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Clinical Medicine > AMU > Flashcards

AMU Flashcards

1
Q

An alternative name for Bell’s Palsy?

A

Facial nerve palsy (CNVII)

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2
Q

What is the most common mononeuropathy?

A

Facial Nerve palsy (CNVII)

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3
Q

In what patient groups is there thought to be a slightly increased incidence of Bell’s Palsy?

A

During Pregnancy and in those with Diabetes

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4
Q

How would you confirm whether a facial nerve weakness was due to an UMN lesion or a LMN lesion?

A

See if the Forehead was affected. Forehead sensation will be NORMAL in cases of UMN lesion due to its bilateral innervation

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5
Q

Define the House-Brackman Scale

A

Scoring system (1-6) used to describe the degree of facial nerve paralysis

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6
Q

What is the most common aetiology of Bell’s Palsy?

A

Infection - Herpes simplex or zoster

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7
Q

What is the treatment for a facial nerve palsy?

A

Prednisolone (preferably within the first 72hours) and Aciclovir (anti-viral)

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8
Q

Name a steroid medication

A

Prednisolone

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9
Q

Give three poor prognostic indicators for Bell’s Palsy

A
  1. Age > 60 yrs
  2. No signs of recovery at 3 weeks
  3. Presence of comorbidities: Pregnancy, Diabetes, Hypertension
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10
Q

Differentials for Bell’s Palsy

A
  1. Stroke
  2. Guillain-Barre syndrome
  3. Lyme Disease
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11
Q

Define Febrile Neutropenia

A

Fever >38 degrees + an absolute neutrophil count of <1.0*10^9/L

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12
Q

What causes neutropenia?

A

Bone marrow suppression

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13
Q

Give 5 potential causes of bone marrow suppression

A
  1. Chemotherapy
  2. Anaemias
  3. Genetic Defects
  4. Drugs
  5. Infections
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14
Q

In how many planes should a suspected fracture be imaged in?

A

At least 2 planes - AP and lateral X-rays

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15
Q

How will a fracture appear on a bone scan and why?

A

Will appear dark on the scan as there is increased Tc uptake at sites of fracture

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16
Q

Why can CT be useful in detecting stress fractures?

A

Good modality for detecting new bone growth

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17
Q

Give 5 possible early complications that can be associated with a bone fracture

A
  1. DVT
  2. PE
  3. Compartment Syndrome
  4. Avascular necrosis
  5. Nerve injury
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18
Q

What is considered to be the most common post-fracture complication?

A

DVT and PE

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19
Q

In cases of late stage avascular necrosis, why will the bone appear darker on X-ray?

A

Collapse of subchondral bone

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20
Q

Recall 4 signs of avascular necrosis

A
  1. Cold pulseless limb
  2. Ischaemia
  3. Paralysis
  4. Parasthesia of the limb
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21
Q

Give 2 clinical signs associated with nerve damage to the common perineal nerve

A
  1. Foot drop

2. Loss of sensation to the dorsum of the foot

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22
Q

Under what category do the majority of nerve injuries associated with bone fractures fall?

A

Traction neuropraxia

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23
Q

Define traction neuropraxia

A

Nerve damage in which the nerve remains intact but is temporarily unable to transmit nerve impulses

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24
Q

What is another name for Sudeck’s atrophy?

A

Reflex sympathetic dystrophy syndrome (also known as algodystrophy)

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25
Q

How does algodystrophy occur?

A

Trauma results in injury to the sympathetic nervous system which in turn will affect the blood supply to the affected region

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26
Q

Recall the 5 main features of algodystrophy

A
  1. Burning pain in the affected area
  2. Skin changes - skin often becomes thin and shiny
  3. Swelling
  4. Excessive sweating
  5. Pain, stiffness and muscle wasting
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27
Q

To which brain region is consciousness (with relation to GCS) most closely related to?

A

Reticular activating system

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28
Q

What is Battle’s sign and what does it indicate?

A

Bruising over the mastoid process which is indicative of a fracture of the base of the skull

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29
Q

What is the most common form of brain tumour?

A

Glioblastoma

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30
Q

Where are ~ 90% of brain tumours located?

A

Posterior Fossa

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31
Q

Treatment of brain tumour

A
  1. Surgery
  2. Radiotherapy
  3. Chemotherapy
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32
Q

Give 5 intracranial causes of altered consciousness

A
  1. Trauma
  2. Neoplasms
  3. Infection
  4. Seizures
  5. Vascular (either haemorrhage or stroke)
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33
Q

Define heart failure

A

The inability of the heart to pump adequate amounts of blood to meet the body’s metabolic demands

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34
Q

What is the annual mortality rate for heart failure?

A

10%

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35
Q

Classical presentation of a patient with heart failure (3)

A
  1. Shortness of breath
  2. Fatigue
  3. Ankle oedema
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36
Q

5 signs associated with heart failure

A
  1. Peripheral oedema
  2. Hepatomegaly
  3. Tachycardia
  4. Tachypnoea
  5. Raised JVP
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37
Q

What is the association between ejection fraction and prognosis for heart failure patients?

A

The lower the ejection fraction the worse the prognosis

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38
Q

Define diastolic heart failure

A

Reduction in heart compliance in turn resulting in comprised ventricular filling and thus also ejection

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39
Q

Name 3 causes of diastolic heart failure

A
  1. Pericardial disease
  2. Restrictive cardiomyopathy
  3. Tamponade
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40
Q

Give 2 potential causes of high-output heart failure

A
  1. Anaemia - reduced blood oxygen carrying capacity

2. Thyrotoxicosis - increased metabolic demand

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41
Q

Causes of heart failure (11)

A
  1. Ischaemia heart disease
  2. Hypertension
  3. Valvular disease
  4. Pericardial disease
  5. Drugs
  6. Myocarditis
  7. Thyrotoxicosis/ Myxedema
  8. Arrhythmia
  9. Cardiomyopathies
  10. Severe anemia
  11. Pulmonary Hypertension
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42
Q

How does hypertension contribute to an increased incidence of arrhythmia?

A

High afterload increases strain on the heart and leads to hypertrophy of cardiac tissue. Hypertrophy is a risk factor for arrhythmia.

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43
Q

Define restrictive heart failure

A

Reduced heart compliance without significant increase in muscle wall thickness. Leading to reduced EDV and CO.

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44
Q

What is the most common cause of restrictive heart failure?

A

Infiltrative disease

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45
Q

Give 4 examples of infiltrative disease

A
  1. Sarcoidosis
  2. Amyloidosis
  3. Haemochromatosis
  4. Endocardial Fibrosis
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46
Q

How does the medullary cardiovascular centre (MCVC) act to increase/ maintain MAP?

A

Reduced vagal tone and increases sympathetic tone, leading to increased heart contractility and rate and this also cardiac output

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47
Q

Though rare, what is the classic symptom of pulmonary oedema?

A

Pink frothy sputum

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48
Q

Define Pulsus Alternans

A

Alternating strong and weak pulse pressures in the arterial wave form during a sinus rhythm

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49
Q

What are the most common causes of Pulsus Alternans? (4)

A
  1. Aortic and mitral valve stenosis
  2. Congestive cardiomyopathy
  3. Effusive pericarditis
  4. General anaesthesia
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50
Q

Define BNP’s

A

Brian natriuretic peptides = peptides that cause natriuresis, diuresis and vasodilation.

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51
Q

Enalapril, Lisinopril and Captopril

A

ACE inhibitors

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52
Q

Angiotensin II inhibitors

A

Candersartan, Valsartan and Losartan

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53
Q

3 examples of beta-blockers

A

bisoprolol, atenolol, cardedilol

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54
Q

Loop diuretic

A

Frusemide

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55
Q

Thiazide diuretics

A

Bendroflumethiazide, hydrochlorothiazide, Chlorthalidone or Indapamide

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56
Q

Potassium Sparing Diuretics

A

Amiloride and Spironolactone

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57
Q

Calcium channel blockers

A

Diltiazem, Verapamil and Amlodipine

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58
Q

Give 4 common pitfalls associated with the management of heart failure clinically.

A
  1. Overuse of diuretics
  2. Use of diuretics as a mono therapy (without use of an ACE-inhibitor)
  3. Failure to treat underlying causes
  4. Failure to monitor electrolyte and renal function
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59
Q

Possible contra-indications for an LP may include…

A
  1. Raised ICP
  2. Coagulopathy
  3. Local infection at site of needle insertion
  4. No consent
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60
Q

Suggest 5 symptoms associated with raised intracranial pressure

A
  1. Headache
  2. Impaired consciousness
  3. Low pulse
  4. Low BP
  5. Papilloedema
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61
Q

What form of acid-base disturbance will severe hypovolaemia most commonly cause?

A

Metabolic acidosis resulting from peripheral anaerobic metabolism.

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62
Q

How do you carry out a fluid challenge?

A

Give the patient 500mls of 0.9% saline as quickly as possible e.g. over 5-10 minutes and then reassess their fluid status

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63
Q

Give 3 potential endogenous causes of meningism

A
  1. Malignancy
  2. Autoimmune disease
  3. Subarachnoid haemorrhage
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64
Q

What is Kernig’s sign?

A

Flex the hip, with the knee flexed. Now extend the knee. Positive test if there is spasm of the hamstring

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65
Q

Name the infective organism that causes Mollaret’s Meningitis

A

Herpes simplex virus type 2

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66
Q

What are the two most common infective agents leading to meningitis in western Europe?

A
  1. Streptococcus Pneumonia

2. Nisseria Meningitidis

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67
Q

Which infective organism more commonly causes meningitis in immunocompromised patients or those aged over 50?

A

Listeria

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68
Q

What is the best drug treatment combination for a Listeria infection?

A

Ceftriaxone and Ampicillin

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69
Q

Suggest an appropriate antibiotic for the initial treatment of meningitis

A

Third generation Cephalosporin IV ( as it is broad spectrum)

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70
Q

Give 2 third generation cephalosporins

A
  1. Cefotaxime

2. Cephalexin

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71
Q

What prophylactic treatment is commonly given to household contacts of a patient with meningococcal meningitis?

A

Rifampicin

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72
Q

Which 3 conditions are considered to be acute coronary syndromes?

A
  1. STEMI
  2. NSTEMI
  3. Unstable Angina
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73
Q

What is the common mechanism of pathology among the acute coronary syndromes?

A

Rupture or erosion of the fibrous cap of a coronary artery plaque

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74
Q

What % of ACS patients are expected to present without pain?

A

~30 %

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75
Q

In what form of ACS is vomiting and sinus bradycardia most commonly seen in?

A

Excessive vagal stimulation is most common in an inferior MI

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76
Q

What are the cardiac differentials of ACS?

A
  1. Angina
  2. Pericarditis
  3. Myocarditis
  4. Aortic dissection
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77
Q

What are the pulmonary differentials of ACS?

A
  1. PE
  2. Pneumothorax
  3. Anything that causes pleuritic chest pain
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78
Q

What are the oesophageal differentials of ACS?

A
  1. Oesophageal reflux
  2. Oesophgeal spasm
  3. Tumour
  4. Oesophagitis
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79
Q

Physiologically, how do platelets induce localised vasoconstriction?

A

They release serotonin and thromboxane A2

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80
Q

Define a transmural MI

A

Infarct that causes necrosis of tissue through the full thickness of the myocardium

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81
Q

Excluding MI, suggest 3 conditions that can cause elevated troponin levels

A
  1. PE
  2. Myocarditis
  3. Renal failure (troponin are chronically raised)
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82
Q

Name an anti-emetic

A

Metoclopramide

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83
Q

Name a low molecular weight heparin

A

Enoxaparin

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84
Q

Name a glycoprotein IIb/III inhibitor

A

Abciximab

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85
Q

Outline the components of the acute management of MI

A

MONA (C)

  1. Morphine
  2. Oxygen
  3. Nitrates
  4. Aspirin
  5. Clopidogrel (for high risk NSTEMI or STEMI)
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86
Q

Recall the components for secondary prevention in ACS

A

COBRA-A

  1. Clopidogrel
  2. Omacar (omega 3)
  3. Bisoprolol
  4. Ramipril
  5. Aspirin
  6. Atorvostatin
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87
Q

Give an example of a potent statin

A

Atorvostatin

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88
Q

Define a mural thrombus

A

Thrombus attached to the wall of the endocardium in a damaged area, or attached to the aortic wall over an intimal lesion

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89
Q

Define Dressler’s Syndrome

A

An autoimmune pericarditis provoked by MI

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90
Q

What is the important caution pharmokinetically when treating an opiate overdose with naloxone?

A

Half life of naloxone is significantly shorter than that of opiates

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91
Q

Give a contra-indication of Flumazenil

A

Long term Benzodiazepine abusers as it can induce withdrawal, including seizures

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92
Q

Give the 3 main causes of hepatic necrosis associated with a paracetamol overdose

A
  1. Jaundice + RUQ pain
  2. Encephalopathy
  3. Hypoglycaemia
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93
Q

Give 4 signs of Aspirin toxicity

A
  1. Tinnitus
  2. Lethargy
  3. Dizziness
  4. Vomiting
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94
Q

What is the ‘most fatal’ hospital acquired infection?

A

Pneumonia

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95
Q

Give 3 potential causes of atypical pneumonia

A
  1. Chlamydia
  2. Legionella
  3. Coxiella burnetti
96
Q

Which two organisms are most commonly implicated in community acquired pneumonias?

A
  1. Streptococcus Pneumonias

2. Haemophilus Influenza

97
Q

Which organism is most commonly associated with hospital acquired pneumonias?

A

Staphlococcus Aureus

98
Q

Recall the 3 main signs associated with pleural effusion

A
  1. Decreased chest expansion
  2. Dullness to percussion
  3. Reduced breath sounds
99
Q

Suggest a typical antibiotic therapy for empyema

A

IV doses of cefuroxime and co-amoxiclav for 5 days (to cover both aerobes and anaerobes) followed by 3-5 weeks of metronidazole monotherapy

100
Q

Give 4 potential causes of aspiration

A
  1. Alcoholism
  2. Inhaled foreign body
  3. Oesophageal blockage
  4. Bulbar palsy
101
Q

Name 2 organisms associated with lung abscesses

A
  1. Staph Aureus

2. Klebsiella Pneumoniae

102
Q

What is ‘rust coloured sputum’ indicative of?

A

Pneumonia - Strep pneumonia as the infective organism

103
Q

Suggest 5 potential causes of a secondary pneumothorax

A
  1. COPD
  2. Cystic Fibrosis
  3. Lung Malignancy
  4. Pneumonia
  5. TB
104
Q

Define a tension pneumothorax

A

Air in the pleural space and the volume continues to increase

105
Q

Recall a sign seen on CXR associated with a tension pneumothorax

A

Trachea may be deviated away from the side of the pneumothorax

106
Q

What are the 3 main signs of the haemodynamically unstable patient?

A
  1. Hypotensive
  2. Tachycardic
  3. Elevated RR
107
Q

5 patient groups considered to be at risk of postural hypotension

A
  1. Elderly
  2. Those with autonomic neuropathy
  3. Antihypertensive medications
  4. Overdiuresis
  5. Multi-Systems atrophy (MSA)
108
Q

Which cranial nerve innervates the carotid sinus baroreceptors?

A

CN IX

109
Q

Which cranial nerve innervates the aortic arch baroreceptors?

A

CN X

110
Q

What is the normal serum range for potassium?

A

3.5-5 mmol/L

111
Q

Give 4 factors that will induce a potassium shift INSIDE cells

A
  1. Insulin
  2. Aldosterone
  3. Beta-adrenergic stimulation
  4. Alkalosis
112
Q

Give 4 factors that will induce a potassium shift OUTSIDE cells

A
  1. Addison’s disease
  2. Beta-blockade
  3. Acidosis
  4. Cell lysis
113
Q

What are the main differentials of hypokalaemia?

A
  1. Diarrhoea and vomiting
  2. Diuretics
  3. Excess mineralocorticoids
  4. Intracellular shift
114
Q

What are the main differentials for hyperkalemia?

A
  1. Oliguric renal failure
  2. Potassium sparing diuretics
  3. Metabolic acidosis
  4. Adrenal Insufficiency
  5. Drugs
  6. Rhabdomyolysis
  7. Artefact due to haemolysis of sample
115
Q

Define secondary hyperthyroidism

A

Thyroid gland is stimulated by pathologically high levels of TSH in the circulation.

116
Q

What stimulates the release of TSH from the anterior pituitary gland?

A

TRH released from the hypothalamus

117
Q

Recall the names of T3 and T4 respectively

A

T3 - Triiodothyronine

T4 - Thyroxine

118
Q

Where is T4 converted to T3?

A

Activation of T4 occurs peripherally in organs such as the kidneys and liver

119
Q

The majority of T3 and T4 in the circulation is bound to which protein?

A

Thyroglobulin

120
Q

What is the most common cause of thyrotoxicosis?

A

Grave’s disease

121
Q

Which form of thyrotoxicosis becomes more common in people aged over 60?

A

Toxic nodular goitre

122
Q

Broadly speaking, what is the pathophysiology of thyroiditis?

A

Destruction of thyroid cells leads to excessive release of thyroid hormones into the circulation.

123
Q

Give 3 gene regions commonly linked to Grave’s disease

A
  1. Human leukocyte antigen region
  2. CTLA4
  3. PTPN22
124
Q

What is thyrotoxic periodic paralysis?

A

Serious complication of hyperthyroidism characterised by muscle paralysis and hypokalaemia due to a massive intracellular shift of potassium

125
Q

Hyperthyroidism can lead to what change in a patients reflexes?

A

Brisk reflexes may be present

126
Q

Alongside thyrotoxic symptoms, what 2 main additional symptoms are associated with the development of a thyrotoxic crisis?

A
  1. Hyperthermia

2. Acute mental disturbances

127
Q

Give 4 ‘precipitating events’ that can be associated with a thyrotoxic storm?

A
  1. Withdrawal of anti-thyroid drugs
  2. Radio-iodine therapy
  3. Infection
  4. Surgery
128
Q

What are the 4 components to the management of a thyrotoxic crisis?

A
  1. IV Fluids
  2. Beta blockers
  3. Anti-thyroid drugs
  4. Steroids
129
Q

What are the differentials diagnoses for thyrotoxicosis?

A
  1. Grave’s disease
  2. Toxic nodular goitre
  3. Ovarian teratomas
  4. Pheochromocytoma
  5. Other causes of weight loss
  6. Some medications
130
Q

Give 3 medications which can cause thyrotoxic symptoms

A
  1. Amiodarone
  2. Lithium
  3. Exogenous Iodine
131
Q

What is the first line anti-thyroid drugs used for the treatment of hyperthyroidism? (2)

A
  1. Carbimazole

2. Propylthiouracil

132
Q

Give 4 potential causes of an enlarged atrium

A
  1. Hypertension
  2. Valvular heart disease
  3. Lung disease
  4. AF
133
Q

Broadly, what are the 3 categories of complications following an MI?

A
  1. Reduced heart contractility
  2. Electrical instability
  3. Tissue necrosis
134
Q

What are the main components of granulation tissue? (4)

A
  1. Fibroblasts
  2. Inflammatory cells
  3. Proliferating capillaries
  4. Type III collagen
135
Q

Scar tissue is formed from what type of collagen?

A

Type I collagen

136
Q

Recall the lab tests considered for a confusion screen (9)

A
  1. FBC
  2. CRP
  3. U and E
  4. Bone profiles (calcium and phosphate levels)
  5. B12 and folate
  6. TFT’s
  7. Glucose
  8. LFT’s
  9. Coagulation/ INR
137
Q

What type of anaemia can be caused by hypothyroidism?

A

Macrocytic anemia

138
Q

Define refeeding syndrome

A

Potentially fatal shift in fluids and electrolytes brought about in malnourished patients that are given artificial refeeding (enterally or parenterally)

139
Q

Give 4 general features of connective tissue disease

A
  1. Inflammation
  2. Fibrosis/scarring
  3. Vasospasm (including Raynaud’s syndrome)
  4. Vascular thrombosis
140
Q

Suggest 4 haematological disorders that are associated with SLE

A
  1. Leukopenia
  2. Lymphopenia
  3. Haemolytic anemia
  4. Thrombocytopenia
141
Q

Outline the 3 aspects of Whipple’s Triad for the diagnosis of hypoglycaemia

A
  1. Plasma hypoglycaemia
  2. Symptoms attributed to a low blood sugar level
  3. Resolution of symptoms with correction of hypoglycaemia
142
Q

What is the most common non-iatrogenic cause of hypoglycaemia?

A

Excess alcohol

143
Q

Suggest 4 drugs/ toxins that can induce hypoglycaemia

A
  1. Pentamidine
  2. Quinine
  3. Paracetamol
  4. Toadstools
144
Q

Give an example of an extrapancreatic IGF-II secreting neoplasm

A

Adrenal tumour

145
Q

Give 2 hormone deficiencies that can lead to hypoglycaemia

A
  1. Hypoadrenalism

2. Hypopituitarism

146
Q

Define strabismus

A

Condition in which the eyes do not align with each other when looking at an object.

147
Q

For what condition is Diazoxide prescribed to treat?

A

Chronic intractable hypoglycaemia

148
Q

According to Patient UK, what are the top 3 most common chronic illnesses among adolescent females?

A
  1. Obesity
  2. Asthma
  3. Anorexia Nervosa
149
Q

Things to include when examining a patient with anorexia (5)

A
  1. Height, weight and BMI
  2. Core temperature
  3. Peripheral vascular (oedema and circulation)
  4. Cardiovascular exam (pulse and BP, check for postural hypotension)
  5. Test muscle power
150
Q

List 10 potential causes of hypomagnesaemia

A
  1. Malabsorption syndromes
  2. Protein calorie malnutrition
  3. Disorders of the parathyroid gland
  4. Chronic alcoholism
  5. Long term PPI therapy
  6. Diabetes
  7. Acute pancreatitis
  8. Re-feeding syndrome
  9. Severe burns
  10. Renal tubular acidosis
151
Q

Outline the components of the Meningism triad

A
  1. Headache
  2. Nuchal rigidity
  3. Photophobia
152
Q

Give the 6 potential causes of cardiac stunning

A
  1. Post reperfusion of a blocked coronary artery
  2. Post cardiac surgery
  3. Post cocaine OD
  4. Post cardiac arrest
  5. Post cardioversion
  6. In association with phaeochromoctymoa
153
Q

Define cranial diabetes insipidus

A

Condition in which the hypothalamus fails to produce sufficient levels of anti-diuretic hormone.

154
Q

Define nephrogenic diabetes insipidus

A

Condition in which the kidneys fail to respond to anti-diuretic hormone

155
Q

Give 3 differentials for a chronic primary headache

A
  1. Tension headache
  2. Migraine headache
  3. Cluster headache
156
Q

Give 3 differentials for a chronic secondary headache

A
  1. Cervical degenerative joint disease
  2. Temperomandibular joint syndrome
  3. Headaches associated with substances or their withdrawal
157
Q

Give 4 substances that can be associated with chronic secondary headache

A
  1. Caffeine
  2. Nitrates
  3. Analgesics (often presenting as chronic daily headaches)
  4. Ergotamine
158
Q

Give the two potential causes of medical morning headaches

A
  1. Sleep disturbances

2. Night-time hypoglycaemia

159
Q

Recall the components of the pneumonic ‘DAVID’ that denote the specific causes of peripheral vascular disease.

A 
D - Diabetes (most common)
A -Alcoholism
V - Vitamin deficiency B12
I - Infective/ inherited i.e. Gullian-Barre/ Charcot-Marie-Tooth
D - Drugs e.g. Isoniazid
160
Q

What are the 6 main mechanisms of peripheral nerve degeneration?

A
  1. Demylination
  2. Axonal degeneration
  3. Wallerian degeneration
  4. Compression
  5. Infarction
  6. Infiltration
161
Q

What changes to heart sounds are associated with mitral regurgitation?

A

Split S2

162
Q

What type of abnormality is shown in an ECG with a constant PR interval with the occasional P wave that is not follow by a QRS complex?

A

Second degree heart block - Mobitz type 2

163
Q

The S4 heart sound is associated with which heart abnormality?

A

Aortic stenosis

164
Q

Which cardiovascular disorders are associated with a collapsing pulse? (2)

A

1 - Patent ductus arteriosus

2 - Aortic regurgitation

165
Q

Soft S1 heart sound is characteristic of which cardiovascular disorder?

A

Mitral regurgitation

166
Q

Soft S2 heart sound is characteristic of which cardiovascular disorder?

A

Aortic stenosis

167
Q

What is the first line treatment for the management of hypertension in < 55 Caucasians?

A

ACE inhibitors

168
Q

Name 2 drugs that can cause bronchospasm as an adverse effect

A

1 - Beta-blockers

2 - Adenosine

169
Q

List the 4 contraindications for the prescription of beta- blockers

A

1 - Uncontrolled heart failure
2 - Asthma
3 - Sick Sinus syndrome
4 - Concurrent use of verapamil

170
Q

What are the 5 clinical features of mitral stenosis?

A 
1 - Mid to late diastolic murmur (heard best on expiration)
2 - Loud S1 with opening snap 
3 - Low volume pulse 
4 - Malar flush 
5 - Atrial fibrillation
171
Q

Which important electrolyte imbalance is associated with the use of loop diuretics?

A

Hypokalemia

172
Q

Name 2 drug types that can potentially induce diabetes

A
  1. Steroids

2. Thiazide diuretics

173
Q

Give 2 endocrine conditions that can subsequently lead to diabetes

A
  1. Cushing’s syndrome

2. Hyperthyroidism

174
Q

Outline 6 complications associated with the subacute presentation

A
  1. Staphylocccal skin infections
  2. Retinopathy
  3. Polyneuropathy
  4. Erectile dysfunction
  5. Arterial disease
  6. Inflammation of the genital - secondary to Candida infection
175
Q

Classify the bacteria Escherichia Coli

A

Gram negative rod

176
Q

Name the gram positive cocci (2)

A
  1. Staphylococci

2. Streptococci

177
Q

Name the gram negative cocci (3)

A
  1. Neisseria Meningitidis
  2. Neisseria gonorrhoea
  3. Moraxella catarrhalis
178
Q

Recall the bacteria classified as gram positive rods/bacilli using the mnemonic [ABCD L]

A

A - Actinomyces
B - Bacillus anthracis
C - Clostridium
D - Diphtheria

L - Listeria monocytogenes

179
Q

Name the 2 main components of mast cell granules

A
  1. Histamine

2. Heparin

180
Q

Give 4 complications associated with Coeliac disease

A
  1. Anemia
  2. Hyposplenism
  3. Osteoporosis
  4. Lactose intolerance
181
Q

Give an example of a class 1a antiarrhythmic drug

A

Quinidine

182
Q

Give 3 conditions that class 1a antiarrhythmics can be used to treat

A
  1. Supraventricular reentry tachycardias e.g. AVNRT and AVRT
  2. AF and atrial flutter
  3. Ventricular tachycardia (VT)
183
Q

Classify and briefly outline the action of class 1a antiarrhythmics

A

Class: Fast sodium channel blockers
Mechanism: Negative dromotrophy

184
Q

Give an example of a class 1b antiarrhythmic drug

A

Lidocaine

185
Q

Give an example of a class 1c antiarrhythmic drug

A

Flecainide

186
Q

Name a contra-indication for the prescription of a class 1c antiarrhythmic such as Flecainide

A

Post MI as this drug class can be proarythmiaogenic

187
Q

Class II antiarrhythmic drugs are otherwise known as?

A

Beta-blockers

188
Q

What is the mechanism of action of class III antiarrhythmic agents?

A

Potassium channel blockers

189
Q

Name 3 examples of class III antiarrhythmic agents

A
  1. Amiodarone
  2. Sotalol
  3. Ibutilide
190
Q

What is the mechanism of action of class IV antiarrhythmic agents?

A

Calcium channel blockers

191
Q

Give 3 examples of class IV antiarrhythmic agents

A
  1. Verapamil
  2. Diltiazem
  3. Nifedipine
192
Q

Give 3 examples of class V antiarrhythmic agents

A
  1. Adenosine
  2. Digoxin
  3. Magnesium sulphate
193
Q

What is the mechanism of action of the I(f) channel blocker Ivabradine?

A

Lowers the heart rate by blocking the I(f) channels in the pacemakers cells of the SA node

194
Q

Give 3 potential adverse effects associated with Ivabradine

A
  1. Visual changes
  2. Bradycardia
  3. Hypertension
195
Q

In what 4 medical conditions is the administration of magnesium sulphate indicated in?

A
  1. Torsades de Pointes
  2. Eclampsia
  3. Constipation
  4. Tocolysis
196
Q

What is the general mechanism of action of digoxin?

A

Inhibition of Na+/K+/ ATPases

197
Q

Give 3 contra-indications for the administration of adenosine

A
  1. Pre-excitation syndromes e.g. WPW
  2. AV block
  3. Asthma
198
Q

Which disease state can cause a pulsatile liver to be noted on clinical examination?

A

Tricuspid regurgitation

199
Q

Define Cadasil syndrome

A

A rare inherited defect in the NOTCH3 gene that leads to stroke and vascular dementia

200
Q

Define Amaurosis fugax

A

A sudden loss of vision in one eye due to an infarct in the retinal artery

201
Q

A difference in brachial blood pressures between right and left can be indicative of what disease state?

A

Subclavian artery stenosis (also known as steal syndrome)

202
Q

What are the 3 key differentials for a TIA?

A
  1. Mass lesion
  2. Epilepsy
  3. Migraine
203
Q

To which receptor type do HIV viruses bind?

A

CD4

204
Q

Give 4 examples of cell types that express CD4 receptors

A
  1. T- cells
  2. Monocytes
  3. Macrophages
  4. Neural cells
205
Q

What is the main clinical difference between HIV-1 and HIV-2

A

HIV-2 has a much greater latency period

206
Q

Outline the 5 principle modalities of HIV transmission

A
  1. Sexual intercourse
  2. Blood products
  3. IV drug use
  4. Needlestick injury
  5. Vertical transmission
207
Q

Categorise the HIV virus

A

RNA retrovirus

208
Q

What are the 4 stages of HIV infection?

A
  1. Seroconversion
  2. Asymptomatic infection
  3. AIDS related complex (ARC)
  4. AIDS
209
Q

Give 4 prodromal features associated with AIDS related complex

A
  1. Opportunistic infections (e.g. candida or herpes simplex
  2. Night sweats
  3. High temp
  4. Diarrhoea
210
Q

HIV is an important differential to consider in any patient presenting with which triad of symptoms?

A
  1. Fever
  2. Malaise
  3. Widespread lymphadenopathy
211
Q

Give 8 examples of AIDS defining infections

A
  1. Candidiasis of respiratory tract or oesophagus
  2. Chronic HSV
  3. Disseminated TB
  4. Toxoplasmosis of the brain
  5. Recurrent salmonella
  6. Pneumocytosis jiroveci pneumonia (PJP)
  7. Lymphoma of the brain
  8. Invasive cervical cancer
212
Q

Outline the 2 stages of HIV antibody testing

A
  1. ELISA (screening test)

2. Western Blot test (secondary diagnosis test)

213
Q

Newly diagnosed patients with HIV should be routinely screened for which conditions? (7)

A
  1. Hepatitis B
  2. Hepatitis C
  3. TB
  4. Toxoplasmosis
  5. CMV
  6. Syphilis
  7. Full STI screen
214
Q

Which values should be monitored every 3 months in patients with HIV?

A
  1. HIV RNA levels (measure viral load)

2. CD4 count

215
Q

ART (antiretroviral therapy) consists of what combination of antiviral drugs?

A
  1. 2 * NRTI’s (Nucleoside analogue reverse transcriptase inhibitors
  2. Either a protease inhibitor (PI) OR a non nucleoside reverse transcriptase inhibitor
216
Q

Give 5 examples of NRTI drugs

A
  1. Zidovudine
  2. Didanosine
  3. Lamivudine
  4. Emtricitabine
  5. Tenofovir
  6. Abacavir
217
Q

Give 7 potential side effects associated with NRTI therapy

A
  1. Leucopenia
  2. GI disturbance
  3. Rashes
  4. Myalgia
  5. Neuropathies
  6. Pancreatitis
  7. Anemia
218
Q

Give 4 examples of protease inhibitors

A
  1. Indavir
  2. Ritonavir
  3. Saquinavir
  4. Lopinavir
219
Q

What are the 3 components of metabolic syndrome?

A
  1. Insulin resistance
  2. Hyperglycaemia
  3. Dyslipidaemia
220
Q

Give 2 examples of NNRTI’s

A
  1. Nevirapine

2. Efavirenz

221
Q

Give 2 side effects associated with NNRTI

A
  1. Hepatitis

2. Dizziness

222
Q

What is an important contra-indication for NNRTI

A

Pregnancy

223
Q

Recall Virchow’s triad of risk factors for DVT

A
  1. Stasis
  2. Hyper coagulability
  3. Vessel wall injury
224
Q

What are the 4 main signs/ symptoms associated with DVT?

A
  1. Red swollen leg (particularly in the calf)
  2. Tenderness
  3. Pitting oedema
  4. Fever
225
Q

What are the 3 main differentials for DVT?

A
  1. Ruptured Baker’s cyst
  2. Cellulitis
  3. Lymphadenopathy
226
Q

Apart from DVT, list 6 other potential causes of a raised D-Dimer test

A
  1. Malignancy
  2. Post MI
  3. Pregnancy
  4. Stroke
  5. Inflammation
  6. Any form of trauma (including post-operatively)
227
Q

Give 4 things to assess on clinical examination of patient presenting with confusion

A
  1. Level of consciousness (GCS/AVPU)
  2. Evidence of head trauma
  3. Sources of infection (e.g. suprapubic tenderness in cases of UTI)
  4. Asterexis (uremia/ encephalopathy)
228
Q

What form of anemia can be caused by hypothyroidism?

A

Macrocytic anemia

229
Q

Why can chronic kidney injury lead to anemia?

A

Reduced EPO production

230
Q

Haematinic investigations include what 4 components?

A
  1. B12 and Folate
  2. Ferritin
  3. Serum iron
  4. Total iron binding capacity (TIBC)
231
Q

What clinical markers are required in order to confirm a diagnoses of SIADH? (3)

A
  1. Serum Osmolality
  2. Urine Osmolality
  3. Urinary sodium and potassium levels
232
Q

Which disorder of the thyroid can lead to hypocalcemia?

A

Hypoparathyroidism

233
Q

Which 3 lab tests are indicated when investigating a patient fo potential refeeding syndrome?

A
  1. U and E’s (hyponatremia/ hypokalaemia)
  2. Bone profile (hypophosphataemia/ hypocalcaemia)
  3. Magnesium (hypomagnesaemia)
234
Q

What 3 viruses should be considered when screening the liver for a potential viral infection?

A
  1. Hepatitis serology (A/B/C)
  2. CMV
  3. EBV
235
Q

Define DIC ( disseminated intravascular coagulopathy)

A

Systemic activation of blood coagulation, which generates intravascular fibrin, leading to thrombosis of small and medium sized vessels. This eventually leads to organ dysfunction and death.

236
Q

What is Horman’s sign and what does it indicate?

A

Increased resistance/ pain on forced dorsiflexion of the foot. Clinical sign of DVT.
Note - should not be routinely tested for in patients as there is a risk of dislodging a clot if present.

Clinical Medicine (8 decks)

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