Corrections 3 Flashcards
What type of cancer can H. pylori lead to?
Gastric lymphoma (MALT)
Where do gastric lymphomas typically arise?
Antrum of stomach
What type of cancer are Reed-Sternberg cells associated with?
Hodgkin’s lymphoma
What is the best test to initially diagnose Cushing’s syndrome?
The LOW-dose (overnight) dexamethasone suppression test
When is the high dose suppression test used in the diagnsois of Cushing’s?
Once Cushing’s syndrome has been confirmed (i.e. by the low-dose test), additional localisation tests can be completed.
The high-dose dexamethasone suppression test is used to discriminate between Cushing’s disease (i.e. pituitary adenoma) or ectopic ACTH production.
What is it called when neurological symptoms are exacerbated by increases in body temperature?
Uhthoff’s phenomenon
What is Uhthoff’s phenomenon usually associated with?
MS
Which type of stroke is characterised by the an ipsilateral CN III palsy and contralateral hemiparesis?
Weber’s syndrome (a type of midbrain stroke)
What is the most common type of Hodgkin’s lymphoma?
Nodular sclerosing
What are the 2 first line medications for spasticity in MS?
Baclofen & gabapentin
1st line medication for oscillopsia (visual fields appear to oscillate) in MS?
Gabapentin
1st line management of polymorphic ventricular tachycardia?
IV magnesium sulphate
1st line for cellulitis in pencicillin allergic patients?
erythromycin, clarithromycin or doxycycline
Note - if pregnant, use erythromycin
Contraindication of pioglitazone?
Bladder cancer
When is a platelet transfusion indicated?
Platelet count of <30x10^9 AND clinically significant bleeding.
1st line medical management of myoclonic seizures in females?
Levetiracetam
What is Guillain-Barre syndrome classically triggered by?
Campylobacter jejuni
Symptoms of Guillain-Barre syndrome?
- double vision
- proximal muscle weakness
- ataxic gate
- diminished reflexes
What is Kaposi’s sarcoma?
Caused by the human herpes virus 8 (HHV-8).
Presents as purple papules or plaques on the skin or mucosa (e.g. GI and respiratory tract).
This is an AIDS-defining condition.
Kaposi’s sarcoma indicates what underlying condition?
HIV
1st line imaging in suspected aortic dissection in clinically unstable patients?
Transoesophageal echocardiography (TOE)
1st line management of Pneumocystis jiroveci penumonia (PCP)?
Oral co-trimoxazole (trimethoprim and sulfamethoxazole).
Or IV pentamidine in severe cases.
Which HIV patients should receive PCP prophylaxis?
All patients with a CD4 count of <200/mm^3
What is a common complication of PCP?
Pneumothorax
What is broad complex tachycardia following a myocardial infarction almost always due to?
Ventricular tachycardia
What is necessary before diagnostic imaging to prevent contrast-induced nephropathy (on the background of CKD)?
1L before and 1L after of 0.9% NaCl
What is Bell’s palsy?
Acute, unilateral, idiopathic facial nerve paralysis.
Who is Bell’s palsy more common among?
- 20-40 y/o
- pregnant women
Features of Bell’s palsy?
1) LMN facial nerve palsy –> forehead affected
2) Post-auricular pain (may precede paralysis)
3) Altered taste
4) Dry eyes
5) Hyperacusis
What should ALL patients with Bell’s palsy receive?
All patients should receive ORAL PREDNISOLONE within 72 hours of onset of Bell’s palsy.
Eye care is also important to prevent exposure keratopathy –> consider artificial tears & eye lubricants
What is the most common clinical pattern seen in motor neuron disease?
Amyotrophic lateral sclerosis (ALS)
What is the most important test when when investigating vitamin B12 deficiency?
Serum intrinsic factor antibodies
Note - these are more useful than gastric parietal cell antibodies
What type of anion gap does DKA cause?
Raised
What is a normal anion gap?
10-18 mmol/L
How do you calculate an anion ga?
(Sodium + potassium) - (bicarb + chloride)
What condition should you consider in diastolic murmur + AF?
Mitral stenosis
Describe the murmur in mitral stenosis
Mid-diastolic murmur heard loudest over the apex
Accentuated with the patient in the left lateral position.
What complication does mitral stenosis commonly cause?
AF (2ary to left atrial enlargement)
How does mitral stenosis cause AF?
Due to atrial enlargement
What is the 1st line anti-motility agent for diarrhoea in IBS?
Loperamide
What is the 1st line medication for constipation in IBS?
Linaclotide (this is a laxative)
What 4 investigations are required in patients with GORD being considered for fundoplication surgery?
1) oesophageal pH monitoring
2) manometry studies
3) endoscopy
4) Barium swallow
What is the purpose fof manometry studies?
This measures the pressures within the lower oesophageal sphincter and helps to confirm the diagnosis of GORD
What scoring system can be used to quantify the disability in activities of daily living?
Barthel index
What can autoimmune haemolytic anaemia (AIHA) be divided into?
‘Warm’ and ‘cold’ types, according to at what temperature the antibodies best cause haemolysis.
Features of autoimmune haemolytic anaemia?
- anaemia
- reticulocytosis
- low haptoglobin
- raised LDH and indirect bilirubin
- blood film: spherocytes and reticulocytes
What is seen on a blood film in autoimmune haemolytic anaemia?
spherocytes and reticulocytes
What test can be done in autoimmune haemolytic anaemia?
direct antiglobulin test (Coombs’ test) –> this will be positive
Which type of Hodgkin’s lymphoma carries the worst prognosis?
Lymphocyte depleted.
How is 3ary hyperparathyroidism characterised?
By extremely high PTH with moderately raised serum calcium
Which electroylte is required for both PTH secretion and its action on target tissues?
Magnesium
What electrolyte deficiency can cause hypocalcaemia?
Hypomagnesaemia –> may both cause hypocalcaemia and render patients unresponsive to treatment with calcium and vitamin D supplementation.
What is the second most common association of HNPCC after colorectal cancer?
Endometrial cancer
What 2 medications are used 1st line to PREVENT angina attacks?
Beta blocker or a CCB
If a CCB is used as monotherapy in prevention of angina attacks, what is used?
A rate-limiting one e.g. verapamil or diltiazem
If a CCB is used in combination with a beta blocker for the prevention of angina attacks, what is used?
A longer-acting dihydropyridine calcium channel blocker e.g. amlodipine or modified-release nifedipine
What is Lymphogranuloma venereum (LGV)?
An STI caused by Chlamydia trachomatis
Describe the 3 stages of LGV infection
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
Management of LGV infection?
Doxycycline (think - same as Chlamydia)
What does isolated rise in GGT in the context of a macrocytic anaemia suggest?
Alcoholism
If a patient present with a painful CN III (oculomotor nerve) palsy with pupil involvement, what is this a classic presentation of?
Posterior communicating artery aneurysm rupture, leading to compression of CN III fibres between the midbrain and the occiput.
Note - This can occur without rupture of the aneurysm and the patient will present solely with a painful CN III palsy.
What is the only test recommended for H. pylori post-eradication therapy?
Urea breath test
How is Vitamin B12 deficiency typically managed?
IM B12 replacement, a loading regime followed by 2-3 monthly injections
E.g: vitamin B12 1mg IM 3x/week followed by 1mg IM every 3 months
What should sickle cell patients be started on long term to reduce the incidence of complications and acute crises?
Hydroxycarbamide
When should all cases of pneumonia have a repeat chest X-ray?
6 weeks after clinical resolution
What condition causes an ‘empty delta sign’ seen on venography?
Sagittal sinus thrombosis
What is the 1st line investigation in rhabdomyolysis?
plasma creatine kinase (CK)
In a patient with suspected anaemia of chronic disease secondary to CKD, what should be checked prior to starting EPO?
Iron status
Name some drugs that cause haemolysis in G6PD deficiency
1) Anti-malarials: primaquine
2) Ciprofloxacin
3) Sulph- group drugs:
- sulphonamides
- sulphasalazine
- sulphonylureas e.g. gliclazide, glipizide
Is prothrombin time or albumin a better measure of acute liver failure?
Prothrombiin time - as has a shorter-half life than albumin
What is the gold standard test for diagnosing venous sinus thrombosis?
MR Venogram
Should you treated asymptomatic bacteria in catheterised patients?
No - just safetynet
What does the diagnostic criteria for T2DM vary according to?
Whether the patient is symptomatic or not (e.g. polyuria, polydipsia)
If the patient IS symptomatic, what:
a) fasting glucose
b) random glucose
is diagnostic of T2DM?
a) ≥7 mmol/l
b) ≥11.1 mmol/l (or after 75g OGTT)
If the patient is asymptomatic, how does diagnostic criteria for T2DM change?
The above critera (i.e. fasting & random glucose measurements) must be demonstrated on TWO separate occasions.
What HbA1c indicates pre-diabetes?
42-47 mmol/mol
In paeds BLS, what is the ratio of compresions to breath?
15:2
(is 30:2 in adults)
Autoimmune haemolytic anaemia (AIHA) may be divided in to ‘warm’ and ‘cold’ types based on what?
According to at what temperature the Abs best cause haemolysis.
What is the nice criteria for starting a GLP-1 mimetics (e.g. liraglutide, exenatide) in T2DM? (3)
1) BMI >35
2) >1% HbA1c red§uction after 6 months
3) Weight loss >3% at 6 months
If there is a delay in CTPA in PE, what can be offered?
Offer treatment dose of DOAC whilst waiting for CTPA.
How does renal tubular acidosis affect the anion gap?
Causes a hyperchloremic normal anion gap metabolic acidosis.
Pathophysiology in HHS?
Hyperglycaemia –> increased serum osmolality –> osmotic diuresis –> severe volume depletion.
What are some precipitating factors for HHS?
- intercurrent illness
- dementia
- sedative drugs
Onset of HHS vs DKA?
DKA - acute (hours)
HHS - gradual (days) so the dehydration and metabolic disturbances may be more extreme
What is the mainstay of management of HHS?
Fluid replacement with 0.9% saline
Is insulin indicated in HHS?
No - only given if blood glucose stops falling while giving IV fluids
What is the danger of giving insulin in HHS?
Can provoke sudden and dramatic fluid shift between compartments –> can result in central pontine myelinloysis.
In any patient with T2DM with established CVS disease, what shoud always be added to metformin?
SGLT-2 inhibitor
Start metformin first and titrate upwards as tolerated, add an SGLT-2 inhibitor regardless of glycaemic control.
Can SGLT-2 inhibitors cause weight loss?
Yes
(often offered 2nd line after metformin in patients with BMI >35)
What medication is used to vasospasm in aneurysmal subarachnoid haemorrhages?
Nimodipine
In the treatment of anaphylaxis, how often can you repeat dose of adrenaline?
Every 5 mins
Why is polyhydramnios a risk factor for placental abruption?
This is due to an increase in pressure within the uterine space, caused by the extra fluid.
What does an ‘unrecordable’ blood glucose mean?
That the blood sugar is high
What is the criteria to diagnose AKI in adults? (3)
1) Rise in creatinine >26µmol in 48 hours
2) Rise in creatinine >50% in 7 days
3) Decrease in urine output <0.5ml/kg/hr for more than 6 hours
What artery is affected in a contralateral homonymous hemianopia with macular sparing and visual agnosia?
Posterior cerebral artery
What is persistent ST elevation after a previous MI very suggestive of?
LV aneurysm
What is a key complication of a LV aneurysm?
Ischaemic stroke
Blood stagnates around a LV ventricle aneurysm, promoting platelet adherence and thrombus formation –> embolism.
What is the initial Abx therapy in suspected meningitis in young adults (before the identification of the causative organism)?
IV ceftriaxone
When is IM benzylpencillin indicated in suspected meningitis?
In a pre-hospital setting (for e.g. a GP surgery), as long as the transit to the hospital is not delayed.
What medication should patients with CKD be started on if they have an ACR >30 mg/mmol?
ACEi
