Bitchy passmedicine questions Flashcards
People with severe renal impairment - LMWH or heparin?
LMWH more likely to cause really bad bleeding - give unfractioned heparin
Pain medications more suitable if someone has chronic kidney disease?
Buprenorphine, fentanyl
NSAIDs and warfarin?
BAD!!!!
Risk of PPIs?
Osteoporosis
What is Leiden V?
Factor V has mutated so not broken down by protein C
Which zones affected in idiopathic pulmonary fibrosis?
Lower zones
Most common type of non-Hodgkin lymphoma
Diffuse large B cell
What can be used to differentiate between a seizure and a pseudoseizure?
Prolactin
becomes elevated 10-20 minutes after a real seizure
Varenicline mechanism of action
Partial nicotinic receptor partial agonist
When is bupoprion contraindicated?
In epilepsy
When is varenicline contraindicated?
Self-harm/depression
Buprenorphine mechanism of action
Noradrenaline and dopamine reuptake inhibitor and nicotinic antagonist
Most common ECG findings of hypercalcaemia
Shortened QT interval
Alteplase mechanism of action?
Activates plasminogen to form plasmin
Nerve responsible for pronation of the hand
Median
Responsible for erysipelas, impetigo, cellulitis, type 2 necrotising fasciitis, tonsillitis
Group A strep - strep pyogenes
What can CLL transform into?
Can transform to non-hodgkin’s lymphoma
this is Rithcer’s transformation
What is Ritcher’s transformation?
When CLL transforms to Non-hodgkins
The three criteria of typical angina
- constrictive pain
- precipitated by physical exertion
- relieved by GTN within 5 minutes
What is the purpose of steroids in COPD?
To reduce the frequency of exacerbations
How does pontine haemorrhage present?
Reduced GCS, quadriplegia, miosis and absent horizontal eye movements
Which vaccinations are given to pregnant women
Influenza and pertussis
Stage 2 hypertension
Clinic BP above 160/100
Why is epidural anaesthesia preferred in GI surgery?
Faster return of normal bowel function
When do VTE’s present post-operatively?
Normally present 5-10 days post operatively
blood transfusion, cellulitis etc present earlier
What is reynold’s pentad?
Carcot’s triad plus low blood pressure and confusion
Investigations for peripheral arterial disease?
Duplex ultrasound is first line
Then do MRA (magnetic resonance angiography)
Difference between O negative and O positive
O negative - rhesus negative
O positive - rhesus positive
VTE prophylaxis for someone undergoing surgery (patient has no bleeding risk factors)
TED stockings and dalteparin at least 6 hours post operation
Useful for monitoring response to colorectal cancer treatment
CEA
Double bubble sign on AXR
Duodenal atresia
Treatment of malignant hyperthermia
Dantrolene - prevents release of Ca2+ from the sarcoplasmic reticulim
Isograft
Transplant to identical sibling
Xenograft
E.g. porcine heart valve
Allograft
Transplant from someone else (not twin)
Autograft
From yourself
Difference between RBCs in CSF and breakdown products in CSF?
RBCs could be from a traumatic tap
The presence of breakdown products is indicative of an SAH
What does cryoprecepitate contain?
Contains factor VIII and fibrinogen
How does malignant hyperthermia present?
Presents with muscle rigidity and increased temperature
A common complication following intraventricular haemorrhage
Hydrocephalus
Most common organism causing cholangitis
E. coli
What is marjolin’s ulcer?
A squamous cell carcinoma occurring at the site of chronic inflammation or previous injury
Treatment of scabies
Permethrin 5% is first line
Pilocarpine mechanism of action
Muscarinic agonist
Difference between caput succedaneum and cephalohaematome?
Caput succimmediate - noticed immediately, may cross suture line
Cephalohaematoma - noticed several hours after birth - may take several months to resolve. Will not cross suture lines
Which organism is responsible for causing scarlet fever?
Group A haemolytic streptococci (strep pyogenes)
Risk factors for sudden infant death syndrome
Prone sleeping Being male Parental smoking Bed sharing Hyperthermia and head covering Prematurity
Progesterone only pill and antibiotics?
No need for extra precautions
The only method of contraception associated with weight gain?
Depo provera
ECG findings of TCA overdose
Prolonged QT
Widening of the QRS complex
Sinus tachycardia
Treatment of TCA overdose
IV bicarbonate
lipid emulsion is increasingly being used
A child has an exacerbation of asthma, what else can you add to their therapy?
Can give them oral prednisolone for 3 days
How might laryngomalacia present?
Usually presents with noisy breathing, if severe may lead to noisy breathing when eating/low weight centile/poor food intake
Risk factors for surfactant lung deficiency
Prematurity Male sex Diabetic mothers Caesarean section Second born of premature twins
Side effects of nicorandil
Headache
Flushing
Anal ulceration
Side effects of nitrates?
Headache
Postural hypotension
Tachycardia
pCO2 and life-threatening asthma?
A normal pCO2 in asthma indicates a life-threatening asthma attack, as it is indicative of a reduced respiratory effort
Explain pCO2 and asthma?
Initially, in an asthma exacerbation, the patient will hyperventilate to blow off CO2 to compensate for the hypoxia.
When the patient becomes tired, this is when they stop trying to breathe it off, so they end up with a NORMAL CO2 –> this is a very bad sign!!!§
Treatment for haemorrhage in cervical cancer?
Palliative radiotherapy
These may mimic amelanotic melanoma?
Keratoacanthoma
How would you diagnose perthes disease?
Plain x-ray
Do technetium bone scan or MRI if x-ray is normal
Which virus causes hand, foot and mouth disease?
Coxsackie A16
How does laryngomalacia present?
Noisy breathing on inspiration - most common cause of stridor in children
Treatment of choice for atypical endometrial hyperplasia
Total hysterectomy with bilateral salpingo-oophrectomy (due to risk of malignant progression)
Swelling or locking of knee in teenager
Osteochondritis dissecans
Croup peak incidence
6 months to 3 years
Most common cause of first trimester spontaneous miscarriages
Antiphospholipid syndrome
Most important cause of ventricular tachycardia
Hypokalaemia (followed by hypomagnesaemia)
Causes of torsades de pointes
Hypothermia, hypokalaemia, hypomagnaesemia
How to differentiate between Knight’s move thinking and flight of ideas
Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
When would you use hyoscine butylbromide or hyoscine hydrobromide?
Hyoscine hydrobromide for respiratory secretions
Hyoscine butylbromide for bowel
Which nerves can be affected in acoustic neuroma?
CNV: absent corneal reflex
CNVII: facial palsy
CNVIII: hearing loss, vertigo, tinnitus
INVESTIGATION IF YOU SUSPECT PLACENTA PRAEVIA
DO A TRANSVAGINAL ULTRASOUND - better than abdominal - better accuracy
