
Q

GHB overdose management

A

Supportive…
Charcoal for up to 1h after ingestion

Presents with
GI side effects
Euphoria
Drowsiness
Cheyne's Stoke and coma
Metabolic acidosis, hypergly, hyperkal ,hypernat
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18
Q

GHB overdose features

A 
Presents with
GI side effects
Euphoria
Drowsiness
Cheyne's Stoke and coma
Metabolic acidosis, hypergly, hyperkal ,hypernat

Dissolves in water and tastes like seaweed!

Gi High Breathing

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19
Q

Rib notching on CXR…. Other signs?

A

Coarctation of the aorta

With late systolic murmur and radiofemoral delay

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20
Q

Women asking chance her child has CF
Husband carrier
Prevalence 1/20

A

1/20 (female carrier risk) X 1/2 (male risk) X 1/2 (female risk of passing gene on

So 1/80

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21
Q

Dislocation of lens upwards Vs downwards

A

Downwards in homocysteinuria

Upwards in Marfan’s

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22
Q

What’s the r mutation in peutz jeghers syndrome

A

STK 11

Serine / threonine kinase

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23
Q

Positive serology for syphilis but presentation with multiple ulcerating subcut nodules present for many years

Diagnosis

A

Yaws
Caused by Treponema pertenue - indistinguishable serology to syphilis…can be present for many years too

Also treated with penicillin though

Skin-skin transmission
multiple lesions appear all over the body

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24
Q

Features of legionella

A

Dry cough, D+V, elevated transaminase, relative Bradycardia
Pleural effusion in 50%
Hyponat
lymphopenia

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25
Q

Features of hashimotos encephalopathy

A

Behavioural, psychiatric disturbance with sensory phenomena

Also assx with anti TPO antibodies

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26
Q

Which lqt has congenital deafness

A

Jowel and Lange-Nielson syndrome has profound deafness

RomaNO ward = NO deafness

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27
Q

Mean age of primary pulmonary hypertension

A

36 years old

Exertional dyspnoea, syncope and RHF

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28
Q

Going under GA, becomes rigid, temp 42, high pCO2

A

Malignant hyperthermia due to isoflurane or halothane

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29
Q

Patient with clubbing and long bone pain

Bone scan showing symmetrical uptake in trabecular bones and the periarticular surfaces

A

Hypertrophic pulmonary osteoarthropathy…….. Seen in bronchial carcinoma

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30
Q

Immunology screen of patient with alcohol excess

A

Raised IgA

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31
Q

Malignancy + raised CK + symmetrical proximal weakness

A

?polymyositis

Treat with prednisolone

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32
Q

Granulomatosis with polyangiitis (Wegener’s granulomatosis) Vs churg Straus

A

graNulomatosis wegeNers Nose - saddle-shape nose deformity, epistaxis, sinusitis, nasal crusting

Both can have sinusitis

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33
Q

Acute heart failure not responding to medical treatment with severe dyspnoea

A

Consider CPAP

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34
Q

Triad for Wernicke’s encephalopathy

A

Ophthalmoplegia, ataxia, encephalopathy

nystagmus is the most common ocular sign

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35
Q

Gram-positive bacilli (or rods)

A 
ABCDL
Actinomyces
Bacillus anthracis
Clostridium, Corynebacterium
Diphtheria
Listeria monocytogenes
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36
Q

criteria for decompressive hemicraniectomy in an acute stroke after presenting as a malignant MCA syndrome:

A
  • 60 or younger
  • Clinical deficits suggestive of infarction in the territory of the middle cerebral artery, with a score on the National Institutes of Health Stroke Scale (NIHSS) of above 15.
  • Decrease in the level of consciousness to give a score of 1 or more on item 1a of the NIHSS.
  • CT showing infarct > 50% of the MCA territory, with or without additional infarction in the territory of the A or PCA on the same side, or infarct volume greater than 145 cm3 as shown on diffusion-weighted MRI.
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37
Q

Patient with HIV and asthma develops cushingoid features…why

A

HIV protease inhibitors are p450 inhibitors, so cause steroid build up from inhalers

Like atazanavir and ritonavir

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38
Q

Thrombectomy after stroke

A

together with intravenous thrombolysis (if within 4.5 hours)…

Within 6hr if confirmed occlusion of the proximal anterior circulation

Or from 6-24hr confirmed occlusion of the proximal anterior circulation with salvageable tissue

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39
Q

Management in an arrest if patient is in asystole , given Adrenaline and develops p-waves

A

P-wave systole….

external pacing can result in a return of spontaneous circulation

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40
Q

Management of immunocompromised patients with neuro toxo - multiple ring enhancing lesions on CT

A

pyrimethamine and sulphadiazine.

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41
Q

dactylitis and distal interphalangeal swelling, joint pain

A

Psoriatic arthritis even if no skin changes

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42
Q

Triad of thallium poisoning

A

fluctuating mood, with or without confusion, painful distal paraesthesia and alopecia

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43
Q
  • sudden painless loss of vision,

severe retinal haemorrhages on fundoscopy

A

Central retinal vein occlusion

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44
Q

What is carcinoid syndrome

A

When metastases are present in liver and release serotonin

Investigation: urinary 5-HIAA

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45
Q

Investigation for GBS

A

Raised CSF protein and normal WBC

Can do nerve conduction

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46
Q

Definition of TIA

A

transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

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47
Q

50yr presents with seizure and drowsiness.

CT shows solid tumour with central necrosis and a rim that enhances with contrast

A

Glioblastoma

  • most common primary tumour in adults
  • poor prognosis (~ 1yr).
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48
Q

Intravenous urogram - clubbed calyces and ring signs.

A

Papillary necrosis

Caused by chronic analgesia use, sickle, TB, pyelonephritis,DM

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49
Q

Treatment for acute intermittent porphyria flare

A

Haem arginate and 10% dextrose can be used to treat flares of acute intermittent porphyria

(Will have increased levels of delta aminolevulinic acid and porphobilinogen in urine)

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50
Q

Causes of gram negative endocarditis

A

HACEK

Haemophilusspecies,
Actinobacillus actinomycetemcomitans,
Cardiobacterium hominis,
Eikenella corrodens, (human bite)
Kingellaspecies
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51
Q

absolute contraindication for electroconvulsive therapy

A

The only absolute contraindication for electroconvulsive therapy is raised intracranial pressure

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52
Q

What is beriberi

A

Vitamin B1 (Thiamin) deficiency,

dry beriberi: peripheral neuropathy
wet beriberi: dilated cardiomyopathy

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53
Q

Patient with gout. Previous asthma and also diarrhoea from colchicine. Management

A

For gout, if NSAIDs and colchicine are contraindicated or not tolerated (e.g. chronic kidney disease, asthma etc), the next option is a oral prednisolone

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54
Q

dyspnoea and hypoxaemia within 72 hours postoperatively

A

basal atelectasis -

mucous trapped in the bronchial tree results in small airway obstruction… Chest physio

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55
Q

Facioscapulohumeral muscular dystrophy inheritance

A

(FSHMD) is an auto dom muscular dystrophy.

Clue is in the name - affects the face, scapula and upper arms first, typically by years

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56
Q

Patient presents with foot drop, left ankle dorsiflexion (2/5) and eversion (2/5), intact ankle inversion and flexion of the big toe

A

More likely common peroneal palsy than L5 ridiculopathy because of intact ankle inversion / flexion of big toe

Common peroneal sensory loss is usually lat aspect of the lower leg and the dorsum of the foot

L5 sensory loss- thin strip down the middle of the anterior lower limb ( not lateral lower leg)

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57
Q

Young female patient presents with signs of stroke. CT brain angio shows “STRING OF BEADS” appearance. Diagnosis?

A

Fibromuscular dysplasia (FMD)

  • a non-atherosclerotic, non-inflammatory condition producing segmental stenoses in all vascular beds
  • confirm with CT angio of kidneys
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58
Q

Pleuritic pain in a pregnant lady, investigations in order

A

ECG & CXR -> bilateral leg dopplers (treat with LMWH if +ve)> if still uncertain , CTPA or VQscan (lower radiation)

RCOG says don’t do D Dimer

V/Q: increased risk of childhood cancer (1/50,000 v 1/1,000,000 in CTPA)
CTPA increased risk of maternal breast cancer (13.6%)

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59
Q

Patient is given digoxin for AF with fast VR but then deteriorates to fast broad complex tachy and becomes unresponsive. Cause?

A

Could be Wolf Parkinson White.. OR cardiac AL amyloidosis

Giving digoxin caused VF arrest

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60
Q

Patient presents with headaches. Normal CT and LP, MRI showed meningeal enhancement, thickening,, and shallow subdural hematoma

A

MRI scan are features of low pressure headaches, so oral fluids, caffeine/blood patch

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61
Q

Patient with RA develops mouth ulcers. Management

A

Stop methotrexate and speak to rheum

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62
Q

Management for optic neuritis

A

IV Methylprednisolone

Better visual recovery and reduced conversion to MS than oral pred
10y risk of MS 38% after initial episode of ON
56% if the MRI had one or more lesions

15y risk 50%

63
Q

Investigation for idiopathic intracranial hypertension

A

LP for pressures >25
Visual field charting
CT venography to role out cerebral venous thrombosis

64
Q

smudge cells

A

Larger percentage of smudge (aka smear) cells is better prognosticaly for CLL

65
Q

Diagnostic test to confirm polyarteritis nodosa (PAN).

A

Renal angiogram (sensitivity 89%, specificity 90%

ANCA are found in around 20% of patients with ‘classic’ PAN

66
Q

Treatment for tick-borne encephalitis…

A

Treatment for tick-borne encephalitis is supportive

67
Q

Management of sickle cell crises

A

Exchange transfusion if neuro complications

Blood transfusion, rehydration etc

68
Q

Difference between cluster headaches, paroxysmal hemicrania and hemicrania continua

A

All trigeminal autonomic cephalalgias…

CH 8/day - every other day
15-180 mins

PH. >5/day,
2-30 min
Responds absolutely to indomethacin

HC. Constant headaches
Responds absolutely to indomethacin

69
Q

Waking with paralysis, particularly after big carby meal

ECG with flat T waves.

A

Hypokalaemic periodic paralysis

; rare autosomal dom

70
Q

HIV positive patient presents with a gradual deterioration in his vision

A

cytomegalovirus retinitis

Typically CD 4 <200

IV ganciclovir
or its prodrug PO valganciclovir

71
Q

HIV neuro toxo Vs CNS lymphoma

A

Toxo more common
CT shows single or multiple ring-enhancing lesions
Mx with sulfadiazine and pyrimethamine

CNS lymphoma single or multiple homogenous lesions (usually single)
Mx steroids and chemo with methotrexate

72
Q

Main SE to council patients with levetiracetam

A

behavioural abnormalities and psychotic symptoms

73
Q

Patient with short history of flu like symp with tender thyroid gland … management

A

Subacute thyroiditis

Symp control w propranolol

74
Q

Hetero Vs homozygous familial hypercholesterolemia

A

Homo usually presents in<30y, chol >15

Hetero >30y, cholesterol > 7.9 mmol/l, with normal triglyceride levels.

75
Q

best test for differentiating between delirium and dementia?

A

Confusion Assessment Method (CAM)

  1. Acute onset and fluctuating course
  2. Inattention (e.g. Counting from 20-1)
  3. Disorganised thinking
  4. Altered levels of consciousness

Needs both 1 and 2, with at least one of 3 or 4

76
Q

Lofgren’s syndrome

A

acute form sarcoidosis
characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia

Typically young Scandinavian female

Treat with pred

77
Q

TCA, e.g. amitriptyline, Overdose symptoms and treatment

A

dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision

IV bicarb

78
Q

GBS management

A

plasma exchange or
IV immunoglobulins

steroids and immunosuppressants have not been shown to be beneficial

79
Q

Churg Straus Vs wegners

A

Both sinusitis
Churg asthma eosinophilia
Weg haemoptysis/epistaxis renal failure

80
Q

Chylothorax Vs pseudochylothorax

A

chylothorax is high in triglycerides and chylomicrons

Pseudochylothorax is high in cholesterol

81
Q

Gout triggers

A

High fructose drinks - tango etc

Beer

82
Q

Management of sarcoid

A

Steroids indicated if:

  1. Hypercalaemia
  2. Extrapulmonary sarcoid
  3. CXR stage II/III with moderate to severe symptoms or progressive disease -
83
Q

PCOS Vs cah

A

Look up

84
Q

Skin test for latent TB. Reaction within a day?

A

Allergic,

Latent TB is a T4 delayed reaction!
But could be because of BCG
Then can do interferon gamma genome

85
Q

Steele-Richardson-Olszewski syndrome aka

A

eponymous name for progressive supranuclear palsy

postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

86
Q

Progressive supranuclear palsy symptoms

A

postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

87
Q

Term for minor trauma can cause new lesions

A

Koebner phenomenon

Warts And ALL (warts, autoimmune, AIDS, lichen planus & lichen sclerosis)

88
Q

Opportunistic infections by JC virus in immunocompromised patient…

A

Progressive multifocal leukoencephalopathy

Esp patients taking natalizumab

89
Q

What is gardener’s syndrome

A

Rare autodom … a variant of familial adenomatous polyposis (<1% of genetic c cancer)

Adenomatous intestinal Polyposis
50% get colon cancer by 39y

Present w change in bowel habits rectal bleeding

90
Q

Bacterial cause of Q fever

A

Coxiella burnetti (g neg)

Farmer, fever, transaminitis

91
Q

Two TIAs in last week mx

A

Crescendo TIA

So admit and CT head carotid dopplers within 24h

92
Q

muscle pain and stiffness following exercise
muscle cramps
myoglobinuria
low lactate levels during exercise

A

McArdle’s disease

autosomal recessive type V glycoge storage
Causing decreased muscle glycogenolsease

Advised to stay active though

93
Q

features of frontotemporal lobar dementias

A

Under 65
Relatively preserved memory
Personality change
Insidious onset

Pick’s disease most common type
W hyperorality, disinhibition, increased appetite, and perseveration behaviours

94
Q

Serotonin syndrome Vs neuroleptic malignant syndrome

A

SS over hours, increased reflexes, clonus, dilated pupils

NMS over days, predominantly rigidity, decreased reflexes,

95
Q

most common cause of adult-acquired epilepsy worldwide

A

Neurocysticercosis

Eggs of the Taenia Solium tapeworm are ingested, oncospheres hatch and migrate to peripheral sites (classically muscles and brain) and become cysticerci, then calcify

mass lesions in the brain ‘swiss cheese appearance’

96
Q

72 hr Post cardiac arrest, in coma. What is indicator of poor prognosis?

A

lack of pupillary light / corneal reflex at 72h is a reliable predictor of death

97
Q

What has best long-term survival benefit w MND

A

NIV

Riluzole also has modest survival benefit of 2-4 months

98
Q

Management for hereditary angioedema

A

IV C1-inhibitor concentrate

Or FFP if that’s not available

99
Q

Differential for pyrexia of unknown origin and bilateral adrenal hyperplasia

A

Lymphoma, TB, or histoplasmosis

Histo is diagnosed w FNA and Groccott strain

100
Q

R sided conductive hearing loss, pulsatile tinitus, wasting on R side of tongue… then develops hoarse voice. Diagnosis?

A

Glomus Jugulare tumour

tumour of the part of the temporal bone in the skull that involves the middle and inner ear structures

101
Q

headaches, blurred vision. Bilat swollen discs and diplopia on vertical gaze. Best next step?

A

CT first to rule out SOL

then can LP

102
Q

Management of granulomatous polyangitis

A

Pred

If end organ damage then IV ciclophosq pulsatile

103
Q

what is brachial neuritis aka neuralgic amyotrophy

A

unknow aetiology, follows infection, vaccination, surgery, trauma…
Starts with acute onset of unilat (occasionally bilat) severe pain, followed 2/52 later by shoulder and scapular weakness several days later

can be axillary sensory loss

Good prog, unless phrenic nerve involvement

104
Q

age of Friedreich’s ataxia and Ataxia telangiectasia

A

10-15y

telangiectasia: <5y

105
Q

what is cataplexy

A

strong emotions causing loss of voluntary muscle tone
Found in 70% of narcoleptics

HLA DQB1*0602 is found in 95% of pt with both narcolepsy and cataplexy

No driving until “control of symptoms”

106
Q

recurrent bacterial infections and low IgA IgG

A

common variable immunodef

B cell maturation defect

107
Q

What is Bickerstaff’s encephalitis?

A

symmetrical opthalmeplegia, ataxia, altered consciousness, hyper-reflexia

Similar to Miller Fisher (also anti GQ1b antibodies) and follows URTI, but Miller fisher has Areflexia and normal consciousness

Tx steroids IgG and plasma exchange

108
Q

What is BRASH syndrome?

A

Viscous cycle of Bradycardia, Renal failure, AV nodal blocking medication, Shock, Hyperkal

109
Q

feat of haemochromatosis

A

fatigue, ED, arthralgia
bronzing of skin
DM
Chronic liver disease, hepatomegaly
Cardiac failure (2nd to dilated cardiomyopathy)
Hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
episodic inflammatory arthritis (especially of the hands)
chondrocalcinosis and pseudogout

110
Q

timescale of HIV seroconversion

A

occurs 3-12 weeks after infection

111
Q

how is Hep B and hep C commonly transmitted in uk

A

anal intercourse and IVDU respectively

112
Q

Gonoccal arthritis vs reactive

A

reactive is large-joint monoarthritis w temp and CRP response

gonococcal arthritis is usually a migratory polyarthritis

113
Q

sore throat, pyrexia, adherent grey membrane over his soft palate and tonsils

A

membrane characteristic of:
diphtheria

Vincent angina can ALSO cause a pharyngeal membrane but there is usually also severe local tissue destruction

114
Q

feat of myotonic dystrophe

A

inherited, but features develop around 20-30yr
bilateral ptosis
facial weakness
distal weakness

115
Q

Duchenne’s vs becker’s vs myotonic dystrophes - younger?

A

Duchenne’s <5y

Becker’s >10y (intellectual impairment much less common)

Myotonic dystrophe 20-30yr

116
Q

Acephalgic migraine

A

Migraine without headache

Up to 38% of migraineurs experience migraine attacks without and with a headache, while 4% of migraineurs exclusively experience migraines without headaches

117
Q

pseudo dementia

A

depression-related

memory issues, deficits in executive functioning, and deficits in speech and language

118
Q

meningitis complicating an ear infection

A

This clinical situation is nearly always due to:

Streptococcus pneumoniae

119
Q

What CD4 count do you expect if your have PCP

A

<200 for PCP or mycobacterium avium

120
Q

what causes lateral medullary syndrome?

A

AKA Wallenberg’s syndrome

infarction of the lateral part of the medulla
by blockage of vertebral artery or the posterior inferior cerebellar artery

… thrombosis or dissection

121
Q

presentation of lateral medullary syndrome?

A

ipsilat Horner’s syndrome, laryngeal, pharyngeal, and palatal hemiparalysis
and cerebellar involvement (ataxia, nystagmus)

122
Q

post elective cholecystectomy w AF, IHD. When do you restart warfarin?

A

usually resumed 12 to 24 hours after surgery

Evidence points towards starting warfarin at the USUAL dosage
w bridging LMWH if high risk

123
Q

presentation of acute intermittent porphyria

A

abdominal and neuropsychiatric symptoms in 20-40 year old females

abdo pain, motor neuropathy, depression
urine turns deep red on standing

124
Q

urine turns deep red on standing

A

Acute intermittent porphyria

125
Q

increasingly blurry vision. Fundoscopy shows pale optic discs, microaneurysms and blot haemorrhages

Drug cause?

A

Ethambutol, known to cause optic neuritis

126
Q

inheritance of Duchenne and Becker’s muscular dystrophies

A

X-linked recessive

127
Q

feat of Myotonic dystrophy

A 
bilat ptosis
myotonic facies (long, 'haggard' appearance)
Distal weakness in DM1
Proximal weakness in DM2
cataracts
128
Q

Strongyloides stercoralis on serology. Management

A

Ivermectin

129
Q

man in 60s gets 6month hx of progressive lower limb weakness w quadriceps and finger/wrist flexors weakness. CK 830

A

Inclusion body myositis

progressive late onset myopathy

130
Q

Temporarily headache, painless loss of vision, branch retinal artery occlusion
Diagnosis

A

Temporal arteritis

IV Methylprednisolone

131
Q

Patient with CLL.
Long bone pain and prox myopathy
Hypophosphatemia

A

Oncogenic osteomalacia
Also in adenocarcinoma

Tx vit d metabolites and Phos replacement

132
Q

Normal pressure hydrocephalus

A

Cognitive impairment
Incontinence
Apraxic gait

(Unlike multisystem atrophy, postural hypotension is rare) also MSA is ataxic gait

133
Q

what cancers do you see Tumour lysis syndrome in?

A

3-7 days after chemo
for high-grade lymphomas and leukaemias

Can get autolysis too but v rare

Remember uric acid stones are Radiolucent

134
Q

bloods in tumour lysis syndrome

A

RAISED uric acid
RAISED potassium
RAISED phosphate
LOW calcium

or 25% change

135
Q

pt w neuroendocrine tumour on palliative chemotherapy becomes increasingly SOB over months.
Flushing, diarrhoea, heart failure.
Diagnosis

A

Carcinoid heart syndrome causing Tricuspid regurge

could be Superior vena cava obstruction

136
Q

presentation of antifreeze OD

A

Ethylene Glycol

similar to alcohol… confusion, slurred speech, dizziness, renal failure

metabolic acidosis with high anion gap and high osmolar gap

Really high lactate but may glycolate being misinterpreted as lactate by machine

137
Q

management of antifreeze OD

A

fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol

Same tx as for methanol OD

138
Q

Adult, tacy at 180 VT, bp 80, conscious. Management

A

Signs of shock so needs synchronised DC cardioversion x3 attempts
but needs sedating first so anaesthetics

Could start Amiodarone before anaesthetics show up (which is next step)

139
Q

Stopping NAC 12h bags?

A

after 3 bags, can stop if:
INR <1.4
and ALT under double top/ double admission

After 4 more stop if:
INR <=1.3
Or INR is <3.0 and falling towards normal on two consecutive blood tests

140
Q

New definition of sepsis

A

Suspected infection
and acute increase of >=2 SOFA points

SBP ≤ 100 mmHg
≥ 22 breaths/min
GCS ≤ 14

141
Q

septic shock definition

A

Sepsis (suspected infection and acute increase >=2 SOFA points)
Lactate >2
Vasopressor req to maintain MAP >65
…despite 30ml/kg in first 3hr

142
Q

ewing’s sarcoma

A

primary bone tumour, particularly in male children/adolescents, severe pain in pelvis/longbones

Anaemia is poor prognostically
x-ray shows ‘onion skin’ appearance

143
Q

management of cyanide poisoning

A 
hydroxocobalamin IV
amyl nitrite (inh), sodium nitrite IV, sodium thiosulfate IV

Can give IV dicobalt edetate if v unwell

144
Q

features of yellow nail syndrome

A

triad of primary lymphoedema, recurrent pleural effusions, dystrophic yellow nails

often have bronchiectasis and sinusitis

145
Q

indications of steroids in sarcoidosis

A

hypercal
eye, heart, or neuro involvement
CXR stage 2 or 3 and symptomatic

BHL + interstitial infiltrates
or diffuse interstitial infiltrates only

146
Q

IVDU, cerebral abscess, mx

A

would be fluclox but high rate of MRSA

so linezolid (good cover and crosses BBB)

147
Q

mx of osteomalacia

A

alfacalcidol

148
Q

pt on the pill presents w headache , double vision, reduced sensation to light touch on the left forehead and cheek

A

Cavernous sinus thrombosis

CN 6th nerve damage typically occurs before 3rd & 4th

149
Q

HIV pregnancy and breast feeding advice

A

vaginal delivery is recommended if viral load <50 copies/ml at 36/40

in the UK all women should be advised not to breast feed

150
Q

When do you treat paracetamol overdose

A 
If staggered (taken over longer than an hour), or unsure of time. 
Or if level is above 100mg/l at 4hr, or 15 at 15
151
Q

30 yr old woman presents with chronic abdo pain, psychiatric issues like depression, and motor neuropathy. Mum had same. Diagnosis?

A

Acute intermittent porphyria

Auto dom

Urine turns deep red on standing

152
Q

Urine turns deep red on standing

A

Acute intermittent porphyria

153
Q

most common bacterial cause of meningitis post neurosurgery

A

staphylococcus epidermis

154
Q

stroke thrombolysis absolute contraindications

A

absolute:
- Seizure at onset
- LP within 1/52
- GI haemorrhage within 3/52
- Stroke/brain injury in last 3months
- Any previous ICH
- Active bleeding
- Pregnancy
- Oesophageal varices
- Uncontrolled BP >200/120

MRCP 2 (13 decks)

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