Corrections 2 Flashcards
Can a patient in VF be conscious?
No - not compatible with a cardiac output
How can a splenectomy affect HbA1c level?
Can give a falsely high HbA1c level due to the increased lifespan of RBCs.
What antibiotic prophylaxis can be given in ascites (for SBP)?
Ciprofloxacin or norfloxacin
Mx of a myxoedemic coma?
Thyroxine & hydrocortisone
What is conduction aphasia classically due to?
A stroke affecting the arcuate fasciculus - the connection between Wernicke’s and Broca’s area
Features of conduction aphasia?
- Speech is fluent
- Repetition is poor
- Comprehension is normal
- Aware of the errors they are making
Location of lesion in Wernicke’s (receptive) aphasia?
Lesion of the superior temporal gyrus (typically supplied by the inferior division of the left MCA).
This area ‘forms’ the speech before ‘sending it’ to Broca’s area.
Features of Wernicke’s aphasia?
- Comprehension is impaired
- Sentences make no sense but speech remains fluent
- Word substitution and neologisms - ‘word salad’
Location of lesion in Broca’s (expressive) aphasia?
Lesion of the inferior frontal gyrus
It is typically supplied by the superior division of the left MCA
Features of Broca’s aphasia?
- Comprehension is normal
- Speech is non-fluent, laboured, and halting
- Repetition is impaired
Features of global aphasia?
Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia
May still be able to communicate using gestures
Weak or potent steroid in plaque psoriasis mx?
Potent steroid e.g. betamethasone
Location of lesion in a painful 3rd nerve palsy?
Posterior communicating artery aneurysm
Why can myasthenia gravis present with distended neck veins and a flushed face?
Due to SVCO –> can be a complication of a thymoma.
Investigation of choice in myasthenia gravis?
Antibody screen –> antibodies against acetylcholine receptors.
Triad of features in acute liver failure?
1) encephalopathy
2) jaundice
3) coagulopathy
What INR defines coagulopathy?
> 1.5
mx of acute limb ischaemia?
1) analgesia
2) IV heparin
3) vascular review
What is standard for the diagnosis and screening of HIV?
HIV p24 antigen & HIV antibody tests (combination)
Mx of an acute anal fissure (<1 week)?
Soften stool (bulk-forming laxatives), dietary fibre, analgesia and topical anaesthetic cream if necessary
CSF glucose vs serum glucose in bacterial meningitis?
CSF glucose is less than half of the serum glucose in bacterial meningitis
Which nerve is affected in Bell’s palsy affecting the L hand side of the face?
Left CN VII LMN lesion (L lesion = L side of face)
What class of drug is rivastigmine?
Acetylcholinesterase inhibitor
Mx of new-onset dysphagia?
It is a red flag symptom that requires urgent endoscopy, regardless of age or other symptoms
Why is diabetes a risk factor for CN III palsy?
due to microangiopathy related neuropathy
2 key causes of an exudative pleural effusion?
1) empyema
2) malignancy
Mx of an empyema?
Insert a chest drain & commence abx
Features of a radial nerve injury?
1) impaired wrist extension (i.e. wrist drop)
2) impaired sensation over the dorsal aspect of the 1st and 2nd metacarpal bones
What fractures can result in radial nerve damage?
Humeral shaft fractures
What infection can trigger guttate psorasis?
Strep infection
What acid base disturbance can be seen in prolonged diarrhoea?
Metabolic acidosis with hypokalaemia
What class of medication is brimonidine eye drops?
Alpha agonists
What is a positive Nikolsky sign?
the epidermis separates with mild lateral pressure e.g. seen in TEN
Any person on anticoagulants with a head injury must receive a CT head within what time frame?
8 hours
Mx of severe urticaria?
A short course of an oral corticosteroid may required in addition to a non-sedating antihistamine
Severe, sudden abdominal pain + out-of-keeping physical exam findings + AF?
Acute mesenteric ischaemia
Can dry ARMD progress into wet ARMD?
Yes
Following panretinal laser photocoagulation up to 50% of patients have what complication?
Reduction in visual fields
What can be used for short-term reduction of erythema in rosacea?
Topical brimonidine
What is ischaemic colitis?
An acute but transient compromise in the blood flow to the large bowel.
What is the gold standard test for diagnosis venous sinus thrombosis?
MR venogram
D-dimer in venous sinus thrombosis?
Raised d-dimer
What is the anatomical site in gallstones least associated with jaundice?
Cystic duct
Blockage of the cystic duct is not associated with jaundice as bile is still able to flow through the common hepatic duct and common bile duct to the sphincter of Oddi, where is it secreted into the duodenum.
Location of the cystic duct?
Connects the gallbladder to the common bile duct
Location of bridging veins?
Between the cortex and venous sinuses
What 3 conditions are seen in MEN type IIa?
1) medullary thyroid cancer
2) parathyroid hyperplasia (leading to hypercalcaemia)
3) phaeochromocytoma
What 2 oral abx can be used in the mx of acne?
1) lymecycline
2) doxycycline
What is the most common identifiable cause of postcoital bleeding?
Cervical ectropion
IV fluid resuscitation formula in paeds?
10ml/kg over 10 minutes
injury to which nerve can cause groin pain after an inguinlal hernia repair?
ilioinguinal nerve
What are salmon patches?
A kind of vascular birthmark which can be seen in around half of newborn babies.
They are pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck.
Prognosis of salmon patches?
They usually fade over a few months, though marks on the neck may persist.
Fever, facial spasms, dysphagia in an intravenous drug user?
Tetanus
note - botulism would cause a flaccid paralysis
What acid base disturbance does renal tubular acidosis cause?
Hyperchloraemic metabolic acidosis (normal anion gap)
What is a common cause of osteoporosis in men?
Hypogonadism –> hypergonadotropic or hypogonadotropic
Check testosterone!
When should women who have been treated for CIN II be offered cervical screening?
6 months later
Define recurrent vaginal candidiasis?
≥4 episodes in a year
Where does paget’s disease of the bone typically affect?
- skull
- spine
- pelvis
- long bones of lower extremities (femur & tibia)
think - drawing a line down middle of patient
Formula for positive predictive value?
TP / (TP + FP)
What is the preferred DIAGNOSTIC test for chronic pancreatitis?
1st line –> CT abdomen
faecal elastase may be used to assess exocrine function if imaging inconclusive
Conservative mx of an STEMI?
Aspirin plus;
- ticagrelor (if patient is not high bleeding risk)
- clopidogrel (if patient is high bleeding risk)
Dose of statins inopatients with established CVD?
High dose –> 80mg
When is S3 (third heart sound) considered normal?
If <30 y/o
Most common site of metatarsal stress fracture?
2nd metatarsal shaft
How soon should category 2 c-sections be performed?
Within 75 minutes
Fundoscopy in anterior ischemic optic neuropathy?
A swollen pale disc and blurred margins
Mx of patients with sudden-onset sensorineural hearing loss?
1) Referral to ENT
2) High dose oral steroids
