Corrections 6 Flashcards
When a blood occurs on one side of the brain, does it affect CN III on the ipsilateral or contralateral side?
Ipsilateral
E.g. R subdural haematoma would cause a R CN III palsy
Patients with ovale or vivax malaria should be given what following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse?
Primaquine
What is Kussmaul’s sign?
When JVP paradoxically increases during inspiration, instead of decreasing as normal.
What does Kussmaul’s sign indicate?
It’s a sign of limited RV filling –> constrictive pericarditis
What is an alternative treatment to atropine/transcutaneous pacing for a symptomatic bradycardia?
Isoprenaline/adrenaline infusion
What is discoid lupus erythematosus?
A benign disorder generally seen in younger females.
It very rarely progresses to SLE (<5%).
Discoid lupus erythematosus is characterised by follicular keratin plugs and is thought to be autoimmune in aetiology.
Features of discoid lupus erythematosus?
- erythematous, raised rash, sometimes scaly
- may be photosensitive
- more common on face, neck, ears and scalp
- lesions heal with atrophy, scarring (may cause scarring alopecia), and pigmentation
Mx of discoid lupus?
1st line –> topical steroid cream
2nd line –> hyroxychloroquine
Typical features of pneumonitis?
- fever
- SOB
- dry cough
- malaise
What reflex is reduced in S1 nerve root compression?
Reduced ankle reflex
What biologic may be used in the mx of complex peri-anal Crohn’s?
Infliximab
When prescribing fluids, what is the daily glucose requirement?
50-100 g/day irrespective of the patient’s weight
Formula for relative risk?
EER / CER
Mx of hypocalcaemia causing a prolonged QT interval as well as hypomagnesaemia?
Prolonged QT interval is an indication for urgent IV calcium gluconate (due to risk of arrhythmias)
Underlying pathological process in dermatitis herpetiformis?
Formation of IgA antibodies
Chest sounds in TRALI vs anaphylaxis?
TRALI –> bilateral coarse crackles due to non-cardiac pulmonary oedema
Anaphylaxis –> bilateral expiratory wheeze
What graphical representation can be used to combine data from more than one study?
Forest plot
What movement typically aggravates medial epicondylitis (golfer’s elbow)?
Wrist flexion and pronation
What 2 features indicate an immediate referral to see a specialist for suspected leukaemia in children & young adults?
1) unexplained petechiae
2) unexplained hepatosplenomegaly
A 48h blood test is recommended for children and young people with general symptoms or signs of leukaemia (e.g. pallor, unexplained fever).
However, when either hepatosplenomegaly or unexplained petichiae are present, the patient should be referred for immediate assessment.
Describe murmur in HOCM
- ejection systolic murmur
- louder on Valsalva
- quieter on squatting
What strains of HPV carry the highest risk of oropharyngeal cancer?
16 & 18
Mx of a psoas abscess?
IV abx & percutaneous drainage
What is the investigation of choice in a psoas abscess?
CT abdomen
What is the ‘psoas sign’?
Lie the patient on the normal side and hyperextend the affected hip. This should elicit pain as the psoas muscle is stretched.
How does a splenectomy affect RBC lifespan?
Causes an increase in RBC lifespan (and therefore falsely high HbA1c)
What is the most common cause of septic arthritis:
a) overall
b) in young sexually active adults
a) Staph. aureus
b) Neisseria gonorrhoea
Mx of renal stones:
a) <5mm and symptomatic
b) 5-10mm
c) 10-20mm
d) >20mm
a) watchful waiting
b) shockwave lithotripsy
c) shockwave lithotripsy OR ureteroscopy
d) percutaneous nephrolithotom
Mx of ureteric stones:
a) <10mm
b) 10-20mm?
a) shockwave lithotripsy +/- alpha blockers
b) ureteroscopy
What classification can be used in ankle fractures?
Weber classification
What is the Weber classification dependent on?
Related to the level of the fibular fracture.
Give the 3 types of Weber classification for ankle fractures
Type A: below the syndesmosis
Type B: fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
Type C: above the syndesmosis which may itself be damaged
Mx of all ankle fractures?
All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis
Mx of Weber A fractures?
Patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot for 6 weeks
Bone profile results in 2ary hyperparathyroidism (2ary to CKD)?
- low calcium
- high phosphate
- high PTH
- high ALP
What is ALP a marker of?
Bone turnover
What is the pathological cause of 2ary hyperparathyroidism in CKD?
Parathyroid hyperplasia
To compensate for hypocalcaemia 2ary to CKD, the parathyroid glands secrete more PTH and cells increase in numbers (hyperplasia) to try and raise serum calcium levels.
Following an SAH, how are most intracranial aneurysms treated?
Coiling by an interventional radiologist
Target INR for mechanical valves:
a) aortic valves
b) mitral valves
a) 3.0
b) 3.5
Abx mx of exacerbations of chronic bronchitis?
Amoxicillin or tetracycline or clarithromycin
Mx of uncomplicated CAP?
Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. in influenza)
Mx of pneumonia possibly caused by atypical pathogens?
Clarithromycin
Mx of HAP:
a) <5 days of admission
b) >5 days after admission
a) co-amoxiclav or cefuroxime
b) piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
Investigation results in Wilson’s?
1) reduced serum caeruloplasmin
2) reduced total serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
- free (non-ceruloplasmin-bound) serum copper is increased
3) increased 24h urinary copper excretion
What should be used to treat acute gout if NSAIDs are contraindicated for example a peptic ulcer?
Colchicine
Role of FAST scans?
Can be used to assess the presence of free fluid in the abdomen and thorax
Describe the two-level DVT Wells score
Active cancer (1)
Paralysis, paresis or recent plaster immobilisation of the lower extremities (1)
Recently bedridden for 3 days or more or major surgery within 12 weeks requiring general or regional anaesthesia (1)
Localised tenderness along the distribution of the deep venous system (1)
Entire leg swollen (1)
Calf swelling at least 3 cm larger than asymptomatic side (1)
Pitting oedema confined to the symptomatic leg (1)
Collateral superficial veins (non-varicose) (1)
Previously documented DVT (1)
An alternative diagnosis is at least as likely as DVT (-2)
When starting bisphosphonate treatment for osteoporosis, when should calcium only be prescribed?
If dietary intake is inadequate
Which nerve root compression results in intact knee & ankle reflexes?
L5
Mx of discoid lupus erythematous?
1st line –> topical steroids
2nd line –> oral hydroxychloroquine
Mx of superficial thrombophlebitis?
Compression stockings (once arterial insufficiency has been excluded)
Features of ACL rupture?
- sudden popping sound
- knee swelling
- instability, feeling that knee will give way
Why is acute intestinal obstruction with dilated bowel loops a contraindication to laparoscopic surgery?
Due to the increased risk of perforation on entering the abdomen
What is the intervention of choice for severe mitral stenosis?
Percutaneous mitral commissurotomy
What is an lternative to metronidazole for patients with bacterial vaginosis?
Topical clindamycin cream
In the mx of pneumothorax, what are some high-risk characteristics that determine the need for a chest drain?
1) Haemodynamic compromise (suggesting a tension pneumothorax)
2) Significant hypoxia
3) Bilateral pneumothorax
4) Underlying lung disease
5) ≥50 years of age with significant smoking history
6) Haemothorax
Role of a cystogram?
A cystogram involves passing radiopaque dye into the bladder, then performing radiographs to assess the course of the bladder contents.
This provides evidence of whether there is any radiopaque fluid that has escaped the bladder and is free in the abdominal cavity.
What % of shoulder dislocations do anterior dislocations account for?
> 95% cases
Location of the humeral head in an anterior shoulder dislocation?
Usually lies in the subcoracoid position
Which 2 types of renal stones are radio-lucent on XR?
1) urate
2) xanthine stones
Which type of renal stone is semi-opaque on XR?
Cystine
Prevalence vs incidence in chronic vs acute disease?
Chronic: prevalence > incidence
Acute: incidence > prevalence
Why is incidence > prevalence in acute disease?
Because cases resolve quickly.
This means more people experience tonsillitis over the year than have it at any single time, leading to a higher incidence than prevalence.
Cause of urinary problems in a man with a history of gonorrhoea?
May be due to a urinary stricture
What is typically the best long-term feeding option in awake patients?
PEG
For a patient with symptomatic stable angina on a CCB but with a contraindication to a beta-blocker, what should the next line treatment be?
Either:
- long acting nitrate
- ivabradine
- nicorandil
- or ranolazine
Define power
The probability to detect a difference in the outcome of interest between two groups if such a difference exists (i.e. correctly reject the null hypothesis).
How can you increase the power of a study (the ability to detect the difference)?
Increase sample size (this will also reduce type II error)
Of organic causes of erectile dysfunction, what is the most common?
Vascular causes
When can you consider stopping anti-epileptics?
If seizure free >2 years, slowly stop anti-epileptics over 2-3 months
What artery is affected in Weber’s syndrome?
Branches of the posterior cerebral artery that supply the midbrain
What is a differential for ST-elevation in someone with no obstructive coronary artery disease?
Takotsubo cardiomyopathy –> cardiomyopathy induced by severe stressful triggers (e.g. emotional upset)
Impact of taking azathioprine & allopurinol together?
They are both inhibitors of xanthine oxidase –> bone marrow suppression
Dose of adrenaline in ALS?
1:10,000 1mg
Signs seen in a scaphoid fracture?
- Point of maximal tenderness over the anatomical snuffbox
- Wrist joint effusion
- Pain elicited by telescoping of the thumb (pain on longitudinal compression)
- Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
- Pain on ulnar deviation of the wrist
What 1st line imaging is indicated in a scaphoid fracture?
Plain film radiographs of the wrist in the AP and lateral view
What is considered the definite investigation to confirm or exclude a diagnosis?
MRI
What is CREST syndrome?
A subtype of limited systemic sclerosis and includes:
1) calcinosis
2) Raynaud’s phenomenon
3) oesophageal dysmotility
4) sclerodactyly
5) telangiectasia
How can a diagnosis of ankylosing spondylitis be best supported?
Sacro-ilitis on a pelvic XR
