April Flashcards
Differentials for patient presenting as Manic
Hypomania Bipolar Affective disorder Anxiety Spectrum Disorder Anorexia nervosa Hyperthyroidism Phaeochromocytoma Drug induced psychosis from illicit substance Cerebral infection/tumour/autoimmune encephalitis
Which mood stabilisers are teratogenic?
Valproate
Carbamazepine
When does NICE recommend long term lithium treatment?
A manic episode involving significant risk and adverse consequences
Bipolar Type 1 disorder with 2 or more acute episodes
Bipolar Type 2 disorder with significant functional impairment or risk
First Rank Symptoms
ABCD A- Auditory hallucinations B- thought Broadcasting C- Controlled thought (delusions of control) D- Delusional perception
Typical antipsychotics
Haloperidol
Chlorpromazine
Atypical antipsychotics
Clozapine
Risperidone
Olanzapine
Consequences of hyperprolactinaemia
Galactorrhea. Menstrual irregularities. Sexual dysfunction. Osteoporosis. Increased risk breast cancer. Serum Prolactin levels should be checked if any pt reports such symptoms.
Vitamin C deficiency signs
gingivitis, loose teeth
poor wound healing
bleeding from gums, haematuria, epistaxis
general malaise
What type of bilirubinaemia is caused by Gilbert’s
UNCONJUGATED HYPERBILIRUBINAEMIA
Which drugs causing drug-induced liver disease give a hepatocellular picture?
paracetamol sodium valproate, phenytoin MAOIs halothane anti-tuberculosis: isoniazid, rifampicin, pyrazinamide statins alcohol amiodarone methyldopa nitrofurantoin
Which drugs causing drug-induced liver disease give a cholestatic picture?
combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine
Which drugs causing drug-induced liver disease can lead to liver cirrhosis?
methotrexate
methyldopa
amiodarone
What intervention is used to control variceal bleeding?
Sengstaken Blakemore tube
Which index is used to identify a severe flare of Ulcerative colitis?
TRUELOVE AND Witt’s
what is the criteria in the truelove and witt’s index to identify a severe flare of UC?
Temperature greater than 37.8°C
Heart rate greater than 90 beats per minute
Anaemia (Hb less than 105g/ L)
Erythrocyte sedimentation rate greater than 30 mm/hour
Treatment for life-threatening C difficile
Oral vancomycin
IV metronidazole
What is spontaneous bacterial peritonitis?
form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.
Which organism is most likely to be isolated from paracentesis in spontaneous bacterial peritonitis?
E COLI
Management for spontaneous bacterial peritonitis
IV Cefotaxime
what time frame indicates pathological neontal jaundice?
Less than 24 hours
2-14 days usually physiological
Common presenting age of pyloric stenosus
2-8 weeks
First line investigation of pyloric stenosis
USS
Features of pyloric stenosus
Projectile, non-bilious vomiting
Hungry after feed
Dehydrated
Weight loss
Signs of pyloric stenosis
Visible gastric peristalsis after test feed
Palpable olive-like pyloric mass
FTT, mouth ulcers occurring after weaning. What is the likely diagnosis?
Coeliac disease
WHAT INVESTIGATIONS ARE NEEDED IN A CHILD with suspected coeliac?
TOTAL IGA AND IGA TISSUE TRANSGLUTAMINASE ANITBODIES
Strawberry tongue is a sign of what condition?
BOTH Kawasaki and Scarlet fever
Major complication of CROHNS and UC and what investigation is useful?
Toxic megacolon
Abdominal X ray
Early signs of haemochromatosis
Fatigue
Arthralgia
Erectile dysfunction
Consequence of long-term PPI use
Hypomagnasemia - leads to muscle aches Can also cause hyponatraemia Osteoporosis Microscopic colitis Increased C difficile infections
What system is used to classify the severity of end stage liver disease (cirrhosis)
Child Pugh
What criteria are listed to classify severity of liver disease in Child Pugh Score?
Bilirubin Prothrombin time Ascites Encephalopathy Albumin
What is the double duct sign and what condition is it found in?
CT - dilation of common bile duct and dilated pancreatic duct
Pancreatic or ampulla vater cancer
Name a complication of Wilson’s disease
Psychosis
What prophylactic medication is required after an episode of spontaneous bacterial peritonitis?
Antibiotics - ciprofloxacin
Tool for scoring malnutrition
MUST
Tool to estimate risk of pressure sore
Waterlow
Which part of the colon is most affected by ischaemic colitis?
Splenic flexure
Abdominal pain, diarrhoea and multiple gastroduodenal ulcers can indicate which syndrome?
Zollinger-Ellison
Ulcers caused by excess gastrin
How are symptoms of zollinger-ellison syndrome controlled?
PPI high dose
What sign may accompany other symptoms of Zollinger Ellison syndrome in 1/3 of patients?
Hyperparathyroidism - due to MEN 1
Presentations of MEN 1
parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
pituitary (70%)
pancreas (50%, e.g. Insulinoma, gastrinoma)
also: adrenal and thyroid
Diagnostic tests for Zollinger Ellison
fasting gastrin levels: the single best screen test
secretin stimulation test
Management of alcoholic ketoacidosis
Thiamine and saline
Hepatomegaly with firm, smooth, tender and pulsatile liver edge is a consequence of which condition
Right heart failure
Which medications should be held during treatment of c diff?
Antiperistaltic, antimotility eg opioids
Also any other antibiotic treatment
What is the first line treatment of Mature Onset Diabetes of Young (MODY)?
Sulfonylurea
What is the mode of inheritance of Mature Onset Diabetes of Young?
Autosomal dominant
What is the first positive sign of diabetic nephropathy?
Proteinuria
What is the first line treatment of diabetic neuropathy?
ACE-i
When would ACE-i be withheld in diabetic patients?
If in AKI
Which bug is found in neuropathic diabetic ulcers?
Pseudomonas
Antibodies are directed towards ? in Hashimoto’s thyroiditis?
TPO
Low t3 and t4
What characterises primary adrenal insufficiency?
Skin tanning
High cortisol =
Cushing’s syndrome
Low dose dexamethasone test is used to confirm
Cushing’s sybndrome
Response to high dose dexamethasone tests indicates what cause of ACTH excess
Pituitary tumour
No response to high dose dexamethasone tests indicates which cause of ACTH excess
Ectopic
Management of adrenal crisis
Urgent corticosteroids (hydrocortisone) and fluids
Why in adrenal crisis will there be a raised WCC?
In response to long-term steroids
Reversal of warfarin in context of major bleed
Withhold
IV vitamin K
Prothrombin complex
Typical presenting features of ALS (MND)
Upper Motor neuron sign in lower limb (increased tone)
Lower motor neuron sign in Upper limb (absent bicep reflex)
Treatment of Steven Johnsons Syndrome
IV fluids
Diagnosis of Steven Johnsons
Macropapular purplish target lesions
Medications - carbomiazipine, sodium valproate, lamotrigine
Covering no more than 10% of body
Tingling, decreased sensation,. Repeated episode of sprained ankles, high stepping gait
Charcot Marie Tooth
Treatment of giant cell arthritis
High dose prednisolone or methylprednisolone if visual disturbance
Findings on temporal artery biopsy in Giant Cell Arteritis
Skip lesions
Acute seizure management
Rectal diazepam
Oral midazolam
IV lorazepam at 5 minute intervals
IV Phenytoin
Long term seizure management
Sodium valproate
Carbamazepine
Lamotrigine
Ethosuxamide
Inheritance of neurofibromatosis
Autosomal dominant
NF1 vs NF2
Cafe au lait
Iris hamartoma
scoliosis
Phaeochromocytoma
Bilateral Vestibular schwannoma
Pathopneumonic sign of MS on CT
Dawson’s finger
- periventricular collections
What is becks triad?
Muffled heart sounds
Raised JVP
Hypotension
What condition is indicated when patient presents with Beck’s triad?
Cardiac tamponade
What are waves on ECG associated with?
Hypothermia
What is the most common ECG finding in pulmonary embolism?
Sinus tachycardia
Management of cardiac tamponade
Urgent pericardiocentesis
ECG finding in cardiac tamponade
Electrical alternans
