Concepts Flashcards
1
Q
What are the STEMI criteria
A
ECG features in two contiguous leads of;
- 2.5mm (2.5 small squares) ST elevation in leads V2-3 in men under 40 or >2.0mm in men over 50
- 1.5mm ST elevation in V2-V3 in women
- 1 mm ST elevation in other leads
- new LBBB
2
Q
What drugs can be used to ease passage of a renal stone
A
a-adrenergic blockers
3
Q
Management of prostatitis
A
quinolone for 14 days
ciprofloxacin
4
Q
MEN 1
A
three P’s
Parathyroid
Pituitary
Pancreas
5
Q
Men 2a
A
Medullary thyroid
hyperparathyroid
phaeochromocytoma
6
Q
Men 2b
A
Medullary thyroid
phaeochromocytoma
Marfanoid body habitus
Neuroma
7
Q
Characterisation of empyema
A
pH < 7.2
Low glucose (<3.4 mmol/L)
LDH > 200
8
Q
What is a normal osmol gap
A
<10
9
Q
How to calculate osmolalitty
A
2Na + 2k + urea + blood glucose
10
Q
What rules out pseudohyponatraemia
A
normal osmolar gap
11
Q
What are the causes of urinary sodium > 20
A
hypovolaemic
- diuretics: thiazides, loop diuretics
- addisons disease
- diuretic stage of renal failure
Euvolaemia
- SIADH
hypothyroidism
12
Q
What are the causes of urinary sodium < 20
A
sodium depletion, extra-renal loss
- diarrhoea, vomitting, sweating
- burns, adenoma of rectum
water excess
- secondary hyperaldosteronism
- nephrotic syndrome
- IV dextrose
- psychogenic polydipsia
13
Q
Treatment of choice for biliary atresia
A
Early surgical treatment
14
Q
PSGN develops ________ after URTI
A
1-2 weeks
15
Q
Management of VT
A
if BP <90mmHg systolic= cardioversion
drug therapy
> amiodarone
> lidocaine
> procainamide
16
Q
Subacute thyroiditis causes ….
A
hyper then hypothyroidism
17
Q
Hashimotos + viral infection
A
De quervains
18
Q
Eosinophilic casts
A
Tubulointerstitial nephritis
19
Q
Management of trigeminal neuralgia
A
Carbamazepine
20
Q
Signs of supraspinatus tendonitis
A
Rotator cuff injury
Painful arc of abduction
Tenderness over acromion
21
Q
Management of uveitis
A
Steroid and cycloplegic (mydriatic) eye drops
22
Q
Drugs causing pupillary constriction
A
Acetazolamide and pilocarpine
23
Q
Acute tubular necrosis =
A
urine osmolality < 350 mOsm/kg
24
Q
Prerenal uraemia
A
kidneys hold on to sodium to preserve volume
25
brown granular casts
acute tubular necrosis
26
Management of acute reactive arthritis
NSAIDs
27
What is the mackler triad
Booerhave ( oesophageal rupture)
vomiting
thoracic pain
subcutaenous emphysema
28
What is kussmauls sign
JVP rising on inspiration- kussmaul's sign
| sign of constrictive pericarditis
29
mneumonic for cardiac tamponade
TAMponade= TAMpaX
absent Y descent
30
Gynaecomastia in lung cancer
adenocarcinoma
31
paraneoplastic syndrome from SCLC
SIADH
ectopic ACTH
lambert-eaton myasthenic
32
What is quincke's sign
nailbed pulsation
| aortic regurgitatoin
33
De musset sign
head bobbing in aortic regurgitation
34
features of ank spon
lower back pain and stiffness of insidious onset
stiffness worse in morning and improves with exercise
pain at night
35
Investigation of Lung cancer
1) CXR
2) non-contrast CT chest, liver adrenals
3) bronchoscopy
4) PET scanning
36
Hyponatraemia correction
osmotic demyelination syndrome
37
hypernatraemia correction
cerebral oedema
38
Correction of hyponatraemia rate
4-6mmol/l in 24 hr
39
secondary vs primary hypothyroid
primary- High TSH, Low T4
| secondary- Low TSH, low T4
40
investigation for 2ry hypothyroidism
MRI
41
Management of primary pneumothorax with SOB or >2cm rim of air
aspiration
42
Murphys sign
acute cholecystitis
| arrest of inspiration on palpation of RUQ
43
In 1ml of standard insulin there are ____ units
100
44
Diagnostic test for guillain barre
Lumbar puncture
45
guillan barre
autoimmune dymelination of PNS due to campylobacter jejuni
46
symptoms of guillan barree
back/leg pain in initial stages of illness
47
Presentation of placental abruption
constant pain
shock out of keeping with visual loss
tender and tense uterus
48
RF for placental abruption
chronic hypertension
49
dose of amiodarone in ALS
300mg
50
what should be stopped in acute c.diff infection
anti-peristaltic drugs
> opioids
antibiotics if possible
51
NICE criteria for reffering patients to 2ry care for treatment of varicose veins
- heavy or aching legs
- skin changes (venous eczema, haemosiderin deposition)
- superficial vein thrombosis
- venous leg ulcer
52
Measurement of PSA should be delayed for _____ after prostatitis
1 month
53
Features of focal seizures with impaired awareness
automatism
| tiredness
54
Management of hypomagnesaemia
IV magnesium is usually given if <0.4 mmol/L or tetany, arrhythmias, or seizures
>0.4 mmol/l
oral magnesium salts (10-20 mmol orally per day in divided doses)
diarrhoea can occur with oral magnesium salts
55
Recommendations for patients with CKD
prescribe ACEi if urinary ACR 70 +
statin therapy
try not to give NSAIDs
56
Causes of anterior mediastinal mass
```
4T'S
Teratoma
Terrible lymphadenopathy
Thymic Mass
Thyroid mass
```
57
What is the issue with st johns wort
P450 inducer, decrease ciclosporin levels, leading to transplant rejection
58
treatment for wilsons
penicillamine
59
disproportionate microcytic anaemia
beta-thalassaemia trait
60
management of sudden onset SNHL
high dose oral corticosteroids
61
anaesthetic for haemodynamically unstable patient
ketamine
62
sensitive scan for DAI
MRI
63
difference between SS and NML
```
ss presents over hours rather than days
SS
- profuse sweating
- myocolonus
-diarrhoea
-hyperreflexia
```
64
features of NML
- pyrexia
- muscle rigidity
- autonomic lability
- agitated delirium with confusion
65
management of organophsophate insectiside poisoning
atropine
66
features of organophosphate poisoning
```
slud
S- alivation
L- acrimation
U- rination
D- efecatio/diarrhoea
Cv- Hypotension, bradycardia
small pupils
muscle fasciculation
```
67
high risk of hepatotoxicity in paracetamol overdose
chronic alcohol use
HIV
anorexia
P450 inducers
68
elevated JVP
hypotension
tachycardia
despite resus
cardiac tamponade
69
lower than expected HbA1c
sickle cell
GP6D deficiency
hereditary spherocytosis
70
higher than expected HbA1c
vitamin B12/folic acid deficiency anaemia
splenectomy
71
postmenopausal woman has fracture
she should be put on bisphosphonates- no need for DEXA
72
hypercalcaemia
hydration
iv bisphosphonate if Ca above 3
73
Drugs causing galactorrhoea
NOT THE SAME AS GYNAECOMASTIA
- metoclopramide, domperidone
- phenothiazine
- haloperidol
- SSRI, opioids
74
Management of variceal haemorrhage
FFP, Vit K
terlipression
octerotide
prophylactic IV antibiotics
75
GPA serology
ANCA
76
management of perforated tympanic membrane
no treatment review in 2 weeks then in 6 weeks
77
presentation of TTP
```
fever
neuro signs
thrombocytopenia
haemolytic anaemia
renal failure
```
78
PTEN mutation
| intestinal hamartomas
cowdens
79
intestinal hamartomas
| pigmentation around mouth
peutz-jeghers
80
L5 radiculopathy
weakness of hip abduction and foot drop
| no reflex lost
81
S1 nerve root compression
sensory loss of posterolateral aspect of leg and lateral aspect of foot
weakness of plantar flexion and reduced ankle reflex
82
L2 nerve root compression
back, groin, anterior thigh pain
83
L3 nerve root compression
sensory loss over anterior thigh, weakened quadriceps, reduced knee reflex
84
L4 nerve root compression
sensory loss over anterior aspect of knee, weakened quadriceps
reduced knee reflex
85
HRT in high risk of DVT
transdermal HRT doesnt increase VTE risk
86
```
Which of the following medications cant be used in pregnancy
> paracetamol
> lamotrigine
> simvastatin
> metformin
>insulin
```
> simvastatin
87
treatment for bronchopulmonary aspergillosis
oral glucocorticoids
88
recommendation after WLE
whole breast radiotherapy
89
what is aplastic anaemia
characterised by pancytopenia and hypoplastic bone marrow
90
causes of aplastic anaemia
- idiopathic
- congenital- faconi, dyskeratosis
- drugs: cytotoxics, chloramphenicol, sulphonamides, phenytoin, gold
- toxins: benzene
- infectons: parvovirus, hepatitis
- radiation
91
management of acne vulgaris
- single topical therapy (topical retinoids, benzoyl peroxide)
-topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
-oral antibiotics:
>tetracyclines: lymecycline, oxytetracycline, doxycycline
tetracyclines
> erythromycin may be used in pregnancy
a single oral antibiotic for acne vulgaris should be used for a maximum of three months
-a topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing.
> Topical and oral antibiotics should not be used in combination
- Gram-negative folliculitis may occur as a complication of long-term antibiotic use - high-dose oral trimethoprim is effective if this occurs
-combined oral contraceptives (COCP) are an alternative to oral antibiotics in women
as with antibiotics, they should be used in combination with topical agents
-Dianette (co-cyrindiol) is sometimes used as it has anti-androgen properties. However, it has an increased risk of venous thromboembolism compared to other COCPs, therefore it should generally be used second-line, only be given for 3 months and women should be appropriately counselled about the risks
-oral isotretinoin: only under specialist supervision
pregnancy is a contraindication to topical and oral retinoid treatment
92
management of graves
carbimazole
93
Causes of bronchiectasis
CF
pertussis
hypogammaglobulinaemia
young syndrome
94
common presenting feature of wilms tumour
abdominal mass
95
what should be offered to all patients with HF anually
influenza vaccine
96
1st line in HF with stable impaired LV function
ACE + BB
97
reduces mortality in HF with ACEi
spironolactone
98
Primary dysmenorrhoea management
NSAID such as mefanamic acid
COCP
99
What differentiates vestibular neuronitis from labyrinthitis?
unaffected hearing in vestibular neuronitis
100
What is suggestive of nephrotic syndrome?
heavy proteinuria and gross oedema
| hypoalbuminaemia from proteinurea causes increased oedema
101
Most common cause of nephrotic syndrome in kids
minimal change glomerulonephritis
102
Causes of MCG
- idiopathic
- drugs: NSAIDs, rifampicin
- Hodgkin's lymphoma, thymoma
- infectious mononucleosis
103
Pathophysiology of MCG
- T-cell and cytokine-mediated damage to the glomerular basement membrane → polyanion loss
- the resultant reduction of electrostatic charge → increased glomerular permeability to serum albumin
104
Features of MCG
> nephrotic syndrome
> normotension - hypertension is rare
> highly selective proteinuria
--only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
>renal biopsy
--normal glomeruli on light microscopy
---electron microscopy shows fusion of podocytes and effacement of foot processes
105
Management of MCG
80% steroid responsive
| Cyclophosphamide if steroid resistant
106
what is candesartan
ARB
107
MOA of alteplase
activates plasminogen to form plasmin
108
how to diagnose ank spon
sacro-ilitis on pelvic X-ray
109
What is LES
rare autoimmune disorder in which antibodies are formed against pre-synaptic voltage-gated calcium channels in the neuromuscular junction. A significant proportion of those affected have an underlying malignancy, most commonly small cell lung cancer. It is therefore regarded as a paraneoplastic syndrome.
110
INR 5.0-8.0 (no bleeding) -
withhold 1 or 2 doses of warfarin, reduce subsequent maintenance dose
111
african patient taking CCB requiring second agent
ARB
112
persistent ST elevation following MI, no chest pain
left ventricular aneurysm
113
scaphoid abdomen + bilious vomiting
intestinal malrotation and volvulus
114
psoriasis exacerbating factor
>trauma
>alcohol
>drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
>withdrawal of systemic steroids
115
confusion in asthma attack
life threatening
