Corrections Flashcards
Glasgow-Blatchford vs Rockall score in an upper GI bleed?
Glasgow-Blatchford –> used at first assessment to determine severity (if they can be managed as outpatient)
Rockall –> used after endoscopy, provide % risk of rebleeding and mortality
What is the purpose of the Mantoux test?
Screening tool for TB
What medication can give a false -ve Mantoux test?
Steroids
What is the main side-effect of using topical decongestants for prolonged periods in allergic rhinitis?
Tachyphylaxis –> the rapid decrease in response to a drug following repeated administration, requiring increasingly larger doses to achieve the same therapeutic effect
When is a diagnosis of atelectasis made?
Clinical diagnosis made when SOB & lower than normal sats occur within 24h of surgery
What enzyme is deficient in suxamethonium apnoea?
Pseudocholinesterase deficiency
What ASA grade is a patient with end stage renal disease undergoing regular scheduled dialysis?
III
How should TPN be administered?
Via a central line as its strongly phlebitic
For correcting Na+ too quickly:
Low to high - pons will die (myelinolysis)
High to low - brain will blow (oedema)
What is a consequence of rapidly correcting hyponatraemia?
Central pontine myelinolysis
What is the muscle relaxant of choice for RSI?
Suxamethonium
Mechanism of lidocaine
Blockage of sodium channels
What can cause malignant hyperthermia?
1) suxamethonium
2) volatile anaesthetics e.g. isoflurane
Diabetes drugs on surgery day:
a) metformin
b) sulfonylureas
c) DPP-4 inhibitors
d) GLP-1 mimetics
a) OD & BD take as normal, TDS (omit lunchtime dose)
b) OD omit dose, BD (omit morning dose for morning operation, omit both doses for afternoon operation)
c) take as normal
d) take as normal
A posterior STEMI can present with ST depression.
What leads would this typically be seen in?
V1-V3
Features of Kawasaki disease?
1) high-grade fever which lasts for >5 days (characteristically resistant to antipyretics)
2) conjunctival injection
3) bright red cracked lips
4) strawberry tongue
5) red palms of the hands and the soles of the feet which later peel
What class of medication is nicorandil?
Potassium channel activator
Indication of Nicorandil?
Angina: has a vasodilatory effect on the coronary arteries.
Side effects of nicorandil?
- headache
- flushing
- anal ulceration
What would global T wave inversion (i.e. not fitting a coronary artery territory) indicate?
Non-cardiac cause e.g. head injury
What are the effects of adenosine:
a) blocked by
b) enchanced by?
a) theophylline
b) dipyridamole (antiplatelet agent)
Mechanism of action of adenosine?
Causes transient heart block in the AV node:
Agonist of the A1 receptor in the AV node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarisation by increasing outward potassium flux.
How does a posterior MI typically present on an ECG?
1) Tall R waves in V1-V3
2) ST depression
What is the Killip Classification?
Quantifies severity of heart failure in NSTEMI and predicts 30-day mortality.
I - No clinical signs heart failure
II - Lung crackles, S3
III - Frank pulmonary oedema
IV - Cardiogenic shock
RBBB is most likely to be caused by occlusion of which artery?
LAD
What is andexanet alfa?
A recombinant form of factor Xa
Wht are the 2 groups of causes of aortic regurg?
1) disease of the aortic valve
2) distortion or dilation of the aortic root and ascending aorta
Pulse pressure in aortic regurg?
Wide
What 2 signs may be seen in aortic regurg?
1) Quincke’s sign (nailbed pulsation)
2) De Musset’s sign (head bobbing)
What manouevre can make an AR murmur louder and easier to hear?
Handgrip manouevre
Main mechanism of amiodarone?
Blocks potassium channels –> inhibits repolarisation and prolongs the action potential.
Is amiodarone an inducer or inhibitor?
Inhibitor
Side effects of amiodarone?
1) Thyroid dysfunction: both hypo- and hyper-
2) Pneumonitis/pulmonary fibrosis
3) Liver fibrosis/hepatitis
4) Corneal deposits
5) Slate grey appearance
6) Photosensitivity
7) Peripheral neuropathy
8) Thrombophlebitis and injection site reactions
9) Lengthens QT
10) Bradycardia
What is Beck’s triad?
Findings associated with cardiac tamponade:
1) hypotension
2) raised JVP
3) diminished heart sounds
Which class of medication can lead to unawareness of hypoglycemic events?
Beta blockers
1st line Abx in native valve infective endocarditis?
IV amoxicillin
What 3 electrolyte imbalances can cause long QT?
1) hypokalaemia
2) hypomagnesaemia
3) hypocalcaemia
What is isosorbide mononitrate?
A long acting nitrate
Which drug is contraindicated in VT?
Verapamil –> can precipirate cardiac arrest
What should be given to patients who are in VF/pulseless VT after 3 shocks have been administered?
IV amiodarone 300mg & IV adrenaline 1mg
General stepwise management of angina?
1) Aspirin & statin –> all patients
2) GTN spray
3) Beta blocker and/or CCB
Diastolic murmur + AF → ?
Mitral stenosis
Why may a pulse ox be falsely high in carbon monoxide poisoning?
Due to similarities between oxyhaemoglobin and carboxyhaemoglobin.
1st line investigation in carbon monoxide poisoning?
VBG or ABG
Management of carbon monoxide poisoning?
1) 100% high-flow oxygen via a non-rebreather mask: target sats 100%
2) hyperbaric oxygen
Is dialysis effective in TCA OD?
No (but it is in salicylate & lithum OD)
Reversal agent of iron?
Desferrioxamine, a chelating agent
Management of cyanide OD?
Hydroxocobalamin
What test is offered to patients with chronic pancreatitis to screen for diabetes?
Annual HbA1c
What is Budd-Chiari syndrome?
A condition characterised by obstruction to hepatic venous outflow.
Also knownas hepatic vein thrombosis.
What is a key investigation in a suspected perforated peptic ulcer?
CXR
What is acalculous cholecystitis?
Gallbladder inflammation without gallstones.
It’s less common, but usually more serious.
What serology result is highly specific for primary biliary cholangitis?
AMA
What condition causes classic ‘beaded’ strictures on ERCP?
UC
What classification system is used to guide management of cellulitis?
Eron classification
Describe the Eron classification
Class I - no systemic toxicity or comorbidity
Class II - systemic toxicity or comorbidity
Class III - significant systemic toxicity or significant comorbidity
Class IV - sepsis or life-threatening infection
What Eron classification indicates admission for IV Abx?
Class III and IV
What is typical 1st line Abx for mild/moderate cellulitis?
Oral flucloxacillin
1st line Abx for mild/mod cellulitis in pregnancy?
Oral erythromycin
1st line Abx for mild/mod cellulitis in penicillin allergy?
oral clarithromycin, erythromycin or doxycycline
What is usually the 1st choice Abx for cellulitis near the eyes or nose?
Co-amoxiclav
1st line Abx in severe cellulitis?
Oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone
What are the 4 types of NF?
Type I: polymicrobial (most common)
Type II: monomicrobial (caused by Streptococcus pyogenes)
Type III: monomicrobial (caused by the Clostridium species most commonly)
Type IV: fungal NF, mainly Candida species
What is gas gangrene?
A form of NF caused by clostridium specicies (C. perfringens), resulting in gas being produced by the bacteria within the tissue.
What is the only definitive management of NF?
Surgical debridement
What is Trousseau’s sign?
Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic –> indicates hypocalcaemia
What lead is T wave inversion a normal variant?
Lead III
Side effects of amiodarone therapy?
1) thyroid dysfunction: hypo- and hyperthyroidism
2) pulmonary fibrosis/pneumonitis
3) liver fibrosis/hepatitis
4) corneal deposits
5) ‘slate-grey’ appearance
6) bradycardia
7) QT lengthening
8) photosensitivity
What are the 2 important drug interactions of amiodarone?
1) decreased metabolism of warfarin –> increased INR
2) increased digoxin levels
Adverse effects of methotrexate?
1) myelosuppression
2) liver fibrosis
3) lung fibrosis
4) mucositis
5) pneumonitis
What investigations need to be regularly monitored in patients on methotrexate?
FBC, U&Es, LFTs
What drug is commonly used in the treatment of SLE?
Hydroxychloroquine
What electolyte abnormality is hypokalaemia often associated with?
Hypomagnesaemia
What can the correction of:
a) hyponatraemia
b) hypernatraemia
too quickly lead to?
a) osmotic demyelination syndrome
b) cerebral oedema
Acute vs chronic hyponatraemia?
Acute: <48h
Chronic: >48h
What type of hyponatraemia does Addisons cause?
Hypovolaemic hyponatraemia (high urinary sodium)
Management of hypovolaemic hyponatraemia?
Isotonic saline (0.9% NaCl)
If serum sodium rises –> supports a diagnosis of hypovolemic hyponatraemia
If the serum sodium falls –> alternative diagnosis such as SIADH is likely
if the serum sodium falls in the mx of hypovolaemic hyponatraemia (with 0.9% NaCl), what does this suggest?
Alternative diagnosis e.g. SIADH
Management of acute, severe hyponatraemia (<120 mmol/L) or symptomatic hyponatraemia?
Hypertonic saline (3%) is typically used.
Symptoms of osmotic demyelination syndrome?
dysarthria
dysphagia
paraparesis or quadriparesis
seizures
confusion
coma
can have ‘locked in syndrome’
How is osmotic demyelination syndrome avoided?
Na+ levels are only raised by 4-6 mmol/L in a 24h period
Management of severe hypocalcaemia?
IV 10% calcium gluconate over 10 mins
How can UH and LMWH affect potassium?
Can cause hyperkalaemia (this is throught to be caused by inhibition of aldosterone secretion).
What is Chvostek sign?
Tapping the facial nerve in front of the ear leads to contraction of the facial muscles on the same side of the face –> indicates hypocalcaemia.
Mechanism of thiazide-like diuretics?
Block the Na/Cl cotransporter in the distal convoluted tubule.
This results in an increased excretion of sodium and chlorine (and therefore water) in the urine.
What is the most common presentation of MEN 1?
Hypercalcaemia
What is the most common presentation of MEN 1?
Hypercalcaemia
What is the max daily dose of metformin?
2g/day
What is the most common complication of thyroid eye disease?
Exposure keratopathy
What are 3 key complications of thyroid eye disease?
1) Exposure keratopathy (most common)
2) Optic neuropathy
3) Strabismus and diplopia
Management of optic neuropathy caused by thyroid eye disease?
it requires urgent medical intervention to prevent permanent vision loss.
What condition is thyroid eye disease seen in?
Grave’s disease
Features of thyroid eye disease?
- exophthalmos
- conjunctival oedema
- optic disc swelling
- ophthalmoplegia
- inability to close the eyelids may lead to sore, dry eyes - if severe and untreated patients can be at risk of exposure keratopathy
