Corrections 7 Flashcards
Systemic vascular resistance in septic shock?
Low
What are the main indications for placing a chest tube in suspected pleural infection? (3)
1) Patients with frankly purulent or turbid/cloudy pleural fluid on sampling
2) The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample
3) Pleural fluid pH <7.2 in patients with suspected pleural infection
What is the treatment of choice for small bowel overgrowth syndrome?
Rifaximin
What are the most common medications assoicated with erythema nodosum?
1) penicillins
2) sulfonamides e.g. sulfalazine
3) COCP
What type of diabetes insipidus can CKD cause?
Nephrogenic
What is oral (pollen) allergy syndrome?
A hypersensitivity reaction to raw plant-based foods which usually causes rapid onset of mild symptoms such as itching.
It is strongly linked with pollen allergies and presents with seasonal variation.
In DIC, what blood products should be given 1st?
FFP and cryoprecipitate may be given whilst awaiting the results of the coagulation studies.
Mx of euvolemic and hypervolemic hyponatraemic patients who don’t have severe symptoms?
Fluid restriction
What are some causes of a false-negative Mantoux test?
1) Immunosuppression e.g. miliary TB, AIDS, steroids
2) Sarcoidosis
3) Lymphoma
4) Extremes of age
5) Fever
6) Hypoalbuminaemia, anaemia
Mx of APS in pregnancy?
1) low dose aspirin: commenced once the pregnancy is confirmed on urine testing
2) LMWH: once a fetal heart is seen on US
The mean +/- 2 standard deviations contains what % of the values?
95.4%
what is De Quervain’s tenosynovitis?
A common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
Features of De Quervain’s tenosynovitis?
1) pain on the radial side of the wrist
2) tenderness over the radial styloid process
3) abduction of the thumb against resistance is painful
What test can be used in the dx of De Quervain’s tenosynovitis?
Finkelstein’s test
The examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus.
What is iliotibial band syndrome?
A common cause of lateral knee pain, particularly in runners.
Features: tenderness 2-3cm above the lateral joint line
What is the most common type of renal stone?
Calcium oxalate
CT features in SAH?
Acute blood in the basal cisterns, sulci, fissures, and in severe cases the ventricular system.
Echo findings in Takotsubo cardiomyopathy?
Apical ballooning of the myocardium (resembling an octopus pot)
What is the ECG finding of deeply inverted or biphasic waves in V2-3 in a person with the previous history of angina is characteristic of?
Wellen’s syndrome.
This is highly specific for a critical stenosis of the LAD artery.
In the 1ary prevention of CVD, the use of statins aims for what % reduction in non-HDL cholesterol?
> 40%
What is the imaging of choice in suspected renal colic?
Non-contrast CT-KUB
Mx of inguinal vs umbilical hernias in paeds?
Inguinal: repair ASAP
Umbilical: manage conservatively (most resolve by age 4-5y)
What is cryptosporidium?
A protozoan parasite
Most common cause of diarrhoea in an HIV patient
Amitriptyline vs duloxetine in eGFR <30?
Amitriptyline > duloxetine
Location of narrowing in adult coarctation of the aorta?
Just distal to the origin of the L subclavian artery.
What is granulomatosis with polyangiitis (GPA)?
Small and medium sized blood vessel vasculitis.
It is an ANCA-associated systemic vasculitis.
What triad of features is seen in GPA?
1) URT: sinusitis, epistaxis, nasal crusting, saddle nose deformity
2) LRT: SOB, cough, haemoptysis, pulmonary nodules
3) Glomerulonephritis: microscopic haematuria
What ocular manifestation can GPA cause?
Scleritis/episcleritis
What antibody is positive in >90% of patients with GPA?
cANCA (pANCA is positive in 25%)
PTH level in sarcoidosis?
Suppressed (due to hypercalcaemia)
Hypercalcaemia is 2ary to increased vitamin D activation
What is impetigo?
A superficial bacterial skin infection caused by Staph. aureus or Strep. pyogenes (GAS).
Can be a 1ary infection or a complication of an existing skin condition e.g. eczema, scabies, insect bites.
Spread of impetigo?
Direct contact with discharges from the scabs of an infected person.
Features of impetigo?
- ‘golden’, crusted skin lesions typically found around the mouth
- very contagious
Mx of limited, localised impetigo?
Hydrogen peroxide 1% cream –> for people who are not systemically unwell or at a high risk of complications.
Mx of extensive/systemic imeptigo?
oral flucloxacillin (or erythromycin if penicillin allergic)
School exclusion in impetigo?
until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
What are the 2 types of impetigo?
1) bullous
2) non-bullous (most common)
When should you offer a referral for bariatric surgery assessment?
1) BMI ≥40
or
2) BMI ≥35 with comorbidies e.g. OA, diabetes, HTN (that would improve with bariatric surgery)
What surgery is indicated in chronic distal aortic & bilateral common iliac occlusive disease?
Aorto-bifemoral bypass graft
What are 3 options for restoration of blood flow to the affected limb in limb ischaemia?
Revascularisation processes:
1) thrombolysis
2) angioplasty
3) surgical bypass
Folliculitis can be a symptom of what condition?
Advanced HIV
What is the usual limit for termination of pregnancy?
24 weeks
Define idealist health theory
Suggests that individual’s construction of health is different in different groups, so they might define health differently
1st line mx of pelvic organ prolapse?
Conservative: weight loss 7 pelvic floor exercises
Formula for number needed to treat?
NNT = 1/absolute risk reduction
Formula for absolute risk reduction?
ARR = risk in control group - risk in treatment group
Under what age are tetracyclines (e.g. doxycycline) contraindicated?
<12 y/o due to tooth discolouration
Continuous vs discrete vs nominal vs categorical variables?
Continuous: Can take any value within a range of values (e.g. 18.5 to 50 in BMI)
Discrete: can only take certain values e.g. number of children (1, 2, 3)
Categorical: can be grouped into categories e.g. blood type, race
Nominal: have no intrinsic order or ranking e.g. hair colour, occupation
Mx of a submassive PE in patients at risk of haemorrhage (e.g. peptic ulcer disease)?
IV heparin –> can be stopped and reversed in the event of recurrent bleeding.
When there is a unilateral sensorineural hearing loss, what is it vital to rule out?
Presence of a vestibular schwannoma or other neoplasma of VIII nerve or brainstem.
Get an MRI scan of the interal acoustic meatus.
What is the method for confirming norovirus?
Stool PCR
Mx of hypoglycaemia:
1) In patients who are conscious, orientated & able to swallow (mild)
2) In patients who are conscious and able to swallow but are confused, disorientated or aggressive (moderate)
3) In patients who are unconscious/fitting or very aggressive or NBM (severe)
1) Glucose tablets
2) Glucogel
3) IV glucose 75ml 20%
What investigation is regularly required in Guillain-Barre?
FVC to monitor respiratory function
Mx of TIA in patients already taking low dose aspirin?
Advise them to take as normal - do NOT give 300mg aspirin
Why are steroids given in a thyroid storm?
Steroids reduce the conversion of T4 to T3
1st line imaging in PAD?
Duplex US
What investigation should be performed prior to any intervention in PAD?
magnetic resonance angiography (MRA)
What medication can reduce renal complications in systemic sclerosis?
ACEi (preferably captopril)
Features of Strep. pneumoniae pneumonia?
- rapid onset
- high fever
- pleuritic chest pain
- herpes labialis (cold sores)
What types of pneumonia can cause cavitating lesions?
- Klebsiella
- Staph. aureus
What may be a useful treatment for keloid scarring?
Intra-lesional steroids
1st line mx of acute pericarditis?
NSAIDs & colchicine
Diagnosis of shingles?
Clinical
What should be added in the mx of diabetes if CVD, high-risk of CVD or chronic heart failure?
SGLT-2 inhibitors
What may posterior shoulder dislocations be associated with?
- electricution
- seizures
What structure is divided in surgical management of carpal tunnel syndrome?
Flexor retinaculum
Mx of myasthenia crisis?
IVIG & plasmapheresis
In valve replacement, at what age are you typically given a bioprosthetic vs mechanical valve?
> 65 y/o for aortic and >70 y/o for mitral valves –> bioprosthetic
Younger patients typically receive a mechanical valve.
Do port wine stains (birthmarks) typically resolve?
No
Often darken and become raised over tim
New asthma guidelines (2024):
- Low dose ICS/formoterol combination inhaler used as needed
- Regular low dose ICS/formoterol combination inhlaer (MART)
- Regular moderate-dose MART
- Check FeNO and eosinophil levels:
a) if either raised –> refer to asthma specialist
b) if neither raised –> consider LTRA or LAMA in addition to moderate dose MART - Refer to asthma specialist
When should treatment be offered in subclinical hypothyroidism?
If TSH level is 5.5-10mU/L –> offer patients <65 y/o a 6 month trial of levothyroxine if TSH remains at that level on 2 separate occasions 3 months apart and they have hypothyroidism symptoms.
