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Maud- Phase 3b > Core Cases Notes > Flashcards

Core Cases Notes Flashcards

1
Q

What is Dysarthria

A

Slurred Speech

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2
Q

What is Dysphasia

A

Problem generating / comprehending speech

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3
Q

What is the conus medullaris

A

End of spinal cord ~ L1-2, after which you have the cauda equina

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4
Q

Describe Guillian Barre syndrome

A

AI polyneuropathy
Occurs post-infection, commonly campylobacter / cytomegalovirus
Presents with mixed proximal / distal weakness which ascends in glove-stocking
Mx: IV Ig, may spontaneously recover

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5
Q

What saccadic eye movements would be typical for cerebellar disease

A

broken saccades, overshoot on lateral gaze

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6
Q

What neural fibres are carried in the internal capsule?

A

Corticospinal tract fibres

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7
Q

What is myeloradiculopathy?

A

Disease of spinal cord/ spinal roots

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8
Q

What is syringomyelia?

A

Formation of fluid-filled cyst in spinal cord

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9
Q

D

A

D

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10
Q

What autoantibodies might you investigate in peripheral neuropathy

A

ANCA / ANA

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11
Q

Describe trigeminal neuralgia

A

Unilateral pain,
Usually maxillary / mandibular
Precipitated by tactile stimulation e.g brushing teeth
Mx: Carbamazepine

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12
Q

Differentials for weakness / wasting of hands

A

MND, cervical rib, pancoast tumour, T1 root lesion, syringomyelia

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13
Q

What is cervical rib

A

Congenital abnormaility

Additional rib at C7

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14
Q

What is a pancoast tumour

A

Tumour of pulmonary apex

Usually non-small cell

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15
Q

Patient has peripheral motor neuropathy, gait?

A

High stepping gait due to foot drop

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16
Q

Patient has peripheral sensory (proprioceptive) neuropathy, gait?

A

Ataxic / stamping gait

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17
Q

Patient has a wide-based, staggering gait (ataxic), where is their likely problem?

A

cerebellum

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18
Q

Describe a hemispheric gait disturbance

A

contralateral hemiplegic gait and contralteral arm flexion

circumduction

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19
Q

Describe a parkinsonian gait

A

Shuffling gait, loss of arm swing, stooped posture

festinant- tendancy to hurry and turn slowly due to instability

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20
Q

What is apraxia

A

Inability to carry out complex tasks e.g walking

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21
Q

Causes of apraxia?

A

cortical disease, diffuse vascular disease, normal pressure hydrocephalus

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22
Q

Describe anterior spinal artery thrombosis

A

Acute onset flaccid paralysis
Reduced reflexes
Normal DCML sensation (vibration, fine touch, proprioception)

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23
Q

Respiratory differentials of breathlessness

A

(CC-AAA-PPP)
COPD, CA,
Asthma, ARDS, Anaphylaxis
Pulmonary Fibrosis, Pneumonia / RTIs, Pneumothorax,

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24
Q

Cardiovascular differentials of breathlessness

A

Heart Failure,
Cardiac Tamponade
PE

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25
Q

What is an air bronchogram

A

Air filled bronchi (dark) seen on CXR caused by opacity of surrounding alveoli. This is pathognomic of consolidation - an infective process

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26
Q

CXR interpretation. What should you look out for in the apex of the lung?

A

Tuberculosis

Lung CA

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27
Q

CXR interpretation. COPD patients show signs of hyperinflation, What are the features of hyperinflation?

A

Flattened diaphragm

Seeing increased posterior ribs from spinal cord (8-9 normal, >/=10 abnormal)

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28
Q

What are the signs of HF on CXR?

A 
ABCDE
Alveolar oedema 
Kerley B lines 
Cardiomegaly 
Dilated upper lobe vessels 
Pulmonary effusion
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29
Q

CXR interpretation. What is a normal cardio-thoracic ratio

A

Heart <50%

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30
Q

CXR interpretation. What are kerley B lines and when might you see them?

A

Fluid in lymphatics, short horizontal lines at lower outer lung fields

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31
Q

ABG interpretation. Low pH, low Co2. Diagnosis? Potential cause?

A

Metabolic acidosis.

DKA, severe diarrhoea / dehydration, prolonged lack of O2 from shock / HF

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32
Q

ABG interpretation. Low pH. High Co2. Diagnosis? Potential cause?

A

Respiratory acidosis

COPD, sedative drugs, atelectasis

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33
Q

Patient is having an asthma attack and is hyperventilating, what is likely to be seen on ABG?

A

Respiratory alkalosis

Raised pH, Low Co2

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34
Q

Patient has severe vomiting, what is acid base balance diagnosis?

A

Metabolic alkalosis

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35
Q

ABG interpretation. High pH. High Co2. Diagnosis? Potential cause?

A

Metabolic alkalosis

Vomiting

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36
Q

ABG interpretation. High pH. Low Co2. Diagnosis? Potential cause?

A

Respiratory alkalosis

Hyperventilation e.g asthma / panic attack

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37
Q

Koilonychia is a sign of what biochemistry deficiency?

A

Fe2+

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38
Q

Clubbing nails is a sign of what GI condition?

A

Crohn’s

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39
Q

Hydrogen breath test is used as an investigation for what?

A

hypolactasia

small bowel bacterial over-growth

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40
Q

What are 2 common causes of raised Ca2+?

A

Primary hyperparathyroidism,

Disseminated malignancy

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41
Q

Patient has raised Ca2+, which investigation should you do as a follow-up assists in distinguishing the differential diagnoses?

A

PTH
Normal/raised PTH- primary hyperparathyroidism
Low PTH- disseminated malignancy

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42
Q

Virchow’s node is found where and is a sign of what?

A

supraclavicular lymph node

intra-abdominal malignancy

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43
Q 
Differential diagnoses for constipation: 
Common 
Metabolic 
Drugs
Neoplasia
A

Common: functional (e.g IBS), depression, idiopathic, inadequate dietary fibre
Metabolic: hypothyroidism, hypercalcaemia
Drugs: opiates, antidepressants, CCBs
Neoplasia: colon/rectal CA

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44
Q

What is the management of giardia?

A

Tinidazole 2g

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45
Q

What is calcium resonium used in the management of?

A

High K+

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46
Q

What is a foecal occult blood test?

A

screening test for colorectal cancer

checks for non-visible blood in stools

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47
Q

Patient has multiple myeloma, what do you see on urine sample?

A

Bence-Jones protein

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48
Q

What is hypochlorhydia and what might be a consequence?

A

low production of stomach acid

may lead to malabsorption

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49
Q

What is chymotrypsin?

A

pancreatic enzyme, converted to trypsin which breaks down protein

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50
Q

Give some differential diagnoses of malabsorption

A

Common: coeliac, crohn’s, chronic pancreatitis
Uncommon: hypolactasia, small bowel bacterial overgrowth, giardiasis, HIV

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51
Q

How can you investigate and manage a small bowel bacterial overgrowth

A

Ix: lactulose test
Mx: Abx (metronidazole and tertracycline)

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52
Q

Loss of lactase from small intestinal brush border is called…

A

hypolactasia

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53
Q

Symptoms, investigations and management of hypolactasia?

A

S&S: bloating, nausea, wind, dirarhoea
Ix: Lactose breath test
Mx: Low lactose diet

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54
Q

Symptoms of Vit C deficiency

A

Bleeding gums
Tooth loosening
Corckscrew hair,
Perifollicular haemorrhages,

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55
Q

Symptoms of Vit D deficiency

A

Osteomalacia- proximal myopathy, bone pain, malaise

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56
Q

Symptoms of Vit K deficiency

A

Easy bruising

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57
Q

What is trulove and witt’s criteria for severe UC?

A

Bowel open >6 times /24hrs + 1 or more of:

HR> 90
Temp >37.5
ESR ? 30mm/hour
Hb<10.5

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58
Q

Pale stools are a hallmark of which overall GI pathology?

A

Malabsorption

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59
Q

Give 3 routine investigations for syncope?

A

ECG, Blood Glucose, Lying and Standing BP

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60
Q

What is syncope?

A

Sudden LOC

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61
Q

What is the pathophysiology of vasovagal syncope?

A

excessive activation of PNS in response to a specific stimuli e.g fear, stress, heat
causes vasodilation and bradycardia –> hypotension and cerebral hypoperfusion –> syncope

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62
Q

What are the ECG changes seen in wolf-parkinson-white syndrome?

A

Shortened PR, wide QRS, slurred upstroke of R (delta) wave

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63
Q

What is the definitive treatment of wolf-parkinson-white syndrome?

A

radio-ablation of accessory pathway

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64
Q

Which condition is characterised by an abnormal accessory conduction pathway between atria and ventricles?

A

Wolf-parkinson-white syndrome

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65
Q

First-dose hypotension is most commonly associated with which anti-hypertensive?

A

ACE

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66
Q

Give 2 ways in which we can minimise the risk of first-dose hypotension?

A

Low starting dose e.g 1.25 ramipril

Take first few doses at night time whilst in bed

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67
Q

What are some potential symptoms of a silent MI

A

epigastric pain, SOB, acute pulmonary oedema, collapse, death

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68
Q

What are the different types of bronchial cancers?

A

Squamous cell CA (35%)
Adenocarcinoma (30%)
Small cell (20%)
Large cell (15%)

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69
Q

What are the investigations for bronchial tumours?

A

Bronchoscopy, washing, biopsy, CT/CXR for spread

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70
Q

Mx: small cell lung CA?
Mx: non-small cell lung CA?

A

Small cell mx= chemo

Non-small cell mx= radio

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71
Q

What is mesothelioma?

A

Malignant tumour of pleura

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72
Q

Patient has chest pain, signs of pleural effusion and has blood-stained effusion, likely diagnosis?

A

Mesothelioma

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73
Q

CXR shows honeycombing and calcified pleural plaques ‘holly leaves’, diagnosis?

A

Asbestosis

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74
Q

Which type of asbestos commonly causes mesothelioma?

A

Blue

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75
Q

Which condition are ACEi CI for?

As a result you should regularly monitor ptx ______?

A

Bilateral renal stenosis

Regularly monitor ptx renal function

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76
Q

Give an example of a loop diuretic

A

Furosemide / Bumetanide

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77
Q

Mechanism of action of loop diuretic

A

Inhibits sodium / chloride channels in the ascending limb of the loop of henle

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78
Q

3 SEs of loop diuretics

A

Hyponatraemia, hypokalaemia, hypotension

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79
Q

Mechanism of action of spironalactone?

A

Aldosterone antagonist,

Increased excretion sodium, reduced excretion potassium

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80
Q

3 SEs of spironolactone?

A

Hyperkalaemia, hyponatraemia, hypotension gynaecomastia, menstrual disturbance

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81
Q

Patient is on spironolactone, what should we monitor regularly?

A

Potassium levels

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82
Q

How is mesothelioma diagnosed / managed?

A

Pleural biopsy

No cure, radio slows growth

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83
Q

Name and mechanism of action of thiazide diuretic

A

Bendroflumethiazide

Inhibit sodium/chloride reabsorption at DCT

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84
Q

SEs of Thiazide diurteics

A

Hypokalaemia, hyponatraemia, hypotension

Hyperuricaemia (can precipitate gout)

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85
Q

Which endocrine problem may cause a hoarse voice?

A

Thyroid CA

laryngeal nerve palsy

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86
Q

Which is the commonest type of thyroid CA?

A

Papillary (80%)

Others: follicular and anaplastic

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87
Q

Name a medication that can be iaetrogenic cause of hypothyroidism

A

Amiodarone

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88
Q

Phaeochromocytoma is a tumour of what?

A

Chromaffin cells of adrenal medulla

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89
Q

Phaeochromocytoma causes secretion of what?

A

Catecholamines (adrenaline and noradrenaline)

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90
Q

Eye signs of graves disease

A

Proptosis (exophthalmous), lid lag, dipolopia

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91
Q

What is carbimazole and what is its major SE we should monitor for?

A

Hyperthyroidism treatment

Agranulocytosis - monitor WBCs

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92
Q

S&S of thyroid storm

A

Substantial weight loss, AF, profuse sweating, previous thyroid surgery, enlarged heart, pleural effusion

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93
Q

Mx of thyroid storm

A

Fluids and electrolytes
Anti thyroid drugs and glucocorticoids
B Blockers

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94
Q

US thyroid reveals single hot nodule, differentials?

A

Thyroid adenoma /CA

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95
Q

US thyroid reveals multiple ‘patchy hot’ nodules, likely diagnosis?

A

Hashimoto’s thyroiditis

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96
Q

US thyroid reveals diffuse hot gland, likely diagnosis and explanation?

A

Graves disease, diffuse stimulation of whole gland by thyroid antibodies

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97
Q

Give an non-infective cause of a febrile patient

A

Multiple pulmonary emboli

Remember that not all febrile patients have infections!

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98
Q

What is ‘double pnemonia’?

A

Severe infections predispose patients to further infections e.,g px with flu more likely to get pneumonia

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99
Q

What defines an ‘atypical’ pneumonia

A

Prominent extra-pulmonary manifestations (in addition to main lung infection)

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100
Q

What does convalescent mean?

A

A person recovering from an illness

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101
Q

Give an example of a macrolide antibotic?

A

Erythromycin
Azithromycin
Clarithromycin

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102
Q

What is Sydenham’s chorea and in which condition would you see it?

A

Rapid purposeless movements of face / arm jerky movements

Rheumatic Fever

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103
Q

Describe erythema marginatum, what condition is this pathognomic?

A

rash starts on trunks / arms as maccules
spreads to form snake like ring with clear middle
worse with heat

rheumatic fever

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104
Q

Patient presents with suspected DVT, they have a family history of PE, give 2 tests that may be carried out as part of a thrombophilia screen

A

Genetic causes: factor V leiden, antibody protein C resistance

Acquired: anti-phospholipid syndrome, antibody protein C resistance

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105
Q

Give an investigation that may be carried out in a patient with suspected glomerulonephritis?

A

antistreptolysin O

detects antibodies against group A strep

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106
Q

Patient has a positive direct coombs test, diagnosis?

A

AI haemolytic anaemia

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107
Q

What is the mechanism / indication of an indirect coombs test?

A

measures antibodies against foreign RBCs in serum

prenatal testing / prior to blood transfusion

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108
Q

What is the causative organism of scarlet fever?

A

Strep pyogenes

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109
Q

Give a cause of haemolytic anaemia?

A

mycoplasma pneumoiae

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110
Q

Treatment of mycoplasma pneumoniae?

A

macrolides e.g erythromycin / clarithromycin

doxycycline

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111
Q

Give an example of a cardiac, neuro and haem extra-pulmonary manifestation of mycoplasma pneumoniae

A 
Cardiac= myocard/pericarditis, conduction abnormality 
Neuro= GBS, peripheral neuropathy, encephalitis
Haem= haemolyitic anaemia
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112
Q

What is the pathophysiology of rheumatic fever

A

hypersentivity reaction to group A strep

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113
Q

What are the major criteria for Rheumatic Fever?

A

Migrating polyarthritis, carditits, syndeham’s chorea, erythema marginatum, subcutaneous nodules

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114
Q

How is rheumatic fever diagnosed?

A

2 major / 1 maj + 2 minor criteria
Antistreptolysin O titre +
Echocardiogram

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115
Q

What is the difference between Staph Aureus bacteraemia / septicaemia

A

Staph aureus bacteraemia= positive blood cultures, no systemic features of sepsis

Staph aureus septicaemia= positive blood cultures with systemic features of sepsis

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116
Q

Name a group A strep

A

Strep pyogenes

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117
Q

Raised ALP is a reliable indicator of…

A

post-hepatic bile duct obstruction

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118
Q

What does indurated mean?

A

Increased fibrous element of tissue commonly associated with inflammation

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119
Q

What are red cell fragments on a blood film an indicator of?

A

haemolytic anaemia

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120
Q

Does an increase or a decrease of antithromin make you more likely to develop DVT?

A

Decreaseased antithrombin = more likely to develop DVT

Antithrombin is a mild blood-thinner

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121
Q

What is protein S?

A

a mild-blood thinner

deficiency of protein S increases the likelihood of blood clots

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122
Q

What is the relationship between HRT and DVT?

A

HRT increases your risk of developing DVT 2-fold

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123
Q

What is fluconazole?

A

Anti-fungal medication

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124
Q

Give 3 classes and examples of drugs that warfarin typical interacts with

A

antibiotics - macrolides e.g erythromycin
antifungals- e.g fluconazole
anticonvulsants e.g valproate

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125
Q

Describe warfarin’s therapeutic index

A

Low / narrow therapeutic index (small changes in metabolism of warfarin can cause bleeding / clotting)

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126
Q

Give a cause of flow murmur due to hyperdynamic circulation

A

severe anaemia

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127
Q

Bone marrow failure resulting in a low production of RBCs is known as…

A

anaplastic anaemia

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128
Q

Give a sign in the eyes which would indicate anaemia

A

pale conjunvtiva

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129
Q

What is fresh frozen plasma? Indications?

A

liquid portion of whole blood
treat conditions with low blood clotting factors (INR >1.5)
replace plasma in fluid exhange
replace low blood proteins

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130
Q

normal range for INR?

A

0.9-1.2

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131
Q

therapeutic range for INR?

A

2-3

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132
Q

high INR score indicates increased risk of…

A

haemorrhage

High=Haemorrhage

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133
Q

low INR score indicates an increased risk of …

A

clotting

LOw=cLOt

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134
Q

What constitutes prothrombin complex concentrate, when might you give it?

A

Clotting factors 2, 9 and 10

Given to prevent bleeding
Specifically in haemophilia B if pure clotting factor 9 not available

Note it does NOT contain clotting factors:
7- haemophilia A
8- the other vit k clotting factor

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135
Q

Which haemophilia type can be treated with prothrombin complex concentrate?

A

Haemophilia B because prothrombin complex concentrate contains clotting factor 9

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136
Q

Patient has DIC, what does this stand for?

PPh?

A

Disseminated Intravascular Coagulation
blood clots develop in small vessels around the body, this uses up platelets and clotting factors increasing the risk of excessive bleeding

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137
Q

Patient has DIC:

Describe their prothrombin time, activated partial thrombin time, fibrinogen levels and d-dimer levels

A

Prothrombin time = prolonged
Activated partial thrombin time= prolonged
Fibrinogen levels= low
D-dimer= raised

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138
Q

What is meant by polychromasia? Give an example of when this may be seen?

A

High levels of immature RBCs (reticulocytes)

Bone marrow stress e.g haemolytic anaemia

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139
Q

Haemophilia A is a genetic mutation resulting in deficiency of which clotting factor?

A

Haemophilia A= factor VIII

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140
Q

Haemophilia B is a genetic mutation resulting in deficiency of which clotting factor?

A

Haemophilia B= factor IX

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141
Q

What is the mechanism of action of aspirin?

A

Anti-platelet
Irreversibly inhibits COX enzyme reducing the production of thromboxane and arachiodonic acid therefore reducing platelet aggregation

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142
Q

Give an indication for aspirin

A

ACS, acute ischaemic stroke

2nd prevention of cardiac, cerebrovascular or peripheral artery disease

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143
Q

What are the vitamin K dependent clotting factors?

A

2,7,9,10

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144
Q

What is the relationship between COCP and DVT/PE?

A

COCP increases risk of developing DVT/PE

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145
Q

Give 2 causes of microcytic anaemia

A

iron deficiency

thalassaemia

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146
Q

Give 3 causes of normocytic anaemia

A

acute bleeding
mixed Fe2+ + Vit B12 / folate deficiency
aplastic
chronic disease

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147
Q

Give 3 causes of macrocytic anaemia

A

vit b12 / folate deficiency
haemolytic anaemia
low T4

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148
Q

Patient has an uncomplicated DVT and is treated with LMWH. They should be discharged on what medication and for what duration?

A

Warfarin

3-6months

149
Q

Biochemistry reveals raised urea, indications?

A

urinary tract obstruction, congestive heart failure, dehydration, severe burns, shock, upper GI bleed

150
Q

What is a seminoma

A

Germ cell tumour of testicles

151
Q

What type of medication is demeclocycline?

A

Tetracycline abx, used in tx of acne

152
Q

i

A

I

153
Q

Where would you expect to find metastases in oestrogen receptor negative breast CA?

A

Negative= visceral mets (liver, lung, brain)

154
Q

What is the commonest site for a malignancy causing hypercalcaemia?

A

Lung CA

155
Q

In addition to an elevated PSA which feature seen on XR would be pathognmonic of prostate CA?

A

Elevated PSA and sclerotic bone mets

156
Q

High levels of Ca2+ detected in blood.

Which hormone is released to reduce Ca2+ levels and from where?

A

Calcitonin released from parafollicular cells in thyroid gland

(when high Ca2+ detected)

157
Q

What is the action of calcitonin?

A

Reduced Ca2+ levels

Inhibits gut absorption
Inhibits reabsorption in kidneys
Stimulates bone deposition (++osteoblasts, – osteoclasts)

158
Q

Low levels of Ca2+ detected in blood. Which hormone is released to raise Ca2+ levels and from where?

A

PTH released from Paraythyroid gland

159
Q

What is the action of parathyroid hormone?

A

Raises Ca2+ levels

Stimulates reabsorption at kidneys
Stimualtes conversion of Vit D to Calcitriol which increases absorption in gut
Stimulates bone resorption (–osteoblasts, ++osteoclasts)

160
Q

Symptoms of hypercalcaemia

A

Bones= pain
Stones= urinary
Abdo Groans= N+V, constipation, indigestion
Psychic Moans= depression, psychosis, fatigue, memory loss

161
Q

What is the purpose of doing a mediastinoscopy?

A

Assess the operability of a potentially curable lung CA

162
Q

Male patient has high levels of B-hCG, what do you suspect?

A

Testicular CA (tumour marker)

163
Q

Patient has high levels of lactate dehydrogenase, what might this indicate?

A

Tissue turnover, may indicate tumour burden

164
Q

What is meant by flaccid paraplegia?

A

Weakness or paralysis due to decreased muscle tone

165
Q

What is mean by spastic paraplegia?

A

Stiffness and increased tone

166
Q

Give a cause of marked ptsosis?

A

CN3 palsy

167
Q

Give a cause of partial ptosis

A

myaesthenia gravis

partial ptosis

168
Q

a young patient presents with bilateral facial pain similar to trigeminal neuralgia. what must you work to exclude as a cause?

A

MS

169
Q

Give a neurological presentation of vitamin B12 deficiency?

A

Positive Babinski sign

extensor platar reflexes

170
Q

Balance requires 3 sensory inputs.. these are from…

A

vision
vestibular (head position)
proprioception (dorsal column)

171
Q

Patient has a positive romberg’s test, what happens on examination, what is the cause?

A

Lose balance when closing eyes

Problem is in spinal cord (dorsal columns)- they cannot detect proprioception

172
Q

Patient is ataxic but has a negative romberg’s test, what is seen on examination and what is that cause?

A

Maintain balance when closing eyes

Problem is in cerebellum

173
Q

A lesion in the internal capsule would cause what symptoms?

A

Mid-moderate hemiplegia with predominant spasticity

174
Q

What are the symptoms of CN3 palsy?

A

Muscles- down and out
Pupil- dilation
Lid- marked ptsosis

(CN3 does 3)

175
Q

Why does a CN3 palsy present with down and out pupil?

A

Superior oblique- CN4 and lateral rectus- CN6 action are unopposed

176
Q

Give 3 causes of anterior spinal artery thrombosis

A

Emboli
In-situ thrombosis
Decompression sickness

177
Q

What sensations are spared in anterior spinal artery thrombosis?

A

fine touch, vibration, proprioception (dorsal column)

178
Q

S&S of anterior spinal artery thrombosis?

A 
Rapid evolution, 
Back pain,
Dorsal column sensation sparing 
Flaccid paralysis 
Reduced reflexes
179
Q

Pregnant mother 38wks goes into cardiac arrest, what changes to CPR would you suggest and why to maximise possibility of spontaneous circulation returning?

A

Position mother in left lateral position
This ensures the foetus is not compressing the IVC

Normal circulation doesn’t return for 5 mins consider emergency C section

180
Q

In pregnancy what normal changes might be detected in:
ECG
Murmurs
Resp/Blood gases

A

ECG- left axis deviation
Murmur- innocent flow murmur
Resp= higher RR–> increased minute volume ventilation–> lower PaCO2

181
Q

Give 4 complications of MI

A 
Valve disease- acute mitral valve regurg due to papillary muscle rupture 
Arrythmias- ventricular arr / AF
Pulomary oedema 
Pericarditis (2-10 wks post)
vsd
182
Q

What is the commonest cause of pre-hospital death as a result of MI?

A

Ventricular arrhythmia

183
Q

What is orthostatic oedema

A

Leg swelling following a prolonged time sitting / standing that goes away when recumbent

184
Q

What is thrombophlebitis

A

inflammatory process causing the formation of blood clots that block 1 or more vessels
superficial clots= superficial thrombophlebitis
deep clots= DVT

185
Q

What is an IVC filter and what are the indications for one?

A

a mechanical filter surgically inserted into IVC to catch blood clots and prevent PEs
Indicated if anticoagulation is CI or if recurrent PEs despite anticoagulation

186
Q

What is the most likely causative organism for IE in IVDU patients?

A

Staph aureus

187
Q 
Third heart sound (S3)
What is it?
When does it occur?
Where is it heard best?
How to hear it?
Who has ut?
A

What- additional heart sound forming a gallop rhythm, lower pitched and fainter than normal sounds, cadence follows work KentuckY
When- mid-diastole after S2
Where- apex
How- bell of stethoscope, ptx. lateral left debicutus position
Who- heart failure

188
Q

What are the indicators on pleural effusion biochemistry of malignancy?

A

Low pH <7.3
Blood
Exudate
Glucose <3.3mmol/L

189
Q

Patient has blood in their pleural effusion, what might this indicate?

A

Malignancy, PE with infarction, trauma

190
Q

What does a MET team stand for?

A

Medical Emergency Team

191
Q

What is the commonest abnormal vital sign seen in critically ill patients?

A

Resp rate

192
Q

What is flumezanil

A

Benzodiazepam antagonist, given IV

193
Q

In what circumstances would you prescribe naloxone?

A

Opiate overdose

194
Q

What type of poisoning is forced alkaline diuresis a treatment?

A

Salicylate poisoning

195
Q

Give 4 examples of opiates

A

Heroin, morphine, plethadine, coedine (metabolised to morphone)

196
Q

What are the scores for GCS (eyes)

A 
Eyes / 4
Spontaneous (4)
To speech (3)
To pain (2)
None (1)
197
Q

What are the scores for GCS (best verbal response)

A 
Best verbal response / 5
Orientated (5) 
Confused (4)
Inappropriate words (3)
Incomprehensible sounds (2)
None (1)
198
Q

What are the scores for GCS (best motor response)

A 
Best motor response / 6
Obey commands (6)
localises pain (5) 
withdraws to pain (4)
Flexion to pain (3)
Extension to pain (2)
None (1)
199
Q

What are the differentials for dullness on respiratory percussion?

A

Tumour
Collapse
Fluid, consolidation, pleural effusion

200
Q

What is the cause of hyper-resonance on respiratory percussion?

A

Pneumothorax

201
Q

What is pleurodiesis

A

Medical procedure that adheres 2 surfaces of pleura together

202
Q

What may cause air under diaphragm on CXR

A

intestinal perforation

203
Q

Which medication overdose causes

a) pupil consitriction
b) pupil dilation

A 
constriction= opiate overdose 
dilation= tricyclic overdose
204
Q

What is section 2 of MHA

A

28 day assessment

205
Q

What drug should be given alongside activated charcoal and why?

A 
laxative, 
activated charcoal (used for detoxification) causes constipation
206
Q

What is the timeframe for when activated charcoal is an effective detoxification method?

A

If given within 2 hours of ingestion of toxin

207
Q

What are the symptoms of a patient who has just been given IV naloxone?

A

sweaty, agitated, hyperventilating, pupil dilation

208
Q

In what patients would non-invasive ventilation be indicated?

A

Type II respiratory failure

209
Q

Bilateral hilar lympahdenopathy is usally a sign of…

A

sarcoidosis

210
Q

Give 3 iatrogenic causes of lung collapse?

A

overrigorous bagging
high inspiratory pressures
inserting ET tube too far

211
Q

What are the components of CURB 65

A

Confusion
Urea >7mmol/L
Resp Rate >30
BP < 90/60

Age >65

212
Q

Pre-tibial myxoedema is a sign seen in what condition?

A

Graves’ disease

213
Q

What is empyema?

When does it occur?

A

Pus in the pleural cavity

Complication of pneumonia or thoracic trauma

214
Q

Are ptx with nephrotic syndrome hyper or hypocoagulable? What is the implication of this?

A

Hypercoagulable

Increased risk of DVT/PE

215
Q

What are the risk factors and suspected trigger for SLE?

A

Female, child-bearing age
Afro-caribbean / asian

Trigger= EBV

216
Q

Signs and symptoms of SLE

DUAL RASH FACE

A

Discoid rash, Ulcers (oral), ANA+, Light sensitive

Renal disorder, Anti-dsDNA, Serositis, Haem disorder

Flushed (malar rash), Arthritis, CNS disorder, ESR raised (crp normal!)

217
Q

Which autoantibodies are abnormal in SLE?

A

ANA (antinuclear antibody)
anti-dsDNA
anti-smooth muscle
antiphospholipid

218
Q

Give 3 investigations for SLE

A

ANA, anti-dsDNA
ESR= raised, CRP=normal
Complement C3/C4 depleted

219
Q

Ptx is having a severe flare up of their SLE?

A

IV cyclophosphamide

High-dose prednisolone

220
Q

What are the 2 rashes typically seen in SLE ptx?

A 
Malar rash (butterfly) 
Discoid rash
221
Q

What is cystinuria

A

Autosomal recessive condition
Proximal tubule does not reabsorb positively charged AAs (especially cysteine). These then pass into urine.

Acidic/neural pH urine causes crystallising of AA forming stones.

222
Q

What is the treatment of cystinuria?

A

penicillamine

223
Q

Give the treatment of each of these 3 causes of renal/bladder stones:
hypercalcuria
urate calculi
cystinuria

A

hypercalcuria- tx thiazide diuretics
urate calculi- tx allopurinol
cystinuria- tx penicillamine

224
Q

What is the commonest composition of a kidney stone

A

calcium oxalate

225
Q

Give 3 dietary components which increase your risk of kidney stones?

A

sodium, protein, oxalate

226
Q

What simple measure can patients do to reduce their risk of getting kidney stones?

A

increase hydration to >3L/day

227
Q

You suspect the patient has Wilson’s disease
You order a 24hr urine sample
What are the results?

A

Raised copper in urine

228
Q

What acid-base balance complication can GBS cause?

A

Respiratory acidosis

Decreased ventilation causes TII respiratory failure

229
Q

How is serum osmolality calculated?

A

(2 x Na) + (2 x K) + glucose + urea

230
Q

What is a U wave (ECG)?

A

small deflection up after T wave

sign of hypokalaemia

231
Q

What is a J wave / Osborne wave (ECG)?

A

immediate deflection up after QRS complex

sign of hypercalcaemia

232
Q

Describe the QRS complex in ventricular tachycardia?

A

Wide QRS complex

233
Q

Describe the ECG features of wolf-parkinson-white syndrome?

A

Short PR
Slurred upstroke of r wave (delta wave)

Wolf= short and slurred

234
Q

What should be involved in a annual DM check

A 
Retinopathy, foot check, 
ACR, U+E
Cholesterol, weight,
HbA1c, glucose 
Smoking status
235
Q

Postural hypotension defined as…

A

Drop in BP >20mmHg from sitting to standing

236
Q

Sx of hypoglycaemia

A

sweating, tachycardia, palpitations, tremor

237
Q

Tinel’s sign and Phalen’s sign are present in carpal tunnel syndrome. What are they?

A 
Tinel's= tapping causes paraesthesia
Phalen'= flexion causes wrist symptoms
238
Q

Give 4 indications for tetracyclines?

A

Acne vulgaris
Lyme disease
Chlamydia
Mycoplasma pneumoniae

239
Q

Which class of antibiotics is associated with photosensitivity?

A

Tetracyclines

240
Q

Patient has open-angle glaucoma. Prescribed beta blocker, how does this help?

A

Reduces aqueous secretion by ciliary body

241
Q

Gliclazides are an example of which drug class?

A

Sulfonylurea

242
Q

What is meant by moribound?

A

At the point of death (look like about to die)

243
Q

What is the common cause of anterior shoulder dislocation?

A

Fall on outstretched hand (FOOSH)

244
Q

What type of shoulder dislocation is associated with seizures/electric shock? What does it look like?

A

Posterior shoulder dislocation

Shoulder locked in internally rotated position

245
Q

What is the karyotype of kleinfelter’s syndrome?

A

47XXY

246
Q

A partial/missing X chromosome in females causes what syndrome? How do they present?

A

Turners syndrome
Short stature, webbed necked, AI hypothyroid,
Primary hypogonadism, primary amenorrhoea

247
Q

Thyrotoxicosis.. AKA…

A

Hyperthyroidism

248
Q

What are the TSH and T4 levels in sick euthyroid?

A

TSH low, T4 low (e.g in chronic illness)

249
Q

Give causes of secondary hypertension

A

Renal artery stenosis, PKD
Conn’s, cushing’s
Phaeochromocytoma, Acromegaly
Aortic coarctation

250
Q

What is the pharmacological mx of HTN caused by phaeochromocytoma?

A

Alpha blockers followed by beta blockers

251
Q

Give the 3 things to do in mx of hypercalcaemia 2nd to CA?

A

IV fluids
Oral/ IV bisphosphonates
Referal to oncology

252
Q

Testosterone is given by what route? what frequency? what should you monitor for?

A

IM , every 4 weeks

Monitor for BPH, prostate CA (PSA/DRE)

253
Q

What cancers metastasise to bone?

A

BLT with kosher pickle

Breast, Lung, Thyroid, Kidney, Prostate

254
Q

How can cancer effect levels of calcium?

A 
bone mets cause ca2+ leakage 
paraneoplastic syndrome (produces protein similar to PTH)
255
Q

Patients with T2DM are more likely to develop hyperosmolar hyperglycaemia state or DKA?

A

Hyperosmolar hyperglycaemic state

256
Q

You are managing a patient with suspected DKA. Blood gas reveals metabolic acidosis. What pH level concerns you enough to call ICU?

A

pH<6.99 call ICU

257
Q

What is the difference in onset between DKA and hyperosmolar hyperglycaemic state?

A 
DKA= acute history. 
HHS= insidious history
258
Q

Describe “sick day rules” and an example of a condition in which this applies?

A

If patient gets sick the patient is under increased stress so need to double their dose of steroids
E.g if low corticosteroid levels in body e.g adrenal insufficiency

259
Q

Give 4 causes of hypocalcaemia

A

AI hypoparathyroidism
Pseudohypoparathyroidism
DiGeorge syndrome

260
Q

Dexamethasone suppression test is used for diagnosing which condition?

A

Cushing’s

261
Q

ACTH synacthen test is used for diagnosing which condition?

A

Adrenal insufficiency

“Adrenal I, ACTH”

262
Q

What at the rotterdam criteria?

A

For diagnosing PCOS, 2/3 of….
Annovulation / oligomenorrhoea / amenorrhoea
Polycystic ovaries on TVUSS - 1 ovary >12 small follicles volume >10
Raised androgens

263
Q

What is the managemnet of PCOS?

A

Weight loss, COCP, Metformin

Anti-androgens= cyproterone acetate
Ovulation induction= anti-oestrogen (clomifene citrate)
Gonadatrohpine (FSH, LH, GnRH analogues)

IVF

264
Q

What is meant by virilization ?

A

Development of male physical characteristics (hair, deep voice, muscle bulk) due to excess androgen production

265
Q

A female patient is diagnosed with an androgen-secreting tumour. How might a excess androgens effect them/

A

Virilisation- develop male physical characteristics e.g hair growth, deep voice, muscle bulk

266
Q

A patient has dry mucous membranes, poor urine output, is thirsty. You suspect they are dehydrated. How do you calculate serum osmolality and do you expect it to be high or low in a dehydrated patient?

A

Serum osmolality= 2 (Na + K) + urea + glucose

Dehydration = high serum osmolality

267
Q

What is the colour change of patients with raynauds?

A

White, Blue, Red

268
Q

What is meant by obstructive sleep apnoea?

A

loss of airway patency despite constant breathing effort

Linked to obesity, hypothyroid, asthma

269
Q

What is balantitis?

A

Inflammation of glans of penis due to infection

270
Q

What bone condition can result in hearing loss?

A

Paget’s disease

271
Q

Kleinfelter’s syndrome is associated with hypogonadism, what is the karyotype for this syndrome?

A

47XXY

272
Q

Kleinfelter’s syndrome is a condition which only effects men, true or false?

A

True,

Men with an extra X chromosome (47 XXY)

273
Q

Female patient presents with primary amenorrhoea, you notice they have a webbed neck, which syndrome could cause this?

A

Turners syndrome

missing / partially missing X chromosome

274
Q 
What are the non-operative tx options for renal stones in the following locations: 
Bladder 
Lower 1/3 ureter 
Middle 1/3 ureter
Upper 1/3 ureter
A

Bladder= endoscopic retrieval
Lower 1/3= uretero rhinoscopy
Middle 1/3= shock wave lithotripsy
Upper 1/3= percutaneous nephrostomy

275
Q 
A patient presents with haematuria, give differentials which relate to the following structures: 
Renal 
Ureteral
Bladder 
Urethral
A

Renal- glomerulonephritis, pyelonephritis, renal cell carcionma, trauma, renal cyst
Ureteral- transitional cell carcinoma, stone, trauma
Bladder- bladder CA, trauma
Urethral- prostate CA, stone, trauma

276
Q

Patient presents to GP embarassed. He says he’s got what feels like a “bag of worms” in his scrotum. What is the diagnosis? What cause should you rule out?

A

Varicocele- dilated veins in scrotum, next to/above 1 or both testes

Rule out renal vein obstruction due to renal tumour

277
Q

You’ve been asked to examine the next gentleman’s hydrocele, what is a hydrocele? how can you examine this?

A

fluid collection in front of testes, usually benign

278
Q

A male patient comes in telling you they have a scrotal swelling, what are the differentials?

A

Testicular cancer
Hydrocele
Varicocele
Epididymal cyst

Sebaceous cyst on scrotum
Inguinal hernia

279
Q

Which bedside test/examination would differentiate between a hydrocele and varicocele?

A

Transillumination

280
Q

A distressed young woman comes to see you saying that she has gotten pregnant unintentionally and wants you to sign off for a termination of pregnancy. What is the criteria for ToP?

A

<24wks pregnant

ToP reduces risk to mothers life
Top reduces risk to mother mental / physical health
Top reduces risk to mental / physical health of existing children
Substantial risk of baby being born with severe mental/physical handicap

281
Q

Give 3 symptoms of an ectopic pregnancy?

A

Abdo pain, amenorrhoea, vaginal bleeding

282
Q

Give 3 differentials of antepartum haemorrhage?

A

Placental abruption, placenta praevia, vasa praevia

283
Q

Patient has painless PV bleeding whilst pregnant, what is likely diagnosis?

A

Placenta praevia

284
Q

What do acromegaly, conn’s syndrome, cushing’s syndrome and phaeochromocytoma all have in common?

A

All causes of secondary hypertension

285
Q

What are the 5 geriatric giants?

A

falls, incontinence, confusion, impaired homeostasis, iatrogenic disorders

286
Q

How is postural blood pressure measured?

A

Measure BP when lying down, immediately on standing, after 1 minute standing, after 3 minutes standing

287
Q

What s the definition of postural hypotension?

A

sustained reduction of systolic BP at least 20, diastolic of at least 10 within 3 minutes of standing

288
Q

Give 2 examples of pharmacological tx of postural hypotension?

A

midodrine

fludrocortisone

289
Q

What is a fragility fracture?

A

fractures resulting from mechanical forces that would not ordinarily result in fracture equivalent to fall from standing height or less

(i.e. mechanical fracture from fall from standing height/less)

290
Q

Primary prevention of osteoporosis?

Secondary prevention of osteoporosis?

A 
Primary= FRAX score / DEXA scan 
Secondary= alendronate
291
Q

What % on FRAX score warrants further assessment on DEXA scan?

A

> 10%

292
Q

What is the management of osteoporosis?

A

Lifestyle- smoking, alcohol, exercise
Vit D
Bisphosphonates

Others:
Denosumab (inhibits receptors which when activated cause osteoclast maturation)
Strontium ranelate (reduce bone turnover, stimulate bone growth)
Raloxifene (binds to oestrogen receptors, same effect
HRT

293
Q

Elderly patient falls on their face, what is the more likely cause of fall?

A

Cardiac

294
Q

Patient falls, are you looking for on urine dipstick? what do you suspect as cause?

A

Protein, blood, nitrites, leukocytes (UTI)

295
Q

Patient falls, why do bladder scan?

A

Urinary retention

296
Q

Which painkiller lowers the seizure threshold and therefore should be avoided in patients with a history of epilepsy?

A

Tramadol

297
Q

Patient is an ex-boxer with parkinsons’ and eplilepsy who has started fighting the staff. The nurses asks you to prescribe haloperiodol to calm him down, what do you do?

A

Don’t prescribe it.
Antipsychotics lower seizure threshold
Instead try a benzodiazepine

298
Q

What is charles bonnet syndrome?

A

Visual hallucinations due to visual loss e.g cataracts / age-related macular degeneration. Patients are generally aware that hallucinations are not real

299
Q

What is the route of administration for gentamycin?

A

IV only!

if question is GP scenario the answer is not going to be gentamicin

300
Q

What is another name of augmentin?

A

Co-amoxiclav

301
Q

Female patient presents with unilateral throbbing headaches, with flashing lights in vision beforehand.
Likeky diagnosis? Which medication might they be taking which is an absolute contraindication?

A

Diagnosis= migraine with aura

COCP CI with migraine with aura

302
Q

CT head shows midline shift, this might indicate…

A

severe swelling, haemorrhage, space occupying lesion

303
Q

CT head shows oedema / swelling, this might indicate…?

A

raised ICP

304
Q

CT head shows crescent shaped dark shadow, what is this likely to be? Pathophysiology?

A

Sub-dural haemorrhage

Strethcing and breaking of bridging cortical veins

305
Q

What colour are dense structures on CT scans?

A

Whiter

306
Q

How can you tell the difference between acute and chronic brain haemorrhage?

A

Acute is brighter

Chronic is darker

307
Q

What might indicate raised ICP on CT head?

If you see what should you do/not do?

A

Ventricles thin/squashed/absent
Loss of differentiation between grey and white matter due to oedema

Don’t lumbar puncture!

308
Q

Patient has a headache, visual disturbance, jaw pain, raised ESR but normal WCC. Which investigation would you follow up with?

A

Temporal artery biopsy- ?GCA

309
Q

What is the consequence of doing a LP in patient with raised ICP

A

Brain herniation and death

310
Q

You suspect SAH, do a LP after what time?

A

> 12hours,

311
Q

Raised protein on LP, indications?

A

Bacterial meningitis, GBS, TB

312
Q

What are the findings on temporal artery biopsy in patient with GCA?

A

Vasculitis
Lymphocyte infiltration
Granulomatous inflammation
Multinucleated giant cells

313
Q

What does papilloedema look like? What does this indicate?

A

Blurring optic disc margins

Raised ICP

314
Q

Patient presents with bilateral pressing headache, history of stressful job and poor sleep. How can you manage this patient?

A

Non-pharm- avoid stressors, exercise, sleep etc.
Ibruprofen 400mg / Paracetamol
Aspirin

Tricyclic antidepressants

315
Q

Amitryiptyline SE

A

Drowsiness, Dry mouth, Constipation

316
Q

What is the pharmacological prophylaxis and management of a patient with migraine?

A

Prophylaxis- propanolol / amitriptyline

Acute-
1) simple analgesia +/- anti-emetic. 2) sumatriptan

317
Q

Patient has very severe headache around the eye which comes on suddenly. They have had several in the past week and had a similar series of headaches a year ago. What is the diagnosis? What is the acute and prophylactic management?

A

Cluster headache

Acute:
Sumatriptan 6mg SC
100% O2 for 15 mins (12-15L)

Prophylaxis- verapamil

318
Q

Patient complains of an electric shooting pain across their face which lasts a couple of seconds, what is the likely diagnosis and management?

A

Trigeminal neuralgia

Carbamazepine / Gabapentin
Surgery to decompress trigeminal nerve

319
Q

Which headache is treated acutely with paracetamol/sumatriptan 50mg and prophylactically with pronaolol/amitriptyline?

A

Migraine

320
Q

Your patients medical records show they are prescribed verapamil for prophylactic treatment for headaches. What is the likely diagnosis? They are worried about having an acute attack, what will you prescribe them to take during a headache?

A

Cluster headache (prophylaxis verapamil)

Acute at tack:
Sumatriptan, 100% O2 for 15 mins

321
Q

How can you assess a patient with NAFLD for fibrosis?

A

Fibroscan (US scan of liver)

NAFLD Fibrosis Score calculator e.g BMI, LFTs, DM

322
Q

Child presents with lethargy, fever, headache assoc. w/slapped cheek rash spread to proximal arms and extensor surfaces. Likely diagnosis?

A

Erthema infectiosum

Parvovirus

323
Q

CT shows petechial haemorrhages in tempral lobe

Patient has fever, headache, confusion, aphasia. Likely diagnosis?

A

Herpes Simplex Encephalitis

Mx- aciclovir

324
Q

Why might a patient with GCA complain of generalised myalgia?

A

Polymyalgia Rheumatica associated with GCA

325
Q

Young man presents with acute headache associated with unilateral periorbital oedema, on examination there is a lateral gaze palsy. Likely diagnosis?

A

Cavernous sinus thrombosis

326
Q

Intense pain around one eye associated with watery eye, redness and constricted pupil. Likely diagnosis?
Management?

A

Cluster headache

Mx- verapamil (proph), sumatriptan 6mg SC / 100% O2 (acute)

327
Q

Frontal headache developed following URTI, worse on leaning forwards, likely diagnosis? usual cause?

A

Sinusitis - usually viral

328
Q

Elderly man presents with severe pain around right eye, assoc. nausea, redness, misty vision, semi-dilated pupil. Likely diagnosis?

A

Acute narrow-angle glaucoma

329
Q

Patient has a headache and nausea which is worse at the weekends, not bad when they are at work or on holiday, what do you need to suspect?

A

Carbon monoxide poisoning

330
Q

What is the definition of domestic abuse?

A

Incident / pattern of incidents of controlling, coercive, threatening behaviour, violence of abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality.
Includes: psychosocial, physical, sexual, financial. emotional

331
Q

What is definition paraesthesia?

A

abnormal sensation caused chiefly by pressure / damage to peripheral nerves
e.g tingling, burning, numbness, warmth, chills

332
Q

What is the pmneumonic VITAMINN CDEF

A 
Vascular 
Infectious/inflammatory 
Trauma 
AI
Metabolic
Iatrogenic 
Neoplasm/ Neurological

Congenital
Degenerative
Endocrine
Functional

333
Q

Vascular differential of parasthesia?

A

Raynaud’s

Stroke/TIA

334
Q

What is the pattern of colour change in raynaud’s?

A

White–> Blue –> Red

335
Q

Inflammatory/infectious cause of parasthesia?

A

GBS, leprosy
HIV
Lime disease
Sarcoidosis

336
Q

What is saturday night palsy?

A

Prolonged pressure on medial side of upper arm (e.g arm hung over back of bench)

337
Q

Trauma differentials parasthesia?

A

saturday night syndrome
fracture
carpal tunnel syndrome

338
Q

Metabolic differentials of parasthesia?

A

Diabetes
Thyroid disease
Renal failure

Hypocalcaemia
Hyper/hypoglycaemia
Hyperkalamaemia
Hypermagnasaemia

339
Q

Iatrogenic differentials of parasthesia?

A

Anticonvulvants e.g topiramate

Chemo e.g cisplatin

340
Q

Neurological differentials of parasthesia?

A

Spinal cord compression
Cauda equina syndrome
Aura of parasthesia e.g migraine
Epilepsy

341
Q

Congenital / inherited differentials of parasthesia?

A

Hereditary neuropathy with pressure palsies

Charcot-marie-tooth disease

342
Q

Degenerative differentials of parasthesia?

A

MS

343
Q

Environmental differentials of parasthesia?

A 
Alcohol
Lead posioning 
Arsenic posioning 
Mercury poisoning 
Deficiencies in B1, B6, B12, E, Folate
344
Q

Functional differentials of parasthesia?

A

Carpal tunnel syndrome

345
Q

Who is carpal tunnel syndrome more common in?

A

Women (smaller wrists)

346
Q

2 common antibiotics that cause parasthesia?

A

nitrofurantoin

metronidazole

347
Q

Blood tests for parasthesia?

A 
Glucose, hba1c- ?DM 
U+E- ?CKD 
WCC- ?infection 
TFTs- ?hyper or hypothyroidism 
Vit D- too much causes 
Vit B1, B6, B12, E deficiency
Folate 
ESR
348
Q

Patient presents with tingling in fingers, you perform nerve conduction studies, which condition are you trying to rule out?

A

carpal tunnel syndrome

349
Q

Non-pharmacological measures for pain management

A 
Wt loss- OA
TENS machines 
Distraction techniques
Acupuncture
Capsaicinn
350
Q

Step 1 of pain ladder

A

Non-opioid analgesics
Paracetamol- avoid in chronic excess alcphol
NSAIDs

351
Q

Step 2 of pain ladder

A 
Mild opioids e.g 
Co-codamol 
Coedine 
Dihydrocodeine 
Tramadol
352
Q

SEs of opioids?

A

Constipation
N+V
Addiction
Neuro/respiratory depression

353
Q

Step 3 of pain ladder + examples

A 
Strong opioids e.g:
Morphine, diamorphine 
Oxycodone 
Fentanyl 
Alfentanil 
Buprenorphoine 
Methadone
354
Q

Step 4 pain ladder

A

nerve blocks
Epidurals
Pumps e.g syringe driver

355
Q

Adjuvant pain management

A

Antidepressants e.g amitryiptylline
Antiepileptics e.g gabapentin / pregabalin
Steroids

356
Q

Child presents with pain, what diagnosis should we always suspect and attempt to rule out?

A

NAI

357
Q

What might indicate a child in pain?

A

Say- they say so
Do- behaviour changes e.g holding arm
React- vital sign changes

358
Q

Streptococcus pneumoniae is a common cause of community acquired pneumonia. Describe the microbiology of strep pneumonia?

A 
Strep pneumonia:
Gram + chains 
Coagulase negative
Alpha haemolytic (green)
Optichin sensitive
359
Q

Staph aureus is a common cause of hospital acquired pneumoinia. Describe the microbiology of staph aureus?

A

Staph aureus:
Gram + clusters
Catalase + (vs strep negative)
Coagulase + (vs staph epidermidis negative)

staph are always positive

360
Q

Give several side effects of opiate use?

A 
Constipation 
N+V
Droswiness 
Dry mouth 
Histamine release (itchy / bronchoconstriction)
Toxicity
361
Q

What is a standard start dose of morphine?

A

20-30mg daily

e.g 5mg 4hrly / 10mg 12hrly

362
Q

Give several factors that increase a patients pain tolerance?

A 
Relief of sx
Sleep / Rest 
Physiotherapy 
Empathy 
Social/psychological support
363
Q

Give several factors that decrease a patients pain tolerance =?

A 
Discomfort 
Anxiety 
Fear 
Poor sleep 
Fatigue
364
Q

How can we manage a palliative patient who is experiencing dysponoea?

A

Optimise asthma/COPD/HF/Infection tx
Opiates e.g morphine
Anxiolytics (mx associated anxiety)- diazepam/TCA/SSRIs
O2 therapy (only if hypoxic)

365
Q

Palliative patient is experiencing restlessness, give 2 examples of medications which can be used for sedating?

A

Haloperidol (less sedating)

Midazolam (quite sedating)

366
Q

Palliative patient is experiencing restlessness, give 2 examples of medications which can be used for sedating?

A

Haloperidol (less sedating)

Midazolam (quite sedating)

367
Q

Anorexia associated with palliative care patient, what medication can be used?

A

15-30mg prednisolone

2-4mg dexamethasone daily

368
Q

Hyoscine butylbromide used for…

Hyoscine hydrobromide used for…

A

Hyoscine butylbromide used for respiratory secretion

Hyoscine hydrobromide used for travel sickness

369
Q

What is the theory behind why anorexia nervosa patients develop hirsutis?

A

develop languno hairs to insulate the body

Maud- Phase 3b (14 decks)

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