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acute medicine Flashcards

1
Q

What rest can confirm anaphylaxis?

A

Serum tryptase

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2
Q

Adult dose of for anaphylaxis

A

500 micrograms (0.5ml 1 in 1000) if older than 12

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3
Q

How long can you confirm serologically that anaphylaxis occurred

A

Serum tryptase are raised for up to 12 hours

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4
Q

What drug is used to treat adrenaline induced ischaemia

A

local injection of phentolamine, a short acting alpha blocker

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5
Q

features of carbon monoide poisoning

A

headache (90%), N&V (50%), vertigo 50%, confusion (30%), pink mucosas,
Sats may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin

So do ABG

typical carboxyhaemoglobin levels
< 3% non-smokers
< 10% smokers
10-30 symptomatic
>30 severe
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6
Q

features of Anti-NMDA receptor encephalitis

A

visual/auditory hallucinations, agitation,

Paraneoplastic syndrome related to ovarian ca

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7
Q

Electrolyte abnormality that increased risk of torsades

A

Hypocalcemia, hypokalemia, hypomag

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8
Q

What is G6PD deficiency

A

X linked recessive disease that triggers haemolytic crises following oxidative stress… I.e. ciprofloxacin or broad beans or henna

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9
Q

STEMI thrombolysis two options of meds

A

tenecteplase is cheaper and easier than TPA

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10
Q

Management after thrombolysis of stemi

A

ECG after 90 minutes, if less than 50% reduction in ST elevation then PCI, but PCI also beneficial for both

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11
Q

Child with neck swelling, biopsy shows starry sky microscopy, diagnosis and causative pathogen

A

Burkitt’s lymphoma and ebv

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12
Q

reduced vision and poorly reactive pupils, homeless gentleman. What has he taken?

A

Methanol

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13
Q

Features of Lambert Eaton syndrome

A

Associated with small cell lung cancer, sometimes breast cancer, or independently

Repeated muscle contraction leads to increased strength … Then weakness (legs then arms), hyporeflexia, autonomic symptoms: dry mouth, impotence, difficultly micturating

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14
Q

Antibody associated with Lambert Eaton syndrome

A

Voltage gated sodium antibodies affecting pre synapses in peripheral nervous system

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15
Q

Antibody is myasthenia gravis

A

Acetylcholine receptor antibody in 85-90%

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16
Q

In renal transplant what is the most important HLA antigen to match

A

DR > B > A

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17
Q

Mechanism of action of N-Acetylcysteine

A

Replenishes glutathione
-it’s a precursor, and glutathione then conjugates and denatures the toxins. Conjugation of paracetamol is saturated in overdose)

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18
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
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19
Q

What virus causes rabies

A

RNA rhabdovirus - lyssavirus , a bullet-shaped cspsid

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20
Q

Normal anion gap

A

10-18 mmol/L

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21
Q

Causes of raised anion gap metabolic acidosis

A

Caused by impaired H+ excretion

Lactate (shock, hypoxia eg PE)
toxins (methanol),
Ketones (DKA)
Renal

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22
Q

Causes of normal anion gap metabolic acidosis

A

Addison’s
Bicarbonate loss ( GI or renal)
Chloride excess
Diuretics

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23
Q

Treatment of serotonin syndrome

A

supportive, IV fluids, benzos, in severe cases : Cyproheptadine (h1 and 5HT antagonist)

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24
Q

Causes of absent radial pulse

A

Takayasu’s arteritis (malaise headache, intermittent claudication)
Aortic dissection with subclavian involvement
Peripheral arterial embolus
Trauma
Iatrogenic (postcath)

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25
What are staghorn calculi usually composed of
Magnesium ammonium phosphate - struvite
26
Two radiolucent calculi types
Urate, xanthine | cystine is semi opaque .. Ground glass
27
Management of tricyclic antidepressants overdose
Iv bicarb may reduce risk of seizures IV lipid emulsion is being used to bind free drug and reduce toxicity DIALYSIS IS INEFFECTIVE
28
Management of high altitude cerebral oedema
Decent and dexamethasone
29
Features of dengue fever
Headache, fever myalgia, pleuritic pain, Mac pap rash
30
Treatment for shigella
Cipro
31
Diagnosis following a discrete episode of antero/retrograde amnesia and repetitive questioning without other impairment... But can remember their own name and DOB
Transient global amnesia
32
Features of amoebiasis
Bloody diarrhoea, stool microscopy trophozoites if 15min or kept warm! Can cause liver abscess. Metro
33
Non nitrate producing bacturia
Gram positive effect staphylococcus
34
causes of toxoplasmosis
cat faeces, but also rat. and undercooked meat
35
important test to do if suspecting toxo
pregnancy, due to congenital toxoplasmosis
36
classic symptoms of infective mononucleosis of low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise...but EBV negative??
consider acute toxoplasmosis infection in an immunocompetent patient remember to then consider pregnancy, due to congenital toxoplasmosis
37
classical features of cyanide poisoning
'classical' features: brick-red skin, smell of bitter almonds
38
Investigation for thyphoid
Large volume blood culture Can use Widal test by low sensitivity and specificity
39
Features of typhoid
Fevers, headaches, arthralgia, Abdo pain constipation , rose spots in trunk... Encephalitis
40
features of Typhus
black eschar and site of entry. fever, headache... treat with doxy
41
Features of drug inducted lupus
Typical features, without renal or neuro
42
Recurrent DVT inr
3.5
43
What do you give to asthmatic with SVT
verapamil because adenosine is contraindicated
44
Treatment for Cryptosporidium
Supportive
45
Features of Wiskott-Aldrich syndrome
recurrent bacterial infections (e.g. Chest) eczema thrombocytopaenia X linked recessive Low IgM
46
What factor is good prognostically for sarcoid
erythema nodosum and not being black (!)
47
lateral femoral cutaneous nerve (LFCN) origin
L2/3 meralgia paraesthetica.
48
Diagnosis of meralgia paraesthetica
Pelvic compression test induces symptoms
49
Patient presenting with auricular chondritis, saddle nose, bilat hearing loss, arthralgia, hoarseness...
Relapsing polychondritis - a multi-systemic condition characterised by repeated episodes of inflammation and deterioration of cartilage... Most commonly ears Saddle nose and deafness are also caused by congenital syphilis... And saddle nose can be seen in Granulomatosis with polyangiitis (Wegener's granulomatosis)
50
Saddle nose deformity... diagnoses
Relapsing polychondritis -reduced hearing and auricular chondritis, all cartilage inflammation Congenital syphilis... Child with deafness, peg shaped upper incisors Granulomatosis with polyangiitis (Wegener's granulomatosis)... Haematuria and cANCA
51
Woman came back from Turkey, seizure, after having headaches. multiple calcified lesions on the CT hea
Neurocysticercosis
52
Thick dense bones prone to fracture...bone pains... Normal calcium ALP and phosphate. Diagnose and mechanism
Osteopetrosis | Defect in osteoclasts activity
53
Patient with meningitis. When do you give dex?
Give with first dose of cefotaxime Continue for 4 days if pneumococcal meningitis suspected This reduces the risk of neurological sequela
54
Patient back from Tanzania, odd behaviour, pyrexial, reversed sleep wake cycle
African trypanosomiasis Aka African sleeping sickness American trypanosomiasis is Chagas. Mostly asym but can get myocarditis
55
Woman fit and well has cats, gets fever and lymphadenopathy. Raised ESR and positive IgG and IgM for toxo. What's management?
Reassure! Immunocompetent patients with toxoplasmosis don't usually require treatment, unless severe Would treat with pyrimethamine, sulfadiazine and folinic acid for 4 to 6 week
56
Patient with peritonsilar abscess develops neck pain...
Patients with peritonsillar abscesses can develop Lemierre's syndrome (thrombophlebitis of the internal jugular vein)- this can present with neck pain and can result in septic pulmonary embolism
57
macroscopic haematuria in young people days after an upper respiratory tract infection... Diagnosis
``` IgA nephropathy (raised c3) Weeks after is post-strep glumerulonephritis (and low compliment levels) ```
58
Patient presents with dissection of descending aorta. What is management
IV labetalol only
59
What is heerfordt syndrome
Subset of sarcoidosis Parotid enlargement, fever, anterior uveitis Bilat hilar lymphadenopathy and erythema nodosum
60
Treatment for cyanide poisoning
hydroxocobalamin (intravenously)
61
Management of torsades de pointes
IV magnesium sulfate is used to treat torsades de pointes
62
Commonest bacteria cause of otitis media
Stept pneumoniae
63
Commonest bacterial cause of tonsillitis
Stept pyogenes
64
Features of Whipple's disease
Middle aged man, with malabsorption (diarrhoea/weight loss), arthralgia, hyperpigmentation and lymphadenopathy Infection... Most common in hla b27 +ve middle aged men
65
Patient presents with rapid weight gain, diplopia in mornings and before meals, and intermittent sweating. What is likely diagnosis
Insulinoma Diplopia related to hypoglycemia
66
What investigation diagnoses obstructive sleep apnea
Polysomnography
67
Features of cholesterol embolism
Eosinophilia (in 70%) Purpura Renal failure Livedo reticularis... net-like rash Often post vascular surgery or angio
68
Definitive management for patient with endocarditis and severe congestive cardiac failure
emergency valve replacement surgery Other indications are overwhelming sepsis despite Abx Recurrent embolic episodes Pregnancy
69
Young female, hypertension and asymmetric kidney... diagnosis
``` fibromuscular dysplasia (90% female) Flash pulmonary oedema and kidney failure following ACEi ```
70
brown/bluish pigment of the ear cartilage or sclera, arthropathy, renal stones, cardiac valve involvement and coronary calcification.. diagnosis
Alkaptonuria
71
Features of leptospirosis
Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker, farmers vets, abbertoire or rat urine Renal failure in 50% jaundice..... Treat with benpen or doxy
72
How long do you monitor someone post anaphylaxis
should be observed for 6–12 hours from the onset of symptoms, as it is known that biphasic reactions can occur in up to 20% of patients
73
management of listeria meningitis
usually under 3m or over 60yr /immunosup IV amoxicillin + gentamicin
74
prophylactic management of contacts of meningitis
Rifamp or Cipro for contacts of meningococcus meningitis
75
patient allergic to latex. What food allergy are they most likely to have?
Latex-Fruit syndrome...so particularly banana, pineapple, avocado, chestnut, kiwi fruit, mango, passion fruit and strawberry
76
patient presents who is eating clay. Diagnosis?
geophagia (ingesting clay/soil) can occur in Zinc deficiency, iron def, pregnancy
77
what blood result would you expect in a diagnosis of cholesterol embolism?
Eosinophilia is seen in around 70% of cases of cholesterol embolisation.
78
Management of witnessed cardiac arrest while on a monitor, which shows VF
up to three successive shocks before CPR for VF or pulseless VT Amiodarone 300mg is administered after the third shock (in shockable rhythms)
79
Management of oesophageal varices.... acute and prevention
Acute; terlipressin | Prevention: propranolol
80
Treatment for local anaesthetic toxicity
IV 20% lipid emulsion
81
Management of severe hypocal
IV calcium gluconate 10ml of 10% over 10 minutes
82
Patient presents with chronic abdo pain, psychiatric issues like depression, and neuropathy. Mum had same. Diagnosis?
Acute intermittent porphyria Auto dom Urine turns deep red on standing
83
Active ingredient in anti freeze poisoning
Ethylene glycol USED to be methanol...... So you don't get loss of vision with antifreeze Mx toxicity with - fomepizole, ethanol is second line
84
Skin necrosis after starting warfarin. Diagnosis
Protein c Def Auto dom, thrombosis
85
Mx of aspirin OD
Charcoal if within an hour,or IV sodium bicarbonate
86
Most common infective cause of haemolytic uraemic syndrome
E coli 0157:h7 accounts for 90% of cases in children
87
Single most important factor to indicate the need for a liver transplant post paracetamol od
pH < 7.3 , 24hr after ingestion Or all of: PT>100 Cr >300 Grade 3 or 4 enceph
88
How do you distribution TRALI and TACO
hypotension in TRALI vs hypertension in TACO Fever and leukopenia in TRALI
89
Patient just started chemo and they develop low calcium, high phosphate, AKI.. diagnosis
Tumour lysis syndrome
90
Patient who is Turkish, Armenian, or Arabic Presents with pyrexia, arthralgia, abdo pain and pleurisy
Familial Mediterranean fever
91
Management of high altitude pulmonary oedema and of high altitude cerebral oedema
HAPE Descent and acetazolamide, nifidipine, dexamethasone | HACE descent and dexamethasone
92
Patient on warfarin for AF, intracranial haemorrhage
Stop warfarin IV vit K 5mg Prothrombin complex concentrate
93
Abdo pain, blue lines on gum, motor neuropathy, constipation . What poison?
Lead poisoning Lead > 10 mcg/dl are considered significant Give D-penicillamine Or DMSA

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