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Bit of everything Flashcards

1
Q

What is a risk factor for MALT lymphoma

A

Hashimoto’s thyroiditis

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2
Q

what can cause torsades de pointes

A
  • macrolides (azithromycin)
  • congenital
  • subarachnoid haemorrhage
  • antipsychotics
  • TCAs
  • myocarditis
  • hypothermia
  • electrolyte imbalances
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3
Q

torsades de pointes on ecg

A

polymorphic ventricular tachycardia associated with a long QT interval
can be irregular

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4
Q

mx of torsades de pointes

A

IV magnesium sulphate

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5
Q

medication that can cause hyponatraemia and hypomagnesaemia

A

PPIs

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6
Q

contraindications of ACS mx when pt is hypotensive

A

GTN spray (worsens hypotension)

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7
Q

chest pain relieved by sitting forwards

A

pericarditis

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8
Q

signs of left ventricular free wall rupture secondary to cardiac tamponade

A
  • diminished heart sounds
  • raised JVP
  • pulsus paradoxus (fall in systolic during inspiration)
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9
Q

what is cardiac tamponade

A

accumulation of pericardial fluid under pressure

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10
Q

mx of diabetic neuropathic pain

A

amitriptyline, duloxetine, gabapentin or pregabalin

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11
Q

palliative pain mx in pt with renal impairment

A

mild-moderate = oxycodone
severe = buprenorphine or fentanyl

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12
Q

presentation of peutz-jegher’s syndrome

A
  • hamartomatous polyps in GIT (mainly small bowel-
    small bowel obstruction is a common presenting complaint, often due to intussusception
    gastrointestinal bleedin
  • pigmented lesions on lips, oral mucosa, face, palms and soles
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13
Q

risk of cancers increased by Hereditary non-polyposis colorectal cancer (HNPCC)

A

colorectal and endometrial

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14
Q

anticoagulant for mechanical heart valve

A

warfarin

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15
Q

causes of hypercalcaemia

A

main 2 accounting for 90%
1. hyperparathyroidism
2. malginancy

other causes
- sarcoidosis
- vit D intoxication
- drugs: thiazides + calcium containing antacids
- acromegaly
- thyrotoxicosis
- dehydration
- addison’s
- paget’s

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16
Q

mid-diastolic murmur loudest over the apex

A

mitral stenosis
commonly causes AF leading to TIA/stroke

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17
Q

early diastolic murmur loudest over the aortic area

A

aortic regurgitation

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18
Q

pansystolic murmur over the apex radiating to the axilla

A

mitral regurgitation
MR can cause AF, therefore the differentiating feature is the timing of the murmur (diastolic in mitral stenosis, systolic in MR)

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19
Q

systolic murmur over the tricuspid area

A

tricuspid regurgitation
very rare in developed country, usually caused by rheumatic fever or carcinoid syndrome

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20
Q

cause of mitral stenosis

A

RHEUMATIC FEVER
rarer causes:
- mucopolysaccharidoses
- carcinoid
- endocardial fibroelastosis

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21
Q

features of mitral stenosis

A
  • dyspnoea
    ↑ left atrial pressure → pulmonary venous hypertension
  • haemoptysis: may range from pink frothy sputum to sudden haemorrhage secondary to rupture of thin-walled and dilated bronchial veins
  • mid-late diastolic murmur (best heard in expiration)
  • loud S1
  • opening snap indicates mitral valve leaflets are still mobile
  • low volume pulse
  • malar flush
  • atrial fibrillation: secondary to ↑ left atrial pressure → left atrial enlargement
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22
Q

how to calculate units of alcohol

A

Alcohol units = volume (ml) * ABV / 1,000

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23
Q

reasons to stop BB in acute heart failure

A
  • shock aka BP < 90/60
  • HR <50
  • second or third degree heart block
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24
Q

side effects of ACEi

A
  • cough
  • hyperkalaemia (if >5.5 need to stop ACEi)
  • angioedema
  • first dose hypotension
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25
Q

what acid base imabalance does cushing’s cause

A

hypokalaemic metabolic alkalosis

levels of cortisol are high–> the cortisol that is not inactivated is free to bind to mineralocorticoid receptors–> increase in water and sodium retention, increased potassium excretion, and increased hydrogen ions excretion–> Low hydrogen ions= alkalosis and less potassium = hypokalemia

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26
Q

What scoring system is most appropriate for identifying if a pt with a PE can be managed as an outpatient?

A

PESI score (PE severity index)

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27
Q

what is ORBIT score

A
  • Outcomes Registry for Better Informed Treatment of Atrial Fibrillation
  • Used to predict bleeding risk in patients on anticoagulation for AF
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28
Q

what is PERC criteria?

A
  • Pulmonary Embolism Rule Out Criteria
  • used to rule out a PE
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29
Q

what is rockwood score?

A

scoring system used to categorise frailty

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30
Q

what is Wells score

A

predicts the likelihood of a patient having a PE or DVT

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31
Q

Features of proximal aortic dissection

A
  • inferior myocardial infarction
  • AR murmur
  • tearing central chest pain
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32
Q

Mackler triad for Boerhaave syndrome:

A
  1. vomiting
  2. thoracic pain
  3. subcutaneous emphysema.
    It commonly presents in middle aged men with a background of alcohol abuse.
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33
Q

Features of pneumothorax

A
  • dyspnoea
  • pleuritic chest pain
  • Hx of asthma or marfan’s
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34
Q

Features of PE

A
  • Sudden dyspnoea
  • pleuritic chest pain
  • Calf pain/swelling
  • On COCP, malignancy
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35
Q

Features of pericarditis

A
  • Sharp pain relieved by sitting forwards
  • May be pleuritic in nature
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36
Q

Features of dissecting aortic aneurysm

A
  • ‘Tearing’ chest pain radiating through to the back
  • Unequal upper limb blood pressure
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37
Q

Features of GORD

A
  • Burning retrosternal pain
  • Other possible symptoms include regurgitation and dysphagia
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38
Q

Features of MSK chest pain

A
  • Pain is often worse on movement or palpation
  • May be precipitated by trauma or coughing
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39
Q

Features of shingles

A

Pain often precedes the rash

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40
Q

Inferior MI ECG changes

A

leads II, III , AVF

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41
Q

anterior MI ECG changes

A

V1-6

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42
Q

Mx of perforated peptic ulcer

A

Diagnosis- Erect CXR
Mx- laparotomy, small defects may be excised and overlaid with an ommental patch, larger defects are best managed with a partial gastrectomy

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43
Q

what or Boerhaaves syndrome

A

Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting.
Usually distal and on the left

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44
Q

Diagnosis of Boerhaaves syndrome

A

CT contrast swallow

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45
Q

Mx of Boerhaaves syndrome

A

Thoracotomy and lavage
< 12 hours after onset primary repair is feasible,
> 12 hours best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin.

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46
Q

What is aortic dissection

A
  • flap or filling defect within the aortic intima
  • Blood tracks into the medial layer and splits the tissues with the subsequent creation of a false lumen. - It most commonly occurs in the ascending aorta or just distal to the left subclavian artery (less common)
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47
Q

Demographic for aortic dissection

A

Afro-carribean males aged 50-70 years

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48
Q

Classification of aortic dissection

A

Stanford
- Type A: lesions with a proximal origin (involves ascending aorta)
- Type B: distal to the left subclavian

DeBakey
- Type I: Starts in the ascending aorta and extends into the descending aorta
Type II: Limited to ascending aorta
Type III: Starts in the descending aorta and extends downward

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49
Q

Complications of MI

A
  • cardiac arrest
  • cardiogenic shock
  • tachyarrhythmias
  • chronic heart failure
  • bradyarrhythmias
  • pericarditis
  • left ventricular aneurysm
  • LVFWR
  • VSD
  • acute mitral regurgitation
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50
Q

Features of MEN1

A

Peptic ulceration, galactorrhoea, hypercalcaemia

Affects the endocrine system through development of neoplastic lesions in the pituitary gland, parathyroid gland and pancreas

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51
Q

Third-line therapy if a patient with heart failure has not responded to first-line (ACEi + beta-blocker) or second-line (aldosterone) therapy.

A

Hydralazine and nitrate
more effective in Afro-Caribbean patients

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52
Q

Mx of chronic heart failure

A
  • 1st line: ACEi + BB (bisoprolol
  • 2nd line: aldosterone antagonists (spironolactone or eplerenone). Can also use SGLT-2 inhibitors in reduced ejection fraction
  • 3rd line: hydralazine and nitrate, ivabradine, digoxin or sacubitril-valsartan
  • annual influenza vaccine and one off pneumococcal vaccine
53
Q

what do statins interact severely with?

A

clarithromycin/erythromycin
(increase in statin conc due to inhibition of enzymes that metabolise statins)

54
Q

apart from statins what else does clarithromycin interact with?

A

warfarin

55
Q

when do you need to stop metformin

A

renal impairment, can cause lactic acidosis

56
Q

what reverses dabigatran (DOAC)

A

idracizumab

57
Q

what reverses apixaban or rivaroxaban

A

andexanet alfa
hard to get so can use prothrombin complex concentrate

58
Q

reversal of warfarin

A

PCC
if unavailable FFP and IV vit K

59
Q

reversal of heparin

A

protamine sulphate

60
Q

what is the rockall score

A

used after endoscopy and designed to predict mortality and rebleeding risk following upper gastrointestinal bleeding.

61
Q

what is the blatchford score

A

assesses the need for intervention in patients presenting with upper gastrointestinal bleeding

62
Q

what is the child-pugh score

A

assess liver function in patients with cirrhosis and predict surgical risk

63
Q

sign of Mixed aortic valve disease

A

bisferiens pulse (when there is aortic regurg and stenosis)

64
Q

reason for collapsing pulse

A
  • aortic regurgitation
  • patent ductus arteriosus
  • hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
65
Q

sign of severe left ventricular systolic (LVSD)

A

pulsus alterans

66
Q

sign of aortic stenosis

A

slow rising pulse

67
Q

sign of HOCM

A

jerky pulse

68
Q

Mx of PE with haemodynamic instability

A

thrombolysis (alteplase)

69
Q

Hypothermia on ECG

A
  • bradycardia <60
  • J waves
  • Prolonged PR, QT and QRS intervals
  • Shivering artefacts
  • VT, VF or asystole
70
Q

medication contraindicteed in VT

A

verapamil (CCB)

71
Q

Most common cause of death following MI

A

VF

72
Q

Triad of phaeochromacytoma

A

sweating, headaches, and palpitations in association with severe hypertension

73
Q

what is hepatorenal syndrome

A

a type of functional kidney impairment that occurs in patients with advanced liver disease.

features
- ascites
- low urine output
- significant increase in serum creatinine.

74
Q

Mx of hepatorenal syndrome

A
  • 1st line: terlipressin (cause vasoconstriction of the splanchnic circulation)
  • 2nd line: volume expansion with 20% albumin
  • 3rd line: transjugular intrahepatic portosystemic shunt (TIPS)
75
Q

Mx of bradycardia with adverse signs (shock, syncope, MI, heart failure)

A

500mcg atropine IV
2nd: transcutaneous pacing

76
Q

risk factors for asystole (indicating the need for transvenous pacing)

A
  • complete heart block with broad complex QRS
  • recent asystole
  • Mobitz type II AV block
  • ventricular pause > 3 seconds
77
Q

cause of raised prolactin

A

Causes of raised prolactin - the p’s
- pregnancy
- prolactinoma
- physiological
- PCOS
- primary hypothyroidism
- phenothiazines, metoclopramide, domperidone

78
Q

drugs used for rate control of AF

A

BB, CCB, digoxin
BB contraindicated in asthma

79
Q

drugs used for rhythm control of AF

A

BB, dronedarone, amiodarone, flecainide

80
Q

causes of raised BNP

A
  • heart failure
  • myocardial ischaemia
  • valvular disease
  • > 70 y/o
  • left ventricular hypertrophy, ischaemia
  • tachycardia
  • right ventricular overload, - hypoxaemia
  • renal dysfunction (eGFR < 60)
  • sepsis
  • COPD
  • diabetes or cirrhosis of the liver
81
Q

what is BNP

A

B-type natriuretic peptide (BNP) is a hormone produced mainly by the left ventricular myocardium in response to strain

82
Q

test to differentiate between IBS and IBD

A

faecal calprotectin

83
Q

drug that causes neutrophilia

A

corticosteroids e.g. dexamethasone

84
Q

Mx of Wolff parkinson white syndrome

A

surgical: radiofrequency ablation of accessory pathway (definitive)
medical: sotalol, amiodarone, flecainide

85
Q

prophylaxis of variceal haemorrhage

A

propanolol

86
Q

prophylaxis for spontaneous bacterial peritonitis

A

ciprofloxacin or norfloxacin

87
Q

most common type of lung cancer in non-smokers

A

lung adenocarcinoma (usually peripheral)

88
Q

signs of haemochromatosis

A
  • fatigue
  • erectile dysfunction
  • arthralgia
  • bronze skin
89
Q

most common cause of death in patients with HOCM

A

ventricular arrhythmia

90
Q

hypertensive medication contradindicated in pregnancy

A

ACEi - cause oligohydramnios and risk fo cardiac/cranial defects

91
Q

Mx of angina

A
  • 1st line: BB or CCB (verapamil or diltiazem
  • 2nd line: if using BB already add CCB (amlodipine, nifedipine)
92
Q

posterior MI ECG findings

A

inversion of typical MI
- Q waves become tall R waves
- ST-elevation becomes ST-depression
- inverted T-waves become upright T-waves

93
Q

Addisonian crisis acid imbalance

A

hyponatraemic, hyperkalaemic acidosis

94
Q

what medication to avoid in bowel obstruction

A

metoclopramide (pro-kinetic can cause preforation)

95
Q

what is atrial myxoma

A

benign tumour most commonly occurring in the left atrium

96
Q

presentation of atrial myxoma

A

triad of:
1. mitral valve obstruction
2. systemic embolisation
3. constitutional symptoms such as breathlessness, weight loss and fever

echo: pedunculated heterogeneous mass typically attached to the fossa ovalis region of the interatrial septum

97
Q

what is buerger’s disease?

A

also known as thromboangiitis obliterans) is a small and medium vessel vasculitis that is strongly associated with smoking.

98
Q

how does carbon monoxide kill you

A

CO binds to the site on haemoglobin normally occupied by oxygen, thereby reducing the oxygen-carrying capacity of the blood. This leads to tissue hypoxia and eventually death.

99
Q

what is social selection/mobility health inequality

A

ill health can limit social mobility due to decreased ability to work, and decreased income, leading to lower social class, which in turn can contribute to health inequalities.

100
Q

what is artefact health inequality

A

Artefact would be proposing that the observed differences are due to differences in measurement

101
Q

what is cultural/behavioural health inequality

A

differences in behaviour cause differences in health.

102
Q

what is idealist health inequality

A

would be suggesting that individuals’ construction of health is different in different groups, so they might define health differently

103
Q

what is materialist health inequality

A

emphasises the role of economic and social factors, such as income, education, and employment, in shaping health outcomes.

104
Q

how to calculate absolute risk reduction

A

ARR = risk in control group - risk in treatment group

105
Q

what is a categorical variable

A

be grouped into categories (e.g. blood type, race)

106
Q

what is a continuous variable

A

can take any value within a range

107
Q

what is a discrete variable

A

only takes certain values usually integers (number of children)

108
Q

what is a nominal variable

A

those that have no intrinsic order or ranking (e.g. hair colour, occupation)

109
Q

life threatening complication of chemotherapy

A

tumour lysis syndrome

110
Q

ix for tumour lysis syndrome

A

urate

111
Q

most appropriate way to assess risk of developing a pressure sore?

A

Waterlow score

112
Q

how to treat animal/human bite-

A
  • co amoxiclav if broken skin or high risk area
113
Q

following a first unprovoked or isolated seizure if brain imaging and EEG normal how can they not drive

A

6 months

114
Q

Patients cannot drive for x months after a seizure if there is abnormal brain imaging or an abnormal EEG.

A

12 months

115
Q

Patients cannot drive for x months after a stroke or TIA.

A

1 month

116
Q

Patients cannot drive for x months if they have multiple TIAs over a short period.

A

3 months

117
Q

how to differentiate TRALI from TACO

A

by the presence of hypotension in TRALI vs hypertension in TACO

118
Q

what is TRALI

A
  • Transufusion related acute lung injury
  • Fever and hypotension present KEY
  • Caused by interaction with anti-WBC antibodies in donor blood and recipient WBCs
  • causes immune complex deposition in pulmonary capillaries
  • Absence of heart failure
  • signs of respiratory distress (tachypnoea, low saturations)
119
Q

what is TACO

A
  • transfusion related circulatory overload
  • Caused by lack of attention to fluid balance
  • pulmonary oedema/fluid overload occur within hours
  • signs of heart failure: ↑JVP, ↑PCWP
  • hypertensive
120
Q

Local anesthetic toxicity can be treated with…

A

IV 20% lipid emulsion

121
Q

salicylate poisoning metabolic derangement

A

aspirin overdose
- respiratory alkalosis initially, breathing fast
- then metabolic acidosis as aspirin is essentially an acid
- makes you drowsy etc.

122
Q

how to give TPN

A

central line (causes phlebitis peripherally)

123
Q

spread of ovarian cancer

A

Confined to the ovaries (Stage 1)
Local spread within the pelvis (Stage 2)
Spread beyond the pelvis to the abdomen (Stage 3)

most common site for lymphatic spread is the para-aortic lymph nodes. The most common site for haematological spread is the liver.

124
Q

how does lidocaine work?

A

Blockage of sodium channels disrupting the action potential

125
Q

serious side effect of suxamethonium anaesthesia

A

malignant hyperthermia

126
Q

how to treat Malignant hyperthermia induced by suxamethonium

A

IV dantrolene therapy

127
Q

reversal of benzos

A

flumazenil

128
Q

test for torn meniscus

A

McMurray’s test

129
Q

how to detect accidental oesophageal intubation

A

capnography (End tidal carbon dioxide monitoring)

Finals (26 decks)

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