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Yr 5 - Passmed Corrections > Corrections 5 > Flashcards

Corrections 5 Flashcards

1
Q

Presentation of thrombosed haemorrhoids?

A
  • significant pain & tender lump
  • exam: purplish, oedematous & tender SC perianal mass
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2
Q

Mx of thrombosed haemorrhoids?

A

If pt presents <72h –> consider referral for excision

If pt presents >72h –> stool softeners, ice packs and analgesia

Symptoms usually settle within 10 days

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3
Q

Mx of 1ary hyperaldosteronism 2ary to bilateral adrenal hyperplasia?

A

1st line –> spironolactone

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4
Q

Mx of 1ary hyperaldosteronism 2ary to adrenal adenoma?

A

Surgery (laparoscopic adrenalectomy)

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5
Q

What class of medication is tolterodine?

A

Antimuscarinic

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6
Q

In BPH, if there is a mixture of storage symptoms and voiding symptoms that persist after treatment with an alpha-blocker alone, what can be added?

A

An antimuscarinic e.g. tolterodine or darifenacin

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7
Q

When is finasteride (5a-reductase inhibitor) indicated in BPH?

A

Indicated if the patient has a significantly enlarged prostate and is considered to be at high risk of progression

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8
Q

How can finasteride affect PSA?

A

Can reduce PSA concs by up to 50%

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9
Q

Diagnostic criteria for an AKI?

A

1) Urine output <0.5ml/kg/hr for more than 6 hours

2) Rise in creat >50% in 7 days

3) Rise in creat >26µmol/L in 48h

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10
Q

What is the benefit of epidural analgesia post-abdo surgery?

A

Faster return to normal bowel function

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11
Q

When is hypertonic (3%) saline indicated in hyponatraemia?

A

In acute severe hyponatraemia (<120 mmol/L)

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12
Q

Mx of motion sickness?

A

1) Hyoscine (best)

2) Cyclizine

3) Promethazine

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13
Q

What is diagnosed as flail chest?

A

Multiple rib fractures with ≥2 fractures in more than 2 ribs

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14
Q

What is a common side effect of thiazide diurects?

A

ED

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15
Q

What is Behcet’s disease?

A

Triad of:

a) oral ulcers
b) genital ulcers
c) anterior uveitis

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16
Q

Mx of a postmenopausal woman, or a man age ≥50 with a symptomatic osteoporotic vertebral fracture?

A

Initiate bisphosphonate therapy immediately

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17
Q

Give some scenarios where bisphosphonates should be initiated straight away (without waiting for a DEXA scan) in suspected osteoporosis?

A

1) Postmenopausal women, and men age ≥50, who are treated with oral glucocorticoids

2) A postmenopausal woman, or a man age ≥50 has a symptomatic osteoporotic vertebral fracture

3) Following a fragility fracture in women ≥ 75 years

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18
Q

Features of Steven-Johnson syndrome?

A

1) the rash is typically maculopapular with target lesions being characteristic

2) may develop into vesicles or bullae

3) Nikolsky sign is positive in erythematous areas

4) mucosal involvement

5) systemic symptoms: fever, arthralgia

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19
Q

Causes of SJS?

A
  • penicillin
  • sulphonamides
  • lamotrigine, carbamazepine, phenytoin
  • allopurinol
  • NSAIDs
  • oral contraceptive pill
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20
Q

What test results indicate a successfully treated syphilis?

A

Negative non-treponemal test & positive treponemal test

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21
Q

Diagnostic criteria for T1DM?

A

If the patient is symptomatic:
- fasting glucose greater than or equal to 7.0 mmol/l
- random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)

If the patient is asymptomatic the above criteria apply but must be demonstrated on two separate occasions.

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22
Q

Iron / calcium carbonate tablets can reduce the absorption of levothyroxine.

How far apart should they be taken?

A

4 hours apart

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23
Q

Mx of a Bishop’s ≥8?

A

A Bishop’s score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

Often no interventions are required.

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24
Q

Mx of latent TB?

A

a) 3 months of isoniazid (with pyridoxine) and rifampicin, or

b) 6 months of isoniazid (with pyridoxine)

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25
Q

Mx of symptomatic dermatophyte nail infections ?

A

Oral terbinafine

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26
Q

Why is acute intestinal obstruction with dilated bowel loops a contraindication to laparoscopic surgery?

A

Due to the increased risk of iatrogenic bowel perforations

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27
Q

What should all patients with PAD take?

A

Clopidogren + statin

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28
Q

Is fluconazole an enzyme inhibitor or inducer?

A

Inhibitor

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29
Q

When starting bisphosphonate treatment for osteoporosis, when should calcium be prescribed?

A

Only if dietary intake is inadequate

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30
Q

There is an increased risk of VTE in patients with nephrotic syndrome. What prophylaxis is required?

A

LMWH

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31
Q

Stage 1-4 of ovarian cancer?

A

1 - confined to ovary
2 - outside ovary but within pelvis
3 - outside pelvis but within abdomen
4 - distant mets

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32
Q

Acute graft failure happens within months, is usually asymptomatic. How is it usually picked up?

A

Rising creatinine, pyuria & proteinuria

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33
Q

Describe a strawberry naevus

A

Strawberry naevi (capillary haemangioma) are usually not present at birth but may develop rapidly in the first month of life.

They appear as erythematous, raised and multilobed tumours.

34
Q

Mx of a strawberry naevus?

A

Typically they increase in size until around 6-9 months before regressing over the next few years (around 95% resolve before 10 years of age).

35
Q

Mx of patients with a moderate acute asthma attack if they have previously had a near fatal attack?

A

Should be admitted to hospital

36
Q

Formula for likelihood ratio for a positive test result?

A

Sensitivity / (1 - specificity)

37
Q

Formula for likelihood ratio for a negative test result?

A

(1 - sensitivity) / specificity

38
Q

What is rectal intussusception?

A

Internal rectal prolapse

Typically presents with symptoms of obstructed defecation.

39
Q

What is rectal intussusception associated with?

A

Childbirth

40
Q

2 options for mx of an oculogyric crisis?

A

1) procyclidine
2) benztropine

41
Q

1st line investigation of DDH in children >4.5 months?

A

XR

42
Q

What is the 1st line imaging when investigating thyroid nodules?

A

US

This may help determine if the nodule has features suspicious of malignancy.

43
Q

What is the most common thyroid cancer?

A

Papillary carcinoma

44
Q

What is springomyelia?

A

A collection of cerebrospinal fluid within the spinal cord.

45
Q

What is the strongest association with springomyelia?

A

a Chiari malformation

46
Q

Give 4 risk factors for avascular necrosis of the femoral head

A

1) steroids
2) chemotherapy
3) alcohol excess
4) trauma

47
Q

What is the investigation of choice in avascular necrosis?

A

MRI

48
Q

What is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?

A

Biliary stenting

49
Q

What is the lifetime risk of cholangiocarcinoma in patients with PSC?

A

20%

50
Q

Why can there be palpable peri-umbilical lymph nodes in patients with cholangiocarcinoma?

A

Sister Mary Joseph nodes

51
Q

Cleaning of postop wounds:

a) <48h after surgery
b) >48h after surgery

A

a) sterile saline
b) patients can shower safely

52
Q

What type of scar may grow beyond the boundaries of the original incision?

A

Keloid scars

53
Q

Mx of toxoplasmosis:

a) in the general population
b) in immunosuppressed

A

a) often requires no treatment

b) Pyrimethamine + sulphadiazine

54
Q

Mechanism of fondaparinux?

A

Activates antithrombin III

55
Q

What are the Ottawa ankle rules for XR?

A

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:

1) bony tenderness at the lateral malleolar zone

2) bony tenderness at the medial malleolar zone

3) inability to walk 4 weight-bearing steps immediately after the injury and in the emergency department

56
Q

What is the most common cause of hypopituitarism?

A

Non-secretory pituitary macroadenoma

57
Q

Which nerve root compression in the lower back causes NO impact on reflexes?

A

L5

58
Q

What reflexes are impacted in the following nerve root compressions:

a) L3
b) L4
c) L5
d) S1

A

a) reduced knee reflex
b) reduced knee reflex
c) reflexes intact
d) reduced ankle reflex

59
Q

Which nerve root compressions in the lower back cause a positive sciatic nerve stretch test?

A

L5 & S1

60
Q

Describe sensory loss in the following nerve root compressions:

a) L3
b) L4
c) L5
d) S1

A

a) Sensory loss over anterior thigh

b) Sensory loss anterior aspect of knee and medial malleolus

c) Sensory loss dorsum of foot

d) Sensory loss posterolateral aspect of leg and lateral aspect of foot

61
Q

Describe weakness in movements in the following nerve root compressions:

a) L3
b) L4
c) L5
d) S1

A

a) Weak hip flexion, knee extension and hip adduction

b) Weak knee extension and hip adduction

c) Weakness in foot and big toe dorsiflexion

d) Weakness in plantar flexion of foot

62
Q

Is amiodarone safe in breastfeeding?

A

No –> is highly lipid-soluble and therefore, extensively stored in body tissues, including breast milk.

63
Q

1st line mx of most patients with a pituitary tumour causing acromegaly?

A

Trans-sphenoidal surgery

64
Q

Mx of unresectable tumours causing acromegaly or if surgery fails to achieve remission of acromegaly?

A

Somatostatin analogues e.g. ocreotide

65
Q

1st line mx of superficial thrombophlebitis?

A

Compression stockings

66
Q

Inheritance of vWd?

A

Autosomal dominant

67
Q

Clotting study results in vWd?

A

1) prolonged bleeding time
2) APTT may be prolonged
3) factor VIII levels may be moderately reduced

68
Q

Mx of vWd?

A

1) TXA for mild bleeding

2) Desmopressin

3) Factor VIII concentrate

69
Q

Role of desmopressin in vWd?

A

Raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells

70
Q

Incubation period for Giardiasis?

A

1 to 2 weeks, but it can extend up to 6 weeks in some cases.

71
Q

What antibiotic can be used in the mx of campylobacter (when indicated e.g. if severe or the patient is immunocompromised)?

A

Clarithromycin

72
Q

Does bloody diarrhoea indicate campylobacter or E. coli?

A

Campylobacter

73
Q

Give some indications of abx treatment in campylobacter

A

1) Severe symptoms: high fever, bloody diarrhoea, or more than eight stools per day)

or

2) Symptoms have lasted more than one week

74
Q

When is carotid endarterectomy considered in patients who have had a TIA?

A

With carotid artery stenosis exceeding 50% on the side CONTALATERAL to the symptom.

75
Q

What are important additional blood tests which form part of the ‘Confusion Screen’?

A
  • TSH
  • B12
  • Folate
  • Glucose
  • Bone profile
76
Q

What is Granulomatosis with polyangiitis?

A

An autoimmune condition associated with a necrotizing granulomatous vasculitis, affecting both the upper and lower respiratory tract as well as the kidneys.

77
Q

Features of Granulomatosis with polyangiitis?

A

1) URT: epistaxis, sinusitis, nasal crusting

2) LRT: dyspnoea, haemoptysis

3) Rapidly progressive glomerulonephritis

4) Saddle-shape nose deformity

5) Vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions

78
Q

What antibody is positive in Granulomatosis with polyangiitis?

A

1) c-ANCA (>90%)

2) p-ANCA (25%)

79
Q

Mx of Granulomatosis with polyangiitis?

A

1) steroids
2) cyclophosphamide (90% response)
3) plasma exchange

80
Q

What does a high insulin & high c-pepide indicate?

A

Endogenous insulin production → Insulinoma or sulfonylurea use/abuse

81
Q

Mx of a young patient who has always had difficulty achieving an erection with normal testosterone levels?

A

Referral to urology

82
Q
A

Yr 5 - Passmed Corrections (8 decks)

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