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Mrcp > acute medicine > Flashcards

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
Q

What are staghorn calculi usually composed of

A

Magnesium ammonium phosphate - struvite

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26
Q

Two radiolucent calculi types

A

Urate, xanthine

cystine is semi opaque .. Ground glass

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27
Q

Management of tricyclic antidepressants overdose

A

Iv bicarb may reduce risk of seizures
IV lipid emulsion is being used to bind free drug and reduce toxicity
DIALYSIS IS INEFFECTIVE

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28
Q

Management of high altitude cerebral oedema

A

Decent and dexamethasone

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29
Q

Features of dengue fever

A

Headache, fever myalgia, pleuritic pain, Mac pap rash

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30
Q

Treatment for shigella

A

Cipro

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31
Q

Diagnosis following a discrete episode of antero/retrograde amnesia and repetitive questioning without other impairment… But can remember their own name and DOB

A

Transient global amnesia

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32
Q

Features of amoebiasis

A

Bloody diarrhoea, stool microscopy trophozoites if 15min or kept warm! Can cause liver abscess.

Metro

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33
Q

Non nitrate producing bacturia

A

Gram positive effect staphylococcus

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34
Q

causes of toxoplasmosis

A

cat faeces, but also rat. and undercooked meat

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35
Q

important test to do if suspecting toxo

A

pregnancy, due to congenital toxoplasmosis

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36
Q

classic symptoms of infective mononucleosis of low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise…but EBV negative??

A

consider acute toxoplasmosis infection in an immunocompetent patient

remember to then consider pregnancy, due to congenital toxoplasmosis

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37
Q

classical features of cyanide poisoning

A

‘classical’ features: brick-red skin, smell of bitter almonds

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38
Q

Investigation for thyphoid

A

Large volume blood culture

Can use Widal test by low sensitivity and specificity

39
Q

Features of typhoid

A

Fevers, headaches, arthralgia, Abdo pain constipation , rose spots in trunk… Encephalitis

40
Q

features of Typhus

A

black eschar and site of entry. fever, headache… treat with doxy

41
Q

Features of drug inducted lupus

A

Typical features, without renal or neuro

42
Q

Recurrent DVT inr

A

3.5

43
Q

What do you give to asthmatic with SVT

A

verapamil because adenosine is contraindicated

44
Q

Treatment for Cryptosporidium

A

Supportive

45
Q

Features of Wiskott-Aldrich syndrome

A

recurrent bacterial infections (e.g. Chest)
eczema
thrombocytopaenia

X linked recessive
Low IgM

46
Q

What factor is good prognostically for sarcoid

A

erythema nodosum and not being black (!)

47
Q

lateral femoral cutaneous nerve (LFCN) origin

A

L2/3

meralgia paraesthetica.

48
Q

Diagnosis of meralgia paraesthetica

A

Pelvic compression test induces symptoms

49
Q

Patient presenting with auricular chondritis, saddle nose, bilat hearing loss, arthralgia, hoarseness…

A

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
Q

Saddle nose deformity… diagnoses

A

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
Q

Woman came back from Turkey, seizure, after having headaches. multiple calcified lesions on the CT hea

A

Neurocysticercosis

52
Q

Thick dense bones prone to fracture…bone pains… Normal calcium ALP and phosphate. Diagnose and mechanism

A

Osteopetrosis

Defect in osteoclasts activity

53
Q

Patient with meningitis. When do you give dex?

A

Give with first dose of cefotaxime
Continue for 4 days if pneumococcal meningitis suspected

This reduces the risk of neurological sequela

54
Q

Patient back from Tanzania, odd behaviour, pyrexial, reversed sleep wake cycle

A

African trypanosomiasis
Aka African sleeping sickness

American trypanosomiasis is Chagas. Mostly asym but can get myocarditis

55
Q

Woman fit and well has cats, gets fever and lymphadenopathy. Raised ESR and positive IgG and IgM for toxo. What’s management?

A

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
Q

Patient with peritonsilar abscess develops neck pain…

A

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
Q

macroscopic haematuria in young people days after an upper respiratory tract infection… Diagnosis

A 
IgA nephropathy (raised c3)
Weeks after is post-strep glumerulonephritis (and low compliment levels)
58
Q

Patient presents with dissection of descending aorta. What is management

A

IV labetalol only

59
Q

What is heerfordt syndrome

A

Subset of sarcoidosis
Parotid enlargement, fever, anterior uveitis

Bilat hilar lymphadenopathy and erythema nodosum

60
Q

Treatment for cyanide poisoning

A

hydroxocobalamin (intravenously)

61
Q

Management of torsades de pointes

A

IV magnesium sulfate is used to treat torsades de pointes

62
Q

Commonest bacteria cause of otitis media

A

Stept pneumoniae

63
Q

Commonest bacterial cause of tonsillitis

A

Stept pyogenes

64
Q

Features of Whipple’s disease

A

Middle aged man, with malabsorption (diarrhoea/weight loss), arthralgia, hyperpigmentation and lymphadenopathy

Infection… Most common in hla b27 +ve middle aged men

65
Q

Patient presents with rapid weight gain, diplopia in mornings and before meals, and intermittent sweating. What is likely diagnosis

A

Insulinoma

Diplopia related to hypoglycemia

66
Q

What investigation diagnoses obstructive sleep apnea

A

Polysomnography

67
Q

Features of cholesterol embolism

A

Eosinophilia (in 70%)
Purpura
Renal failure
Livedo reticularis… net-like rash

Often post vascular surgery or angio

68
Q

Definitive management for patient with endocarditis and severe congestive cardiac failure

A

emergency valve replacement surgery

Other indications are overwhelming sepsis despite Abx
Recurrent embolic episodes
Pregnancy

69
Q

Young female, hypertension and asymmetric kidney… diagnosis

A 
fibromuscular dysplasia (90% female)
Flash pulmonary oedema and kidney failure following ACEi
70
Q

brown/bluish pigment of the ear cartilage or sclera, arthropathy, renal stones, cardiac valve involvement and coronary calcification.. diagnosis

A

Alkaptonuria

71
Q

Features of leptospirosis

A

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
Q

How long do you monitor someone post anaphylaxis

A

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
Q

management of listeria meningitis

A

usually under 3m or over 60yr /immunosup

IV amoxicillin + gentamicin

74
Q

prophylactic management of contacts of meningitis

A

Rifamp or Cipro for contacts of meningococcus meningitis

75
Q

patient allergic to latex. What food allergy are they most likely to have?

A

Latex-Fruit syndrome…so particularly banana, pineapple, avocado, chestnut, kiwi fruit, mango, passion fruit and strawberry

76
Q

patient presents who is eating clay. Diagnosis?

A

geophagia (ingesting clay/soil) can occur in Zinc deficiency, iron def, pregnancy

77
Q

what blood result would you expect in a diagnosis of cholesterol embolism?

A

Eosinophilia is seen in around 70% of cases of cholesterol embolisation.

78
Q

Management of witnessed cardiac arrest while on a monitor, which shows VF

A

up to three successive shocks before CPR for VF or pulseless VT

Amiodarone 300mg is administered after the third shock (in shockable rhythms)

79
Q

Management of oesophageal varices…. acute and prevention

A

Acute; terlipressin

Prevention: propranolol

80
Q

Treatment for local anaesthetic toxicity

A

IV 20% lipid emulsion

81
Q

Management of severe hypocal

A

IV calcium gluconate 10ml of 10% over 10 minutes

82
Q

Patient presents with chronic abdo pain, psychiatric issues like depression, and neuropathy. Mum had same. Diagnosis?

A

Acute intermittent porphyria

Auto dom

Urine turns deep red on standing

83
Q

Active ingredient in anti freeze poisoning

A

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
Q

Skin necrosis after starting warfarin. Diagnosis

A

Protein c Def

Auto dom, thrombosis

85
Q

Mx of aspirin OD

A

Charcoal if within an hour,or IV sodium bicarbonate

86
Q

Most common infective cause of haemolytic uraemic syndrome

A

E coli 0157:h7 accounts for 90% of cases in children

87
Q

Single most important factor to indicate the need for a liver transplant post paracetamol od

A

pH < 7.3 , 24hr after ingestion

Or all of:
PT>100
Cr >300
Grade 3 or 4 enceph

88
Q

How do you distribution TRALI and TACO

A

hypotension in TRALI vs hypertension in TACO

Fever and leukopenia in TRALI

89
Q

Patient just started chemo and they develop low calcium, high phosphate, AKI.. diagnosis

A

Tumour lysis syndrome

90
Q

Patient who is Turkish, Armenian, or Arabic Presents with pyrexia, arthralgia, abdo pain and pleurisy

A

Familial Mediterranean fever

91
Q

Management of high altitude pulmonary oedema and of high altitude cerebral oedema

A

HAPE Descent and acetazolamide, nifidipine, dexamethasone

HACE descent and dexamethasone

92
Q

Patient on warfarin for AF, intracranial haemorrhage

A

Stop warfarin
IV vit K 5mg
Prothrombin complex concentrate

93
Q

Abdo pain, blue lines on gum, motor neuropathy, constipation
.

What poison?

A

Lead poisoning

Lead > 10 mcg/dl are considered significant

Give D-penicillamine
Or DMSA

Mrcp (21 decks)

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