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Finals Revision > Day 1 > Flashcards

Day 1 Flashcards

1
Q

What level must the injury occur to cause autonomic dysreflexia?

A

Above T6 Level

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2
Q

What are the signs of autonomic dysreflexia?

A

Extreme hypertension
Flushing & sweating
Agitation
Haemorrhagic stroke

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3
Q

How is autonomic dysreflexia treated?

A

Removal/control of stimulus and treatment of life threatening hypertension and/or bradycardia

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4
Q

What can thiazide diuretics cause?

A

Hypercalcaemia and hypocalciuria

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5
Q

How do thiazide diuretics work?

A

Inhibiting sodium reabsorption in the beginning of the distal convoluted tubule by blocking NA-Cl symporter

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6
Q

Which drugs can cause urinary retention?

A
  • tricyclic antidepressants e.g. amitriptyline
  • anticholinergics
  • opioids
  • NSAIDs
  • disopyramide
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7
Q

What would you expect with an ABPI of 1.0-1.2

A

Normal

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8
Q

What would you expect with an ABPI of <0.9

A

Severe disease, refer urgently

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9
Q

ABPI >1.2

A

Calcified, stiff arteries

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10
Q

ABPI 0.3

A

Critical limb ischaemia

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11
Q

ABPI 0.5

A

Hyperaemic changes and ulceration

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12
Q

Steps for managing asthma

A
  1. SABA
  2. SABA + Low dose inhaled ICS
  3. SABA + Low dose inhaled ICS + LTRA
  4. SABA has + ICS +LABA, continue LTRA
  5. SABA +/- LTRA switch ICS/LABA for maintenance and reliever, that includes ICA
  6. SABA +/- LTRA + medium dose ICS MART
  7. SABA + LTRA
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13
Q

What is the most common renal tumour?

A

Renal adenocarcinoma

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14
Q

Where does renal carcinoma affect?

A

Renal parenchyma

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15
Q

Where does transitional cell carcinoma affect?

A

urothelial surfaces

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16
Q

How do renal adenocarciomas affect other systems?

A

Cannon ball mets in lungs causing haemoptysis

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17
Q

What is bechet’s syndrome?

A

Auto-immune inflammation of vessels.

  1. oral ulcers
  2. genital ulcers
  3. anterior uveitis
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18
Q

Elderly female with unquenchable thirst and inappropriately raised PTH

A

solitary adenoma causing primary hyperparathyroidism

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19
Q

Management of an acute anal fissure (< 1 week)

A

-soften stool
-dietary advice: high-fibre diet with high fluid intake
- bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
- lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics
analgesia

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20
Q

Management of a chronic anal fissure

A

the above techniques should be continued
-topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin

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21
Q

Depigmentation + loss of sensation

A

Leprosy

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22
Q

The vast majority of cases of bacterial endocarditis are caused by….

A

gram positive cocci.

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23
Q

INR > 8.0 (minor bleeding) -

A

stop warfarin, give intravenous vitamin K 1-3mg, repeat dose of vitamin K if INR high after 24 hours, restart when INR < 5.0

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24
Q

Kallman’s syndrome -

A

LH & FSH low-normal

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25
Q

What causes kallmans?

A

failure of gonadotropin-releasing hormone (GnRH) secreting neurons migrating to the hypothalamus. It results in hypogonadotropic hypogonadism. Therefore, hormone profile will show a low testosterone and a low/ inappropriately normal LH and FSH. It presents with delayed puberty and anosmia in a male, who may be normal or above average height.

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26
Q

What causes Androgen insensitivity syndrome?

A

X-linked recessive condition, resulting in an overall resistance to testosterone. The patient will have a male karyotype (46XY) with an external female phenotype. External female genitalia will be present and breasts may develop at puberty, due to the conversion of testosterone to oestradiol. However, there will be no internal female organs, and testicles will be present in the abdomen (potentially causing a groin swelling). If not identified at birth, it can present with primary amenorrhoea.

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27
Q

Kleinfelter would show

A

High FSH & LH with low testosterone

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28
Q

Meningitis in children < 3 months

A

give IV amoxicillin in addition to cefotaxime to cover for Listeria

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29
Q

Meningitis in children > 3 months

A

IV cefotaxime

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30
Q

3rd generation OCP _____ risk of VTE

A

Increases

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31
Q

hormone replacement therapy: the risk of VTE is _____ in women taking oestrogen + progestogen preparations compared to those taking oestrogen-only preparations

A

higher

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32
Q

Ciclosporin can cause

A

Nephrotoxicity

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33
Q

How does ciclosporin work?

A

Decreases clonal proliferation of T cells by reducing IL-2 release, binds to cyclophilin forming a complex which inhibits calcineurin

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34
Q

What can cyclizine precipitate?

A

Fall in Cardiac Output

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35
Q

How does cyclizine work?

A

H1-receptor

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36
Q

The person with epilepsy may qualify for a driving licence if they have been free from any seizure for ____

A

1 year

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37
Q

If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity …..

A

medical treatment can be tried (e.g. IUS, tranexamic acid, COCP etc)

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38
Q

Offer _____ or _____ as first-line treatment to children, young people and adults with newly diagnosed focal seizures.’

A

Offer carbamazepine or lamotrigine as first-line treatment to children, young people and adults with newly diagnosed focal seizures.’

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39
Q

Offer ______ if sodium valproate is unsuitable

A

Offer lamotrigine if sodium valproate is unsuitable

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40
Q

Offer _______ or sodium valproate as first-line treatment to children, young people and adults with absence seizures.’

A

Offer ethosuximide or sodium valproate as first-line treatment to children, young people and adults with absence seizures.’

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41
Q

ITP is a type _ immune reaction

A

2- antibody mediated

defective B cells produced IgM or IgG antibodies that directly attack host antigens

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42
Q

How to monitor standard heparin

A

APTT

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43
Q

How to monitor LMWH

A

Anti-factor Xa

44
Q

Minimal change disease nearly always presents as ……

A

nephrotic syndrome

45
Q

Prognosis of minimal change disease

A
  • 1/3 have just one episode
  • 1/3 have infrequent relapses
  • 1/3 have frequent relapses which stop before adulthood
46
Q

Osteoarthritis pain management

A

paracetamol + topical NSAIDs (if knee/hand) first-line

47
Q

10 weeks pregnant, hypertensive, potassium 2.9

A

Primary hyperaldosteronism

48
Q

Small testes and precocious puberty indicate

A

Adrenal cause of symptoms

49
Q

What is precocious puberty?

A

development of secondary sexual characteristics before 8 years in females and 9 years in males

50
Q

An astrocytoma or any other form of brain tumour would cause central precocious puberty and this would cause …….

A

bilateral testicular enlargement

51
Q

Testotoxicosis would cause advanced development in all areas and would be associated with a history of …….

A

sexual aggression during childhood

52
Q

A sex cord-gonadal stromal tumour would cause …..

A

unilateral enlargement of the affected testicle

53
Q

An idiopathic cause of precocious puberty would cause ….

A

advanced development in all areas of pubertal development and thus the testicles would be enlarged.

54
Q

The ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicates

A

extracapsular breast implant rupture.

55
Q

Following referral to ENT, patients with sudden-onset sensorineural hearing loss …..

A

are treated with high-dose oral corticosteroids

56
Q

How does carbamazepine work?

A

Carbamazepine is a P450 enzyme inductor

Be wary of COCP use

57
Q

The major risk factors for SIDS are:

A 
prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity
58
Q

If a patient declines the offer of a chaperone then you should…

A

fully document this and their reasons for refusal but this does not mean you should not examine them

59
Q

Croup management

A

A single dose of oral dexamethasone (0.15 mg/kg) is to be taken immediately regardless of severity
-prednisolone is an alternative if dexamethasone is not available

60
Q

Emergency treatment of croup

A

high-flow oxygen

nebulised adrenaline

61
Q

_______are first-line in patients with benign prostatic hyperplasia

A

Alpha-1 antagonists

62
Q

_____ is the most common cause of type 2 necrotising fasciitis

A

Streptococcus pyogenes

63
Q

Hepatocellular carcinoma is commonly diagnosed with ……

A

imaging and an elevated alpha fetoprotein

64
Q

Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In organic paresis, the contralateral leg will ____ due to ______ when attempt is made to lift paralysed leg.

In non-organic (e.g. conversion disorder) ______

A

Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In organic paresis, the contralateral leg will contract due to involuntary hip extension when attempt is made to lift paralysed leg.

In non-organic (e.g. conversion disorder) no contraleteral contraction is felt

65
Q

If fibrinolysis is given for an ACS, an ECG should be repeated after _______

A

60-90 minutes

66
Q

Panic attacks can result in respiratory…..

A

Alkalosis with low CO2, normal O2 and normal HCO3. Hypocalcaemia can develop secondary to this.

67
Q

Pyridostigmine is a….

A

long-acting acetylcholinesterase inhibitor

reduces the breakdown of acetylcholine in neuromuscular junction,

temporarily improving symptoms of myasthenia gravis

68
Q

After an initial negative result when testing for HIV in an asymptomatic patient, offer…..

A

a repeat test at 12 weeks

69
Q

For resuscitation, the NICE guidelines advocate a ____

A

crystalloid that contain sodium in the range 130 to 154 mmol/l, with a bolus of 500 ml over no more than 15 minutes.

70
Q

…….are the treatment of choice for allergic bronchopulmonary aspergillosis

A

Oral glucocorticoids

71
Q

Spinal cord transection after trauma can present with ______

A

neurogenic shock

72
Q

Spinal shock refers to the …..

A

loss of sensation, motor paralysis, and hyporeflexia seen after some SCIs

73
Q

In hyperkalaemia the first priority is to

A

stabilise the myocardium with intravenous calcium gluconate.

74
Q

6 months - 6 years adrenaline dose for anaphylaxis….

A

150 mcg (0.15ml 1 in 1,000)

75
Q

At what age would the average child acquire the ability to crawl?

A

9 months

76
Q

________commonly presents desaturation on exertion and often Chest x-ray appears normal

A

Pneumocystis jiroveci

77
Q

which blood product is most likely to cause an iatrogenic septicaemia with a Gram-positive organism?

A

Platelets are stored at room temperature and must be used soon after collection. This places them at increased risk of culturing gram positive organisms.

78
Q

which blood product is most likely to cause an iatrogenic septicaemia with a Gram-negative organism?

A

packed red cells as these are stored at 4 degrees.

79
Q

______ are recommended for superficial thrombophlebitis

A

Compression stockings

80
Q

Hypomagnesaemia: IV magnesium is usually given if …..

A

<0.4 mmol/L or tetany, arrhythmias, or seizures

81
Q

In 2018 NICE updated their rheumatoid arthritis guidelines. They now recommend ……

A

disease-modifying antirheumatic drug (DMARD) monotherapy with a short-course of bridging prednisolone.

82
Q

Joint aspirate in rheumatoid arthritis shows a ____ WBC count, predominantly ____. Appearance is typically ____ and _____ with absence of crystals

A

Joint aspirate in rheumatoid arthritis shows a high WBC count, predominantly PMNs. Appearance is typically yellow and cloudy with absence of crystals

83
Q

When dealing with heart failure not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy, a widened QRS complex favours ______

A

cardiac resynchronisation therapy

84
Q

important side effects of thiazide-like diuretics such as indapamide

A

Sexual dysfunction

85
Q

Blood stained nipple discharge is most likely to be associated with a ____

A

papilloma

86
Q

Notching of the inferior border of the ribs is present in around 70% of adults with ________

A

coarctation of the aorta

87
Q

Acute tubular necrosis occurs secondary to _______.

A

nephrotoxic agents ofr renal ischaemia.

88
Q

Lewy body dementia typically presents with _____- in contrast to other forms of dementia

A

fluctuating cognition

89
Q

Thiazides can _____ glucose tolerance

A

worsen

90
Q

Features of essential tremor and management

A

Features
>postural tremor: worse if arms outstretched
>improved by alcohol and rest
>most common cause of titubation (head tremor)

Management
>propranolol is first-line
?primidone is sometimes used

91
Q

Side effects of ACEi

A

cough + hyperkalaemia

92
Q

Genital ulcers

painful: ?
painless: ?

A

painful= herpes much more common than chancroid

painless= syphilis more common than lymphogranuloma venereum

93
Q

_____ is a common causative agent for ascending cholangitis

A

e. coli

94
Q

Globus pharyngis (also known as globus hystericus) is the_____.

A

persistent sensation of having a ‘lump in the throat’, when there is none.

95
Q

_______ may be a useful investigation in clinically unstable patients with a suspected aortic dissection

A

Transoesophageal echocardiography (TOE)

96
Q

If patients have persistent myocardial ischaemia following fibrinolysis then …….

A

PCI should be considered

97
Q

______ is an adverse effect that is associated with thiazide diuretics.

A

Hyponatraemia

98
Q

When prescribing fluids, the potassium requirement per day is ….

A

1 mmol/kg/day

99
Q

Contraindications to thrombolysis

A 
>active internal bleeding
>recent haemorrhage, >trauma or surgery (including dental extraction)
>coagulation and bleeding disorders
>intracranial neoplasm
>stroke < 3 months
>aortic dissection
>recent head injury
>severe hypertension
100
Q

Children under 3 months with a suspected UTI should be …..

A

referred to specialist paediatrics services

101
Q

Cushing’s syndrome ____

A

hypokalaemic metabolic alkalosis

102
Q

_________ are typically spared in motor neurone disease

A

Eye movements

103
Q

Gentamicin adverse affects

A

ototoxicity + nephrotoxicity

104
Q

As per NICE guidelines; the following would warrant continuous CTG monitoring if any of the following are present or arise during labour;

A

> suspected chorioamnionitis or sepsis, or a temperature of 38°C or above

> severe hypertension 160/110 mmHg or above

> oxytocin use

> the presence of significant meconium

> fresh vaginal bleeding that develops in labour - this was a new point added to the guidelines in 2014

105
Q

Infertile men are ….. testicular cancer

A

three times more likely to develop

106
Q

………. are first-line treatment for prolactinomas, even if there are significant neurological complications

A

Dopamine agonists (e.g. cabergoline, bromocriptine)

Finals Revision (29 decks)

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