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April Flashcards

1
Q

Differentials for patient presenting as Manic

A 
Hypomania
Bipolar Affective disorder
Anxiety Spectrum Disorder
Anorexia nervosa
Hyperthyroidism
Phaeochromocytoma
Drug induced psychosis from illicit substance
Cerebral infection/tumour/autoimmune encephalitis
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2
Q

Which mood stabilisers are teratogenic?

A

Valproate

Carbamazepine

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3
Q

When does NICE recommend long term lithium treatment?

A

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

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4
Q

First Rank Symptoms

A 
ABCD
A- Auditory hallucinations
B- thought Broadcasting
C- Controlled thought (delusions of control)
D- Delusional perception
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5
Q

Typical antipsychotics

A

Haloperidol

Chlorpromazine

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6
Q

Atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine

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7
Q

Consequences of hyperprolactinaemia

A 
Galactorrhea.
Menstrual irregularities.
Sexual dysfunction.
Osteoporosis.
Increased risk breast cancer.
Serum Prolactin levels should be checked if any pt reports such symptoms.
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8
Q

Vitamin C deficiency signs

A

gingivitis, loose teeth
poor wound healing
bleeding from gums, haematuria, epistaxis
general malaise

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9
Q

What type of bilirubinaemia is caused by Gilbert’s

A

UNCONJUGATED HYPERBILIRUBINAEMIA

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10
Q

Which drugs causing drug-induced liver disease give a hepatocellular picture?

A 
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
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11
Q

Which drugs causing drug-induced liver disease give a cholestatic picture?

A

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

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12
Q

Which drugs causing drug-induced liver disease can lead to liver cirrhosis?

A

methotrexate
methyldopa
amiodarone

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13
Q

What intervention is used to control variceal bleeding?

A

Sengstaken Blakemore tube

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14
Q

Which index is used to identify a severe flare of Ulcerative colitis?

A

TRUELOVE AND Witt’s

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15
Q

what is the criteria in the truelove and witt’s index to identify a severe flare of UC?

A

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

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16
Q

Treatment for life-threatening C difficile

A

Oral vancomycin

IV metronidazole

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17
Q

What is spontaneous bacterial peritonitis?

A

form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.

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18
Q

Which organism is most likely to be isolated from paracentesis in spontaneous bacterial peritonitis?

A

E COLI

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19
Q

Management for spontaneous bacterial peritonitis

A

IV Cefotaxime

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20
Q

what time frame indicates pathological neontal jaundice?

A

Less than 24 hours

2-14 days usually physiological

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21
Q

Common presenting age of pyloric stenosus

A

2-8 weeks

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22
Q

First line investigation of pyloric stenosis

A

USS

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23
Q

Features of pyloric stenosus

A

Projectile, non-bilious vomiting
Hungry after feed
Dehydrated
Weight loss

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24
Q

Signs of pyloric stenosis

A

Visible gastric peristalsis after test feed

Palpable olive-like pyloric mass

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25
Q

FTT, mouth ulcers occurring after weaning. What is the likely diagnosis?

A

Coeliac disease

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26
Q

WHAT INVESTIGATIONS ARE NEEDED IN A CHILD with suspected coeliac?

A

TOTAL IGA AND IGA TISSUE TRANSGLUTAMINASE ANITBODIES

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27
Q

Strawberry tongue is a sign of what condition?

A

BOTH Kawasaki and Scarlet fever

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28
Q

Major complication of CROHNS and UC and what investigation is useful?

A

Toxic megacolon

Abdominal X ray

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29
Q

Early signs of haemochromatosis

A

Fatigue
Arthralgia
Erectile dysfunction

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30
Q

Consequence of long-term PPI use

A 
Hypomagnasemia - leads to muscle aches
Can also cause hyponatraemia
Osteoporosis
Microscopic colitis
Increased C difficile infections
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31
Q

What system is used to classify the severity of end stage liver disease (cirrhosis)

A

Child Pugh

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32
Q

What criteria are listed to classify severity of liver disease in Child Pugh Score?

A 
Bilirubin
Prothrombin time
Ascites
Encephalopathy
Albumin
33
Q

What is the double duct sign and what condition is it found in?

A

CT - dilation of common bile duct and dilated pancreatic duct
Pancreatic or ampulla vater cancer

34
Q

Name a complication of Wilson’s disease

A

Psychosis

35
Q

What prophylactic medication is required after an episode of spontaneous bacterial peritonitis?

A

Antibiotics - ciprofloxacin

36
Q

Tool for scoring malnutrition

A

MUST

37
Q

Tool to estimate risk of pressure sore

A

Waterlow

38
Q

Which part of the colon is most affected by ischaemic colitis?

A

Splenic flexure

39
Q

Abdominal pain, diarrhoea and multiple gastroduodenal ulcers can indicate which syndrome?

A

Zollinger-Ellison

Ulcers caused by excess gastrin

40
Q

How are symptoms of zollinger-ellison syndrome controlled?

A

PPI high dose

41
Q

What sign may accompany other symptoms of Zollinger Ellison syndrome in 1/3 of patients?

A

Hyperparathyroidism - due to MEN 1

42
Q

Presentations of MEN 1

A

parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
pituitary (70%)
pancreas (50%, e.g. Insulinoma, gastrinoma)
also: adrenal and thyroid

43
Q

Diagnostic tests for Zollinger Ellison

A

fasting gastrin levels: the single best screen test

secretin stimulation test

44
Q

Management of alcoholic ketoacidosis

A

Thiamine and saline

45
Q

Hepatomegaly with firm, smooth, tender and pulsatile liver edge is a consequence of which condition

A

Right heart failure

46
Q

Which medications should be held during treatment of c diff?

A

Antiperistaltic, antimotility eg opioids

Also any other antibiotic treatment

47
Q

What is the first line treatment of Mature Onset Diabetes of Young (MODY)?

A

Sulfonylurea

48
Q

What is the mode of inheritance of Mature Onset Diabetes of Young?

A

Autosomal dominant

49
Q

What is the first positive sign of diabetic nephropathy?

A

Proteinuria

50
Q

What is the first line treatment of diabetic neuropathy?

A

ACE-i

51
Q

When would ACE-i be withheld in diabetic patients?

A

If in AKI

52
Q

Which bug is found in neuropathic diabetic ulcers?

A

Pseudomonas

53
Q

Antibodies are directed towards ? in Hashimoto’s thyroiditis?

A

TPO

Low t3 and t4

54
Q

What characterises primary adrenal insufficiency?

A

Skin tanning

55
Q

High cortisol =

A

Cushing’s syndrome

56
Q

Low dose dexamethasone test is used to confirm

A

Cushing’s sybndrome

57
Q

Response to high dose dexamethasone tests indicates what cause of ACTH excess

A

Pituitary tumour

58
Q

No response to high dose dexamethasone tests indicates which cause of ACTH excess

A

Ectopic

59
Q

Management of adrenal crisis

A

Urgent corticosteroids (hydrocortisone) and fluids

60
Q

Why in adrenal crisis will there be a raised WCC?

A

In response to long-term steroids

61
Q

Reversal of warfarin in context of major bleed

A

Withhold
IV vitamin K
Prothrombin complex

62
Q

Typical presenting features of ALS (MND)

A

Upper Motor neuron sign in lower limb (increased tone)

Lower motor neuron sign in Upper limb (absent bicep reflex)

63
Q

Treatment of Steven Johnsons Syndrome

A

IV fluids

64
Q

Diagnosis of Steven Johnsons

A

Macropapular purplish target lesions
Medications - carbomiazipine, sodium valproate, lamotrigine
Covering no more than 10% of body

65
Q

Tingling, decreased sensation,. Repeated episode of sprained ankles, high stepping gait

A

Charcot Marie Tooth

66
Q

Treatment of giant cell arthritis

A

High dose prednisolone or methylprednisolone if visual disturbance

67
Q

Findings on temporal artery biopsy in Giant Cell Arteritis

A

Skip lesions

68
Q

Acute seizure management

A

Rectal diazepam
Oral midazolam
IV lorazepam at 5 minute intervals
IV Phenytoin

69
Q

Long term seizure management

A

Sodium valproate
Carbamazepine
Lamotrigine
Ethosuxamide

70
Q

Inheritance of neurofibromatosis

A

Autosomal dominant

71
Q

NF1 vs NF2

A

Cafe au lait
Iris hamartoma
scoliosis
Phaeochromocytoma

Bilateral Vestibular schwannoma

72
Q

Pathopneumonic sign of MS on CT

A

Dawson’s finger

- periventricular collections

73
Q

What is becks triad?

A

Muffled heart sounds
Raised JVP
Hypotension

74
Q

What condition is indicated when patient presents with Beck’s triad?

A

Cardiac tamponade

75
Q

What are waves on ECG associated with?

A

Hypothermia

76
Q

What is the most common ECG finding in pulmonary embolism?

A

Sinus tachycardia

77
Q

Management of cardiac tamponade

A

Urgent pericardiocentesis

78
Q

ECG finding in cardiac tamponade

A

Electrical alternans

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