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Yr 5 - Passmed Corrections > Corrections 6 > Flashcards

Corrections 6 Flashcards

1
Q

When a blood occurs on one side of the brain, does it affect CN III on the ipsilateral or contralateral side?

A

Ipsilateral

E.g. R subdural haematoma would cause a R CN III palsy

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2
Q

Patients with ovale or vivax malaria should be given what following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse?

A

Primaquine

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3
Q

What is Kussmaul’s sign?

A

When JVP paradoxically increases during inspiration, instead of decreasing as normal.

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4
Q

What does Kussmaul’s sign indicate?

A

It’s a sign of limited RV filling –> constrictive pericarditis

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5
Q

What is an alternative treatment to atropine/transcutaneous pacing for a symptomatic bradycardia?

A

Isoprenaline/adrenaline infusion

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6
Q

What is discoid lupus erythematosus?

A

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.

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7
Q

Features of discoid lupus erythematosus?

A
  • 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
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8
Q

Mx of discoid lupus?

A

1st line –> topical steroid cream

2nd line –> hyroxychloroquine

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9
Q

Typical features of pneumonitis?

A
  • fever
  • SOB
  • dry cough
  • malaise
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10
Q

What reflex is reduced in S1 nerve root compression?

A

Reduced ankle reflex

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11
Q

What biologic may be used in the mx of complex peri-anal Crohn’s?

A

Infliximab

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12
Q

When prescribing fluids, what is the daily glucose requirement?

A

50-100 g/day irrespective of the patient’s weight

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13
Q

Formula for relative risk?

A

EER / CER

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14
Q

Mx of hypocalcaemia causing a prolonged QT interval as well as hypomagnesaemia?

A

Prolonged QT interval is an indication for urgent IV calcium gluconate (due to risk of arrhythmias)

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15
Q

Underlying pathological process in dermatitis herpetiformis?

A

Formation of IgA antibodies

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16
Q

Chest sounds in TRALI vs anaphylaxis?

A

TRALI –> bilateral coarse crackles due to non-cardiac pulmonary oedema

Anaphylaxis –> bilateral expiratory wheeze

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17
Q

What graphical representation can be used to combine data from more than one study?

A

Forest plot

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18
Q

What movement typically aggravates medial epicondylitis (golfer’s elbow)?

A

Wrist flexion and pronation

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19
Q

What 2 features indicate an immediate referral to see a specialist for suspected leukaemia in children & young adults?

A

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.

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20
Q

Describe murmur in HOCM

A
  • ejection systolic murmur
  • louder on Valsalva
  • quieter on squatting
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21
Q

What strains of HPV carry the highest risk of oropharyngeal cancer?

A

16 & 18

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22
Q

Mx of a psoas abscess?

A

IV abx & percutaneous drainage

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23
Q

What is the investigation of choice in a psoas abscess?

A

CT abdomen

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24
Q

What is the ‘psoas sign’?

A

Lie the patient on the normal side and hyperextend the affected hip. This should elicit pain as the psoas muscle is stretched.

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25
Q

How does a splenectomy affect RBC lifespan?

A

Causes an increase in RBC lifespan (and therefore falsely high HbA1c)

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26
Q

What is the most common cause of septic arthritis:

a) overall
b) in young sexually active adults

A

a) Staph. aureus
b) Neisseria gonorrhoea

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27
Q

Mx of renal stones:

a) <5mm and symptomatic
b) 5-10mm
c) 10-20mm
d) >20mm

A

a) watchful waiting

b) shockwave lithotripsy

c) shockwave lithotripsy OR ureteroscopy

d) percutaneous nephrolithotom

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28
Q

Mx of ureteric stones:

a) <10mm
b) 10-20mm?

A

a) shockwave lithotripsy +/- alpha blockers

b) ureteroscopy

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29
Q

What classification can be used in ankle fractures?

A

Weber classification

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30
Q

What is the Weber classification dependent on?

A

Related to the level of the fibular fracture.

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31
Q

Give the 3 types of Weber classification for ankle fractures

A

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

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32
Q

Mx of all ankle fractures?

A

All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis

33
Q

Mx of Weber A fractures?

A

Patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot for 6 weeks

34
Q

Bone profile results in 2ary hyperparathyroidism (2ary to CKD)?

A
  • low calcium
  • high phosphate
  • high PTH
  • high ALP
35
Q

What is ALP a marker of?

A

Bone turnover

36
Q

What is the pathological cause of 2ary hyperparathyroidism in CKD?

A

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.

37
Q

Following an SAH, how are most intracranial aneurysms treated?

A

Coiling by an interventional radiologist

38
Q

Target INR for mechanical valves:

a) aortic valves

b) mitral valves

A

a) 3.0
b) 3.5

39
Q

Abx mx of exacerbations of chronic bronchitis?

A

Amoxicillin or tetracycline or clarithromycin

40
Q

Mx of uncomplicated CAP?

A

Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. in influenza)

41
Q

Mx of pneumonia possibly caused by atypical pathogens?

A

Clarithromycin

42
Q

Mx of HAP:

a) <5 days of admission
b) >5 days after admission

A

a) co-amoxiclav or cefuroxime

b) piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

43
Q

Investigation results in Wilson’s?

A

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

44
Q

What should be used to treat acute gout if NSAIDs are contraindicated for example a peptic ulcer?

A

Colchicine

45
Q

Role of FAST scans?

A

Can be used to assess the presence of free fluid in the abdomen and thorax

46
Q

Describe the two-level DVT Wells score

A

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)

47
Q

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

A

If dietary intake is inadequate

48
Q

Which nerve root compression results in intact knee & ankle reflexes?

A

L5

49
Q

Mx of discoid lupus erythematous?

A

1st line –> topical steroids

2nd line –> oral hydroxychloroquine

50
Q

Mx of superficial thrombophlebitis?

A

Compression stockings (once arterial insufficiency has been excluded)

51
Q

Features of ACL rupture?

A
  • sudden popping sound
  • knee swelling
  • instability, feeling that knee will give way
52
Q

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

A

Due to the increased risk of perforation on entering the abdomen

53
Q

What is the intervention of choice for severe mitral stenosis?

A

Percutaneous mitral commissurotomy

54
Q

What is an lternative to metronidazole for patients with bacterial vaginosis?

A

Topical clindamycin cream

55
Q

In the mx of pneumothorax, what are some high-risk characteristics that determine the need for a chest drain?

A

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

56
Q

Role of a cystogram?

A

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.

57
Q

What % of shoulder dislocations do anterior dislocations account for?

A

> 95% cases

58
Q

Location of the humeral head in an anterior shoulder dislocation?

A

Usually lies in the subcoracoid position

59
Q

Which 2 types of renal stones are radio-lucent on XR?

A

1) urate
2) xanthine stones

60
Q

Which type of renal stone is semi-opaque on XR?

A

Cystine

61
Q

Prevalence vs incidence in chronic vs acute disease?

A

Chronic: prevalence > incidence

Acute: incidence > prevalence

62
Q

Why is incidence > prevalence in acute disease?

A

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.

63
Q

Cause of urinary problems in a man with a history of gonorrhoea?

A

May be due to a urinary stricture

64
Q

What is typically the best long-term feeding option in awake patients?

A

PEG

65
Q

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?

A

Either:
- long acting nitrate
- ivabradine
- nicorandil
- or ranolazine

66
Q

Define power

A

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).

67
Q

How can you increase the power of a study (the ability to detect the difference)?

A

Increase sample size (this will also reduce type II error)

68
Q

Of organic causes of erectile dysfunction, what is the most common?

A

Vascular causes

69
Q

When can you consider stopping anti-epileptics?

A

If seizure free >2 years, slowly stop anti-epileptics over 2-3 months

70
Q

What artery is affected in Weber’s syndrome?

A

Branches of the posterior cerebral artery that supply the midbrain

71
Q

What is a differential for ST-elevation in someone with no obstructive coronary artery disease?

A

Takotsubo cardiomyopathy –> cardiomyopathy induced by severe stressful triggers (e.g. emotional upset)

72
Q

Impact of taking azathioprine & allopurinol together?

A

They are both inhibitors of xanthine oxidase –> bone marrow suppression

73
Q

Dose of adrenaline in ALS?

A

1:10,000 1mg

74
Q

Signs seen in a scaphoid fracture?

A
  1. Point of maximal tenderness over the anatomical snuffbox
  2. Wrist joint effusion
  3. Pain elicited by telescoping of the thumb (pain on longitudinal compression)
  4. Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
  5. Pain on ulnar deviation of the wrist
75
Q

What 1st line imaging is indicated in a scaphoid fracture?

A

Plain film radiographs of the wrist in the AP and lateral view

76
Q

What is considered the definite investigation to confirm or exclude a diagnosis?

A

MRI

77
Q

What is CREST syndrome?

A

A subtype of limited systemic sclerosis and includes:
1) calcinosis
2) Raynaud’s phenomenon
3) oesophageal dysmotility
4) sclerodactyly
5) telangiectasia

78
Q

How can a diagnosis of ankylosing spondylitis be best supported?

A

Sacro-ilitis on a pelvic XR

79
Q
A

Yr 5 - Passmed Corrections (7 decks)

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