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Fourth Yerar > CCC > Flashcards

CCC Flashcards

1
Q

Causes of new LBBB

A

Always pathological- treat as STEMI

myocardial infarction
diagnosing a myocardial infarction for patients with existing LBBB is difficult
rhe Sgarbossa criteria can help with this - please see the link for more details
hypertension
aortic stenosis
cardiomyopathy
rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia

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2
Q

How to define first degree heart block (criteria)

A

PR interval >200ms

It is usually asymptomatic and doesn’t require treatment

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3
Q

What kind of drug is clopidogrel

A

Antiplatelet
Primary or secondary (?) prevention of cardiac events

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4
Q

Hypertension with hypokalaemia and hypernatraemia 3 differentials

A

Primary hyperaldosteronism is the most common (often asymptomatic and no signs on PE)

Plasma renin:aldosterone and low- dexamethasone suppression test to figure out between Cushing and renal artery stenosis

NB that primary hyperaldosteronism may not present with hypokalaemia and is most commonly caused by idiopathic bilateral adrenal hyperplasia causing an adenoma that secretes aldosterone

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5
Q

Which medication commonly causes low magnesium

A

PPIs

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6
Q

What kind of drug is indapamide

A

thiazide-like diuretic.

Added when ACE- I isn’t enough (or CCB)

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7
Q

old man, bone pain, raised ALP only

A

Pagets disease

Increased bone turnover

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8
Q

What is pulses paradoxus

A

fall in systolic blood pressure of greater than 10mmHg with inspiration

can be measured using manual blood pressure recordings

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9
Q

Triad of cardiac tamponade (fluid in pericardium)

A

raised JVP, pulses paradoxus and muffled/quiet heart sounds

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10
Q

What type of drug is losartan

A

Angiotensin receptor blocker

Used first line in hypertension (either tat or ACE-I)

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11
Q

What typically raises gamma GT levels

A

Alcohol consumption

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12
Q

Treatment for acute heart failure (acronym

A

Pour SOD

Pour away fluids (reduce fluids)
Sit up right
Oxygen
Diuretics

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13
Q

What do you give in chronic heart failure as first line treatment (with reduced LV ejection fraction)

A

Beta blocker and ACE inhibitor

Even if they would normally take CCB for HT give ACE-I

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14
Q

If angina is not controlled with a beta blocker and GTN spray what should you add

A

Long acting dihydropyridine calcium channel blocker e.g. modified release nifedipine

Not verapamil or diltiazem as these has negative chronotropic effects

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15
Q

New BP of more than 180/120, no other symptoms what do you do

A

Check for end-organ damage

By doing urgent ECG, urine dip and blood tests

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16
Q

How do you treat a young person presenting with AF for the first time with symptoms but not too bad

A

Anticoagulants for 3 weeks then cardioversion to sort the rhythm

Don’t cardiovert instantly as there is a risk of atrial thrombosis

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17
Q

Young woman with high BMI presents with bilateral headaches worse on bending over and visual symptoms e.g. optic disk blurring

A

Idiopathic intracranial hypertension

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18
Q

“Starry sky” appearance on biopsy for raised lymph nodes

A

Non-Hodgkin’s lymphoma

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19
Q

What do you give someone from black A/ A-C origin if their CCB isn’t enough

A

Give an ARB over an ACE-I e.g. losartan

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20
Q

3 ECG signs of digoxin toxicity

A

Down-sloping ST depression (reverse tick)
Flattened/ inverted T waves
Short QT interval

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21
Q

Is FEV1:FVC ratio low or high in obstructive and restrictive illness

A

In obstructive illness the ratio is low as it is difficult to get air out, but it eventually gets out (probs less than normal)

In restrictive illness the amount that can escape is reduced so ratio is. Normal but FVC will be low

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22
Q

Is anterior or posterior MI more likely to cause LBBB

A

Anterior (or anteroseptal)

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23
Q

Episodic pruritis after a hot bath, with elevated Hb and platelets and mild splenomegaly

A

Polycythaemia Vera

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24
Q

Which organism most commonly causes infective exacerbations of COPD

A

Haemophilus influenzae

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25
Q

How can you differentiate between primary and secondary hyperparathyroidism on blood results

A

Both will have high parathyroid hormone

Primary will have high calcium (PTH should descrease as Ca increases and if it doesn’t you know its a problem with PT gland)

Secondary will have low/ normal calcium to counter the high Ca so you know it’s caused by something else. Secondary will also have high phosphate

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26
Q

ST elevation in ALL LEADS

A

Think pericarditis

Presents with chest pain eased on sitting forward, flu-like symptoms, breathlessness

“Saddle-shaped” ST elevation

PR depression is the most specific ECG marker for pericarditis

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27
Q

PR depression on ECg

A

Most specific ECG marker for pericarditis

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28
Q

First line Investigation for suspected pericarditis

A

Tranthoracic echocardiography

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29
Q

Pansystolic murmur 3 causes

A

Mitral regurgitation
Tricuspid regurgitation
VSD

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30
Q

4 features of multiple myeloma (acronym

A

CRAB

(hyper)Calcaemia
Renal failure
Anaemia (and thrombocytopenia)
Bone fractures

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31
Q

Does chrons have bloody or non-bloody diarrhoea

A

Non-bloody (usually)

Also commonly presents with weight loss and abdominal pain (rarer in UC) due to malabsorption

UC usually has bloody diarrhoea

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32
Q

What is first line anticoagulants now in stroke prevention

A

Factor Xa inhibitors

E.g. rivaroxaban,apixaban, edoxaban

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33
Q

How to differentiate between pericarditis and Dressler’s syndrome

A

Dressler’s syndrome typically occurs weeks/months after an MI/ cardiac surgery (thought to be autoimmune response)

Pericarditis would typically present sooner after an event

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34
Q

How to differentiate between bilateral adrenal hyperplasia and renal artery stenosis (both causes of high blood pressure)

A

Renin levels

If high then secondary cause e.g. renal artery stenosis

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35
Q

Secondary prevention drugs after cardiac event

A

DABS

Dual antiplatelet therapy (clopidogrel/ticagrelor and aspirin)
ACEi
Beta blocker
Statin

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36
Q

Which endocrine deficiency can come after thyroid gland removal

A

Hypocalcaemia due to dmaage to parathyroid gland

Presents with paraesthesia, muscle cramps, spasms

Long QT on ECG

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37
Q

How does hypocalcaemia present on ECG

A

Long QT

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38
Q

What is guttate psoriasis

A

Following streptococcal infection, common in young people

‘Tear drop’ scaly papules on trunk/ limbs, acute onset

Autoimmune reaction p, could never have it again, could have chronic psoriasis

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39
Q

What is the most common cause of blepharitis (swollen, itchy eyelids)

A

Seborrhoeic dermatitis

Normally causes lesions in the scalp p, periorbital p, auricular and nasolabial folds. Can also cause otitis external

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40
Q

Kaposi’s sarcoma

A

caused by HHV-8 (human herpes virus 8)
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)

Indication of underlying HIV infection

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41
Q

What is th3 most common cardiac manifestation of SLE

A

Pericarditis

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42
Q

Most specific ecg finding in pericarditis

A

PR depression

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43
Q

Most common side effects of Tamsulosin

A

Dizziness and postural hypotension

Relaxes smooth muscle in prostate and bladder, but also causes systemic vasodilation hence SE

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44
Q

What is first line in smoking cessation

A

patients should be offered nicotine replacement therapy (NRT), varenicline or bupropion - NICE state that clinicians should not favour one medication over another

Bupropion is an Atypical antidepressant which lowers seizure threshold

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45
Q

Which blood test indicates proteinuria

A

Albumin to creatinine ratio

> 3mg/mmol means protein in urine

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46
Q

How do you treat proteinuria in CKD

A

ACE-I or ARB first line

Then

SGLT-2 inhibitors

Mitigate hyperfiltration so stop protein being leaked out into urine

(Also used in type 2 diabetes but makes glucose get excreted)

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47
Q

What is first line anticoagulant in AF

A

DOACs

E.g. apixaban, dabigatran, edoxaban, rivaroxaban

Warfarin is second line

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48
Q

What is first line Abx in COPD when someone is allergic to penicillin

A

Doxycycline/ clarithromycin

Not erythromycin (indicated if pregnant)

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49
Q

Is the Total Gas Transfer (TLCO) raised or lowered in asthma

A

Raised as the alveoli are healthy and trying to compensate for the lower air flow

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50
Q

How does prolactinoma present in a woman `

A

Excess prolactin:
- amenorrhoea
- infertility
- galactorrhoea
- osteoporosis

  • headache
  • visual disturbance (near optic chiasm- classically lateral visual fields impaired)
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51
Q

Is bronchiectasis obstructive or restrictive

A

Obstructive

Damaging and widening of the airways due to insult e.g. infection, inflammation (most commonly CF, TB)

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52
Q

What do you give first line in COPD

A

A SABA or a SAMA

So salbutamol or a SAMA like ipratropium

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53
Q

What is first line Abx in COPD prophylaxis

A

Azithromycin

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54
Q

Pityriasis versicolor typical presentation

A

Young man just been on holiday

Patches of skim discoloration mainly on trunk (pale/brown/pink/ depigmented)

Flaky/ itchy skin often

Treat with topical anti fungal e.g. ketoconazole shampoo

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55
Q

How to treat pityriasis veriscolor

A

Topical antifungals

Ketoconazole shampoo first line

If doesn’t work probably something else

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56
Q

Lichen planus classic presentation

A

purple, pruritic, papular, polygonal rash on flexor surfaces

Treat with potent topical steroids

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57
Q

How to treat lichen planus

A

Potent topical steroids

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58
Q

Flaky and itchy scalp with hair loss

A

Tinea capitis

Seborrheic dermatitis would have greasy scalp and no hair loss

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59
Q

Which joints are affected in rheumatoid, psoriatic, osteoarthritis

A

Rheumatoid= proximal interphalangeal joints

Psoriatic= distal interphalangeal joints

Osteoporosis= larger joints

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60
Q

What is the most common cause of primary hyperparathyroid

A

Parathyroid adenoma 80%

Parathyroid hyperplasia 15%

Parathyroid carcinoma 1%

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61
Q

Which t2dm medication does not cause weight gain

A

DPP-4 inhibitor (weight neutral)

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62
Q

Common side effects of opioids for pain relief

A

Constipation (always prescribe laxative)
N nd v (prescribe prn antiemetic)
Drowsiness (often temporary)
Confusion/ delirium/ hallucinations (consider dose reduction if pain free)
resp depression (low sats and low RR)

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63
Q

Top 5 cytotoxic chemotherapy side effects

A

1) Neutropenia- more susceptible to infection/ sepsis
2) Nausea and vomiting
3) Hair loss
4) Mucositis (inflammation of mouth/ gut)-> diarrhea, sores, pain
5) VTE

Also consider weight loss and anaemia

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64
Q

What other kind of drug if often given as a pre-med alongside antiemetics in chemo

A

Steroids e.g. dexamethasone

Weigh up against side effects of steroids

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65
Q

Top 5 immunotherapy side effects

A

1) Rash
2) Pneumonitis
3) Diarrhoea and colitis
4) Thyroid issues-acute thyroiditis then hypothyroid
5) Adrenal insufficiency and crisis

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66
Q

Give 3 components of the immune regulatory system that is faulty in cancer and commonly targeted in immunotherapy

A

Cytotoxic T Lymphocyte Antigen 4 (CTLA4) expressed on T Lymphocytes

Programmed Cell death protein 1 (PD1) expressed on lot of immune cells

Programmed death ligands 1 (PDL1) expressed on lots of cells

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67
Q

How do you manage severe rash in immunotherapy (acute)

A

High dose IV steroid

Specialist referral

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68
Q

How does Pneumonitis present in immunotherapy side effects

A

Cough (often dry)
SOB
Reduced exercise tolerance
Fatigue

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69
Q

How to treat pneumonitis in immunotherapy side effects

A

Oral steroid (high dose))

If opportunistic infection developed will need antibiotics

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70
Q

How can hepatitis present in immunotherapy side effect

A

Jaundice

Right sided abdominal pain

Fatigue

May also be asymptomatic

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71
Q

How’s does nephritis present in immunotherapy side effects

A

Often asymptomatic at first

Weakness, fatigue, anorexia, malaise
Thirst
Reduced urine output

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72
Q

How to treat hyperthyroidism as a result of immunotherapy

A

Carbimazole/ propranolol

Not steroids

Can continue cancer therapy, may be on thyroid meds for life

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73
Q

Side effects of high dose steroid use in immunotherapy side effects

A

Sleep disturbance
Mood change
Indigestion
GI bleed
Weight gain
Hypertension
Increased infection risk

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74
Q

What are the 4 types/indications of cancer treatment

A

Radical/ curative- only/main method of treatment
Adjuvant- following another type of treatment
Palliative- symptom control
Neo-adjuvant- prior to surgery

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75
Q

What is the most common type of radiotherapy

A

Photon- penetrates tissue and then produces secondary electrons which cause DNA damage

Other types include electrons and protons

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76
Q

How long after radiotherapy would you expect to get pneumonitis

A

6-8 weeks after RT- treat with high dose steroids and oxygen

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77
Q

How to treat neuropathic pain

A

Antidepressants and anticonvulsants

E.g. amitriptyline and gabapentin/ pregablin

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78
Q

How long do fentanyl transdermal patches last for

A

72 hours

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79
Q

What is xerostomia

A

Dry mouth

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80
Q

Which hormonal therapy for breast cancer in ER positive

Pre and post menopausal

A

Tamoxifen in pre/perimenopause

Aromataze inhibitors e,g, letrozole in post-menopausal

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81
Q

Acute sarcoidosis presentation

A

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia

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82
Q

Which two cancers most commonly cause bowel obstruction

A

Ovarian

Bowel

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83
Q

Symptoms of bowel obstruction

A

N and V
Colicky pain
Abdo distension
Dull aching pain
Diarrhea/ constipation

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84
Q

What are the two types of antispasmodics

A

Antimuscarinics (anticholinergics) e.g. hyoscine butylbromide)

Smooth muscle relaxants

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85
Q

Features of pulmonary oedema

A

Dyspnoea
Orthopnoea
Foaming at the mouth
Paroxysmal nocturnal dyspnoea
Distress

Diagnosed on CXR

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86
Q

How to treat pulmonary oedema

A

Diuretics

Dimorphine

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87
Q

3 drugs for congestive cardiac failure

A

Diuretics , digoxin , ACEi

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88
Q

What is the commonest region for metastatic spinal cord compression

A

Thoracic (2/3)

Cervical and lumbar also

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89
Q

How do you diagnose MSCC

A

MRI scan

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90
Q

How do you manage MSCC

A

Corticosteroids (dexamethasone 16mg)

Surgery often favored when there is a mechanical collapse of the vertebral body, but less likely to be used if here is extensive disease elsewhere

Can also try chemo and radiotherapy

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91
Q

What is the most common causing problem in SVCO

A

Extensive lymphadenopathy in the upper mediastinum e.g. in lung cancer we or lymphoma

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92
Q

How do you manage SVCO

A

High dose corticosteroids (Dexamethasone 16mg daily)

Urgent vascular stenting is treatment of choice often followed by chemo / radiotherapy

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93
Q

What two blood tests do you need to order if thinking hypercalcaemia

A

Serum calcium corrected for serum albumin so order LFT’s and calcium

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94
Q

How does albumin levels affect calcium levels

A

Calcium and albumin bind to each other so when albumin is low calcium is low

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95
Q

How do you manage hypercalcaemia

A

Rehydration using normal saline
IV bisphosphonate e.g. pamidronate

Bisphosphonates inhibit bone resorption which decreases the amount of calcium being released into the blood stream

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96
Q

Which 2 anti-emetics are most likely to cause skin irritation through a syringe driver

A

Cyclizine

Levomepromazine

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97
Q

Which benzo can you not give in a syringe driver

A

Diazepam

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98
Q

How does headache secondary to raised intracranial pressure in malignancy present

A

Headaches worse in mornings, improves on standing

Occasional visual changes

Papilloedema?

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99
Q

High urea levels in GI bleed- upper or lower

A

Upper

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100
Q

Which lung cancer causes Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

A

Small cell lung cancer

Increased water retention due to overproduction of ADH x hyponatraemia

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3
4
5
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101
Q

Oral codeine to oral morphine conversion

A

Divided by 10

100mg of oral codeine= 10mg morphine

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102
Q

Oral morphine to sub-cut morphine conversation rate

A

Divide by 2

20mg oral morphine to 10mg sub-cut morphine

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103
Q

Oral morphine to oral oxycodone conversion

A

Divide by 2

20mg oral morphine =10mg oral oxycodone

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104
Q

Oral oxycodone to sub-cut oxycodone

A

Divide by 2

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105
Q

Which stage of lung cancer is the most common stage to present with

A

Stage 4

Associated with the worst prognosis (most advanced stage)

106
Q

What is the most common subtype of lung cancer

A

Adenocarcinoma (usually associated with non-smoking but still more common in smokers)- 50%
Squamous cell carcinoma- 30%
Small cell carcinoma- 15%
Large cell carcinoma- 5%

Increase in adenocarcinoma in smokers due to fine filters being introduced

107
Q

Give 3 paraneoplastic syndromes that can occur due to small cell lung cancer

A

Ectopic ACTH production

SIADH syndrome of inappropriate ADH production

Eaton Lambert Sydrome (big like myasthenia gravis)

108
Q

Which type of lung cancer causes paraneoplastic syndromes including SIADH, ectopic ACTH production and Eaton lambert syndrome

A

Small cell lung cancer

109
Q

Where else do you target with radiotherapy in small cell lung cancer

A

Brain because that is the place that it is most likely to relapse to

Improves survival by 5%

110
Q

TNM staging for lung cancer

A

T= Tumour.
T1= contained within the lung (a,b,c is <1-3cm)
T2= either 3-5cm (a,b) or involved main bronchus/ visceral pleura or lung collapse
T3= 5-7 cm or more than one tumour or involved chest wall, parietal pleura, phrenic nerve or pericardium
T4= >7cm or more than one lobe or involved diaphragm, mediastinum, heart, major vessel, trachea, vagus nerve, oesophagus, spinal bone, carina

N= Node
N0= no lymph node involvement
N1= lung/ hilum lymph nodes
N2= mediastinum or under the carina lymph nodes
N3= contralateral lung, supraclavicular or apical lymph node involvement

M= metastasis
M0= no metastasis to other lobe/ anywhere else
M1= cancer has spread:
M1a= both lungs, pleura, pericardium, malignant pleural effusion.
M1b= single area of cancer outside the chest e.g. liver/ brain/ lymph node
M1c= more than one area of cancer elsewhere

111
Q

T part of TNM staging for lung cancer

A

T= Tumour.
T1= contained within the lung (a,b,c is <1-3cm)
T2= either 3-5cm (a,b) or involved main bronchus/ visceral pleura or lung collapse
T3= 5-7 cm or more than one tumour or involved chest wall, parietal pleura, phrenic nerve or pericardium
T4= >7cm or more than one lobe or involved diaphragm, mediastinum, heart, major vessel, trachea, vagus nerve, oesophagus, spinal bone, carina

112
Q

N part of TNM staging for lung cancer

A

N= Node
N0= no lymph node involvement
N1= lung/ hilum lymph nodes
N2= mediastinum or under the carina lymph nodes
N3= contralateral lung, supraclavicular or apical lymph node involvement

113
Q

M part of TNM staging for lung cancer

A

M= metastasis
M0= no metastasis to other lobe/ anywhere else
M1= cancer has spread:
M1a= both lungs, pleura, pericardium, malignant pleural effusion.
M1b= single area of cancer outside the chest e.g. liver/ brain/ lymph node
M1c= more than one area of cancer elsewhere

114
Q

First line in confusion without a reversible cause

A

Haloperidol

Could also choose chlorpromazine or levomepromazine

If in terminal phase then treat with midazolam

115
Q

What is the difference between hyoscine hydrobromide and hyoscine butylbromide

A

Both used for secretions in end of life care

BUTYLBROMIDE does not cross the blood brain barrier and so has no CNS effect

Hydrobromide does cross the blood brain barrier and can cause sedation/ confusion

So use hydrobromide is used when you want calming/ sedation effects alongside reduced secretions

116
Q

What is the indication for oxycodone over morphine

A

Renal impairment

117
Q

What is the indication for 2 week wait for bladder cancer

A

Over 60 patient with unexplained non-visible haematuria AND either dysuria or raised white cells

118
Q

What is the 2 common cancers associated with lynch syndrome (HNPCC- hereditary non-polyposis colorectal cancer)

A

Colorectal (80%)

Endometrial (60%)

119
Q

What is the most common specific side effect of axillary node clearance in breast cancer

A

Lymphedema in the arm causing functional arm impairment

120
Q

How does silicosis present

A

Persistent cough
Increasing exertional dyspnoea

Often mining occupation

Egg-shell calcification of the hilar lymph nodes
Upper zone fibrosis

121
Q

Contraindications for lung cancer surgery

A

SVCO
FEV <1.5
MALIGNANT pleural effusion
Vocal cord paralysis

Due to extent of spread making it unlikely to be curative

122
Q

How to interpret plasma and urine osmalality

A

Plasma osmalality= concentration of stuff in plasma- high osmalality means lots of stuff (concentrated)

Urine osmalality= content ration of stuff in urine- high osmalality means concentrated urine

So in SIADH the urine osmalality is increased as water is retained

123
Q

Order of the large bowel

A

Caecum
Ascending colon
Hepatic flexure (top right)
Transverse colon
Splenic flexure (top left)
Descending colon
Sigmoid colon (back to midline)
Rectum

124
Q

Classic triad of renal cell carcinoma

A

Flank pain
Haematuria
Palpable abdominal renal mass

Around 20% have fever

125
Q

What is the difference between fibroadenoma and fibroadenosis

A

Fibroadenoma is common in women under 30- discrete, non-tender, highly mobile lumps (breast mice)

Fibroadenosis is lumpy, painful breasts worse before menstruation. Common in middle aged women. Aka fibricystic disease

126
Q

Which breast condition resembles eczema of the nipple/areola

A

Paget’s disease of the breast

= intraductal carcinoma

Associated with reddening and thickening of the area

127
Q

How to differentiate between a femoral and inguinal hernia

A

?femoral more common in females

Femoral= below and lateral to pubic tubercle
Inguinal= above and medial to pubic tubercle

128
Q

Why do small cell lung cancers cause paraneoplastic syndrome

A

They contain neurosecretory granules that can release neuroendocrine hormones

129
Q

Which lung cancer is linked to asbestos

A

Mesothelioma

Malignancy affecting the mesothelial cells

Large latent period and prognosis is very poor

130
Q

Which nerve gives you a hoarse voice in lung cancer

A

Recurrent laryngeal nerve

131
Q

which nerve causes diaphragm weakness and SOB in lung cancer

A

Phrenic nerve palsy

132
Q

What is Pemberton’s sign

A

Raising the hands over the head causes facial congestion and cyanosis
Sign of SVCO
Medical emergency

133
Q

what is Horner’s syndrome

A

Triad of partial ptosis, miosis, and anhydrosis caused by a Pancoast tumour (pulmonary apex) pressing on the sympathetic ganglion

134
Q

Which type of lung cancer causes Hypercalcaemia

A

Squamous cell carcinoma

Ectopic parathyroid hormone production

135
Q

How do you manage breast cancer prior to surgery

A

If palpable lymphadenopathy do axillary node clearance (risk of arm lymphadema and arm impairment)

If no lymphademopathy then do a sentinel node biopsy to assess the nodal burden

136
Q

Which HPV subtypes are cancerous

A

16 and 18 and 33?

6 and 11 are associated with genital warts

137
Q

Which cancer does high amounts of HPV infections cause

A

Anal cancer

138
Q

What is pernicious anaemia

A

Autoimmune disorder affecting the gastric mucosa resulting in b12 deficiency

  • intrinsic factor antibodies → bind to intrinsic factor blocking the vitamin B12 binding site
  • gastric parietal cell antibodies → reduced acid production and atrophic gastritis. Reduced intrinsic factor production → reduced vitamin B12 absorption

vitamin B12 is important in both the production of blood cells and the myelination of nerves → megaloblastic anaemia and neuropathy

139
Q

Occupational risk factor forbladder cancer

A

Dye and rubber workers
Aromatic amines

Also found in cigarettes

140
Q

Which type of cancer do rubber/ dye workers get

A

Transitional cell carcinoma of the bladder

141
Q

Risks of TRUS biopsy

A

Recital discomfort
Blood in urine / semen
Urine infection potentially leading to sepsis (3%)

Trans rectal ultrasound biopsy

142
Q

T staging of prostate cancer

A

T1 is not palpable or visible (only found on biopsy)
T2 is within prostate
T3 is breaching prostrate capsule
T4 is cancer growing into rectum/ bladder

143
Q

What is the systemic medical treatment for metastatic prostate cancer

A

Androgen deprivation therapy

Also consider chemo, enzalutamide

Prostate cells require testosterone to grow

144
Q

Side effects of androgen deprivation therapy ADT

A

Hot flushes
Sexual function
Muscle loss
Memory problems
Weight gain
Fracture

145
Q

What is neutropenic sepsis

A

Neutrophils of less than 1 and either

Temp above 38
Or
Other signs

146
Q

When after chemo does neutropenic sepsis normally present

A

7-14 days

147
Q

How does malignancy case hypercalcaemia

A

Transforming Growth Factor Alpha:
- produced by tumour cells
- powerful stimulator of bone resorption

Parathyroid hormone related peptides:
-mimics PTH, stimulating bone resorption increasing plasma calcium

148
Q

How to manage hypercalcaemia

A

Rehydrate with IV fluids
If needed (Ca above 3) give bisphosphonates e.g. zalendronic acid

If bad renal function give pamindronate

149
Q

What are the two choices of bisphosphonates given in malignant hypercalcaemia

A

Zalendronic acid

If bad renal function give
Pamindronate

150
Q

What is a bruit heard in the upper abdomen indicative of

A

Intestinal angina

151
Q

What does a low and high dose dexamethasone test help you diagnose and how

A

Cushing’s disease

In the test, patients are given dexamethasone to mimic cortisol- should reduce ACTH through negative feedback

If the ACTH is suppressed by high-dose dexamethasone and not low dose then it is a pituitary problem (pit is high up, high dose)

In a normal person it would be suppressed by low-dose

152
Q

What is the surgical procedure to remove a distal transverse or descending Colon cancer

A

Left hemicolectomy

Respects descending an distal part of transverse colon- anastomosis to join proximal and distal bowel segments

153
Q

Which type of thyroid cancer has raised calcitonin levels

A

Medullary

Perhaps might lead to decreased calcium as calcitonin decreases calcium levels

154
Q

Which type of obstruction has high serum amylase levels

A

Small Bowel

Due to pressure on the pancreatic duct or a reflex response to the obstruction and change in digestive processes

Basically it just happens in small Bowel

155
Q

Which testicular lesion is usually palpable separate and posterior to the testicle

A

Epididymal cyst

Can be painless or tender if infected

156
Q

Painless obstructive jaundice and palpable gallbladder

A

Most likely cancer

Think pancreatic- unlikely to be gallstones (Courvoisier’s law)

157
Q

What sign can be seen on CT in pancreatic cancer

A

Double duct sign

Combined dilation of the common bile duct and pancreatic duct

158
Q

How does subacute thyroiditis (de Guervain’s thyroiditis) present

A

Hyperthyroidism
Tender goitre
After recent viral infection

159
Q

What type of procedure for rectal tumours (apart from lower-rectal tumours)

A

Anterior resection

160
Q

What is the procedure for lower rectal tumours

A

A domino-perineal excision of the rectum

161
Q

Which type of lung cancer is associated with gynecomastia

A

Adenocarcinoma

162
Q

What are the types of testicular cancer

A

Over 95% are germ cell which has 2 divisions:
- seminomas
- non-seminomas (e.g. teratoma)

Non-seminoma germ cell testicular tumours are associated with raised hCG and AFP

163
Q

What do you give to patients with a sore mouth (especially at the end of life)

A

Benzydamine hydrochloride

164
Q

First line inv for stable angina

A

Contrast-enhanced CT coronary angiogram

165
Q

What type of antihypertensive is contraindicated in renovascular disease

A

ACEi

166
Q

What is first line investigation for someone with stable angina

A

CT coronary angiography

To assess blood flow through the coronary arteries to look for narrowing or blocking

167
Q

What ENT condition is a common complication of seborrhoeic dermatitis

A

Otitis externa

168
Q

What do you give first line meds in diabetes with bad kidney function (<30)

A

Not metformin

Give a DPP-4 inhibitor instead (e.g sitagliptin)

169
Q

What do you give in T2DM patients after metformin with heart failure/ heart disease/high risk of developing a CV disease

A

SGLT-1 inhibitor (gliflozins e.g. dapagliflozin)

170
Q

What are the only two T2DM drugs you can add dapagliflozin to for triple therapy

A

Metformin and a sulfonylurea

Don’t add it onto pioglitazone

171
Q

If a skin lesion is describes as violaceous what is a likely other part of the body to be affected

A

Mucous membranes

Lichen planus (purple, pruritic, polygonal, papular rash on flexor surfaces)
Up to 70% of patients have mucous membrane involvement

172
Q

How do you assess exocrine pancreatic function in chronic and acute pancreatitis

A

For acute measure serum amylase

For chronic measure faecal elastase

173
Q

What investigation do you do when someone presents with a hydrocele

A

Urgent USS to find underlying cause e.g. tumour

Other cases e.g. epididymo-orchitis, torsion

174
Q

What is a common complication of DKA causing seizures

A

Cerebral oedema

Caused by rapid fluid resuscitation in DKA

Causes headache, irritability, seizures and ultimately coma and death

Occurs in 1% of DKA treatment

175
Q

What kind of a murmur is caused by atrial septal defect

A

Ejection systolic

Louder on inspiration

Fixed splitting of the second heart sound

176
Q

What is the first line anti-hypertensive in CKD if the albumin-creatinine ratio is >30

A

ACEi e.g. ramipri

Helps to manage protein getting excreted in the urine

177
Q

What are the 6 causes of macrocytic anaemia

A

FAT RBC

Foetus (preg)
Alcoholism
Thyroid (hypo)

Reticulocytosis
B12/folate
Cirrhosis

178
Q

Weight effect of SGLT2 inhibitors e.g. gliflozins

A

Weight loss to due excretion of glucose

179
Q

Erratic blood glucose control, bloating and vomiting in T1DM with early satiety

A

Think gastroparesis

180
Q

Which type of lung cancer is associated with Cavitating lesions

A

Squamous cell carcinoma

Also associated with clubbing

181
Q

Which antiemetic would you prescribe for gastric stasis

A

Metoclopramide

182
Q

Which anti-emetic would you give for an intracranial cause of nausea and vomiting

A

Cyclizine

183
Q

How does idiopathic pulmonary fibrosis present

A

Gradual onset of SOB
Dry cough
Clubbing

End-ispiratory crackles in both bases
Restrictive spirometry

Diagnose with a CT scan

manage with pulmonary rehab, meds not that effective

Poor prognosis 3-4 years

184
Q

First line investigation for suspected testicular cancer

A

Testicular USS

185
Q

What is the most common type of prostate cancer

A

Adenocarcinoma

186
Q

Which type of thyroid cancer has increased calcitonin

A

Medullary thyroid cancer

Papillary is the most common

187
Q

What pain relief should be given in mild/moderate and severe renal impairment

A

In mild/moderate give oxycodone

In severe give either buprenorphine or fentanyl

188
Q

How do you get from oral morphine to sub-cut diamorphine

A

Divide by 3

Diamorphine and morphine are different

189
Q

What is a big risk factor for squamous cell carcinoma of the bladder

A

Schistosomiasis

= a Parasitic worm disease

190
Q

What is the most common side effect of finasteride for BPH

A

Gynaecomastia

Also can have low libido and ejaculation disorders

Due to decrease in testosterone

191
Q

Double duct sign on imaging

A

Pancreatic cancer

Due to dilatation of the pancreatic and common bile ducts

192
Q

Coffee bean sign on abdo X-ray

A

Sigmoid volvulus

Twisting of the sigmoid colon (bottom S shaped bit)

Causes LBO

193
Q

What is the normal method of treatment in small cell lung cancer

A

Chemotherapy

with adjuvant radiotherapy when the disease is well limited

194
Q

On barium swallow how to differentiate between achalsia and cancer

A

Achalasia gives a birds beak appearance (smooth, well-defined edges)

Cancer gives an apple core appearance

195
Q

First line investigation when suspecting pancreatic cancer

A

CT abdomen

196
Q

Nitrofurantoin can be given for UTI unless what

A

EGFR <45

197
Q

What is first line Abx for animal bites

A

Co-amoxicillin

198
Q

What to give instead of fluclox in penicillin allergy

A

Erythromycin

At least for skin infections

199
Q

What to do in subclinical hypothyroidism when they arent very symptomatic

A

Do not give levothyroxine instantly

Redo TFT in 3 months

200
Q

Which anti-emetic in chemical/ toxic cause of vomiting e.g. in chemo

A

Haloperidol

201
Q

Which antihypertensive is the most likely to cause low sodium

A

Thiazide-like diuretics

202
Q

What is an alternative to amitriptyline in diabetic neuropathy management

A

Duloxetine

?pregablin?

Capsaicin cream if localised pain?

203
Q

What is the ACR threshold for a lower clinic BP target of 130/80

A

70

204
Q

How does proctitis present

A

Proctitis= inflammation of the rectum not prostate (but is a common complication of prostate cancer radiotherapy)

Bloody diarrhea
Tenesmus
Able pain

Similar to UC which also inflames the rectum

205
Q

In HNPCC which is the most common male and female cancers after colon

A

Endometrial in women
Prostate in men

206
Q

What is the most common type of colorectal cancer

A

Adenocarcinoma

207
Q

New vertigo, loss of balance, Mild past pointing

A

Think posterior stroke and refer asap

208
Q

What are the 4 statuses that need to be established to guide breast cancer treatment

A

BRCA status
ER/PR status (hormonal therapy)
HER2 status
PDL-1 status (immunotherapy)

209
Q

Why is left sided varicocele more common

A

Angle at which the left testicular vein enters the left renal vein

210
Q

What is the strongest risk factor for anal cancer

A

HPV

211
Q

Which cancer does Sjögren’s syndrome put you at risk of

A

Lymphomas

212
Q

How to distinguish between pancreatic and liver cancer from LFTs

A

Pancreatic cancer shows a cholestatic patter (ALP disproportionately high compared to ALT and AST)

Liver cancer may cause hepatocellular pattern which is higher ALT or AST

213
Q

If ALP is raised how can you make sure that it is a liver problem and not being produced by the bone or placenta

A

Whenever the source of elevated ALP is the liver, gamma-glutamyl transpeptidase (GGT) levels are also raised.

I’m primary biliary cholangitis AMA is also high

214
Q

Which to our marker is used to monitor colorectal cancer

A

Carcinoembryonic antigen

215
Q

Asian heritage predisposes you to which type of ENT cancer

A

Nasopharyngeal

216
Q

Which vaccine do you give to people with coeliac

A

Pneumococcal

Their spleen can be dysfunctional due to disease meaning that the immune system is weak to ‘encapsulated organisms’’

217
Q

Two drugs for orthostatic hypotension

A

Fludrocortisone and midodrine

218
Q

side effects of ACEi counselling

A

common= GI upset, nausea, rash
dry cough- can change if problematic
postural hypotension- lower dose
angiodema- <1%= swollen face and lips- emergency

219
Q

monitoring counselling ACEi

A

UandEs before giving to check renal function

yearly BP checks and yearly UandEs

220
Q

how to take bisphosphonates

A

once a week on the same day every week

take first thing in the morning 30 mins before food with a big glass of water

after taking sit/ stand up for 30 mins

will take 6 months to kick in

if you forget to take then just take asap dont take two

221
Q

side effect counselling bisphosphonates

A

GI/ oesophageal irritation, nausea
muscle pain
above should settle in a month

osetonecrosis of the jaw is rare but serious- mouth ulcers that wont heal, pain in mouth and swelling of face. if happens seek urgent medical advice

222
Q

how to differentiate between metastatic prostate cancer and myeloma in back presentation

A

myeloma is lytic (osteoclast activity whilst suppressing osteoblast activity)

prostate metastasis is sclerotic (slow growing changes over time?)

223
Q

medical Mx options for migraine

A

NSAIDs
Paracetamol
Triptans- take a second dose if it resolves, if it doesnt work dont take another dose
Antiemetics if vomiting e.g. metoclopramide

dont use opioids

224
Q

how do triptans work in migraines

A

5-HT receptor agonists (bind to serotonin receptors)

effects:
- cranial vasoconstriction
- inhibits pain transmission
- inhibits inflam neuropeptide release

CI in hypertension, previous cardiac event due to vasoconstriction

225
Q

how do you prevent migraines

A

avoid triggers e.g. foods like chocolate, cheese, stress, bright lights, dehydration, not enough sleep

prophylactic meds e.g. propanolol, amitriptyline.

you can give prophylactic triptans for menstrual migraines

226
Q

what is MS

A

autoimmune disease where the WBC in ur body attack the myelin sheath in your CNS (oligodendrocytes). this causes a range of symptoms depending on where but commonly causes optic neuritis (unilateral reduced vision, pain on movement)

some patients can relapse and remit for life and some progress

diagnosis is made on the clinical picture, excluding other causes for Sx and MRI scans/ LP to detect oligoclonal bands

227
Q

what on LP demonstrates MS

A

oligoclonal bands in the CSF

228
Q

how do you manage MS

A

Symptomatically
high dose steroids either oral or IV methylpred on acute flares
disease modifying drugs e.g. natalizumab IV

229
Q

most common presentation of MS

A

optic neuritis (unilateral reduced vision, pain on movement)

can present in a number of sub-acute attacks which will mostly relapse and remit

230
Q
A
231
Q

Which antidiabetic drug would you add to metformin in someone with a high bmi

A

DPP4 Inhibitor e.g. gliptin

Or

SGLT2 inhibitor e.g. gliflozin

232
Q

Which Abe do u give in UTI with bad kidney function

A

Trimethoprim

Nitro CI in egfr lt 45

233
Q

4 parts of CENTAUR criteria

A

1) History of fever 2) tonsillar exudates 3) no cough 4) tender anterior cervical lymphadenopathy.

234
Q

Which ABbx can u not take with alcohol

A

Metronidazole

235
Q

Which antihypetensive causes side effects with statins

A

CCB e.g. amlodipine with simvastatin causes muscle weakness and myalgia

236
Q

Give an example of a mildly, moderately, potent and very potent topical corticosteroids

A

Mildly potent= hydrocortisone 0.1/0.5/1.0/2.5
Moderately potent= betamethasone valerate 0.025% (betnovate) or eumovate
Potent= betametasone valerate 0.1% (stronger betnovate) or diprosone
Very potent= clobetasol propionate 0.05 (Dermovate)or Nerison Forte

237
Q

How strong a topical steroid is hydrocortisone

A

Mildly potent

238
Q

How strong Betnovate-RD

A

Moderately potent- 0.025%

If it was 0.1% betamethasone valerate it would be potent

239
Q

How to grade CKD based on eGFR

A

G1-G5

G5= eGFR<15
G4= 15-30
G3b= 30-45
G3a= 45-60
G2= 60-90
G1 >90

240
Q

How to grade CKD based on ACR

A

A1= <3
A2=3-30
A3= >30

241
Q

When are people with CKD offered ACEi

A

If they have an urine ACR>70

If they have hypertension and an ACR>30

if they have diabetes and an ACR >3

Make sure to monitor for hyperkalaemia as can be caused by CKD and ACEi

242
Q

When is dapagliflozin offered to patients with CKD

A

It is an SGLT-2 inhibitor

Given to diabetics with a urine ACR>30

Also considered in any diabetic with a urine ACR between 3 and 30
And in any patient with an ACR>22.6

243
Q

What are the two medical Tx for BPH and side effects

A

Alpha-blockers e.g. tamsulosin
- relaxes smooth muscle
- improves symptoms
- causes postural hypotension

5-alpha reductase inhibitors e.g. finasteride
- converts testosterone to androgen
- gradually reduces size of the prostate
- causes sexual dysfunction

You can take both of them if you’re symptomatic and want to reduce prostate size

244
Q

Which T2DM medications cause weight gain

A

Insulin
Sulphonylureas

Also thiazolidinediones and meglitinides but who cares

245
Q

Which T2DM drugs cause hypos

A

Insulin
Sulphonylureas
SGLT-2 inhibitors e.g. gliflozins

246
Q

Which types of cancer are more likely to present with neutropenic sepsis

A

Haematological
Germ cell
Breast

As they have more intense chemo regimes and it is the chemo which targets the bone marrow - neutropenia

247
Q

What do they give in patients with a high risk of neutropenia

A

GSCF (fligrastim or lenograstim)

Haematopoitic growth factors and they pr,ote stem cell proliferation

Shortens the duration of time that someone is neutropejic for

248
Q

Most common cancers that have an MSCC

A

Breast
Lung
Prostate
Haematological

249
Q

Management of suspected MSCC

A

16mg dex with PPI cover
Urgent MRI spine
If positive consider surgery / radiology but would refer to oncology

250
Q

Which parts of the colon are most commonly cancerous

A

Rectum (1/3)
Sigmoid colon (whole left side = 1/3)

The rest is 1/3

251
Q

Gout medical management options and when you would choose one over the other

A

NSAIDs or Colchicine

Not NSAIDs if renal impairment, cardiac failure and ischaemic heart disease

252
Q

Central and peripheral lung cancers which type

A

Squamous and Small cell are Sentral and associated with Smoking

LA is on the coast (Large cell and Adenocarcinoma are peripheral)

253
Q

Steroid and dose in initial Mx of MSCC

A

dexamethasone 16 mg

254
Q

Where is the chemoreceptor trigger zone that signals nausea in toxicity e.g. chemo

A

Floor of the fourth ventricle Outside the blood brain barrier

Haloperidol and levomepromazine are the antiemeitcs of choice (levo is more sedating

And also used in end of life but not in Parkinson’s

Detects things that cause vomiting in the blood

255
Q

3 common side effects of cyclizine

A

Dry mouth

Hypotension

Drowsiness

256
Q

Difference between metoclopramide and domoeridone

A

Both strong dopaminergic prokinetics

Metoclopramide is central And domperidone is peripheral only

Useful for gastric causes

Domperidone can be used in PD , meto can’t

257
Q

Most common side effect of ondnsetron

A

Comstipation

258
Q

Which antiemetic is a 5HT-3 antagonist

A

Domperidone

259
Q

Which paraneoplastic syndromes are not caused by small cell lung cancer

A

Hypercalcaemia caused by SCC

Gynaecomastia caused by adenocarcinoma

Rest caused by SCLC

260
Q

How to differentiate between gout and pseudo gout on joint fluid examination

A

monosodium urate crystals of gout are needle-shaped and negatively birefringent of polarised light.

The calcium pyrophosphate crystals of pseudogout are rhomboid-shaped and positively birefringent.

Fourth Yerar (5 decks)

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