Day 1 Flashcards
1
Q
What level must the injury occur to cause autonomic dysreflexia?
A
Above T6 Level
2
Q
What are the signs of autonomic dysreflexia?
A
Extreme hypertension
Flushing & sweating
Agitation
Haemorrhagic stroke
3
Q
How is autonomic dysreflexia treated?
A
Removal/control of stimulus and treatment of life threatening hypertension and/or bradycardia
4
Q
What can thiazide diuretics cause?
A
Hypercalcaemia and hypocalciuria
5
Q
How do thiazide diuretics work?
A
Inhibiting sodium reabsorption in the beginning of the distal convoluted tubule by blocking NA-Cl symporter
6
Q
Which drugs can cause urinary retention?
A
- tricyclic antidepressants e.g. amitriptyline
- anticholinergics
- opioids
- NSAIDs
- disopyramide
7
Q
What would you expect with an ABPI of 1.0-1.2
A
Normal
8
Q
What would you expect with an ABPI of <0.9
A
Severe disease, refer urgently
9
Q
ABPI >1.2
A
Calcified, stiff arteries
10
Q
ABPI 0.3
A
Critical limb ischaemia
11
Q
ABPI 0.5
A
Hyperaemic changes and ulceration
12
Q
Steps for managing asthma
A
- SABA
- SABA + Low dose inhaled ICS
- SABA + Low dose inhaled ICS + LTRA
- SABA has + ICS +LABA, continue LTRA
- SABA +/- LTRA switch ICS/LABA for maintenance and reliever, that includes ICA
- SABA +/- LTRA + medium dose ICS MART
- SABA + LTRA
13
Q
What is the most common renal tumour?
A
Renal adenocarcinoma
14
Q
Where does renal carcinoma affect?
A
Renal parenchyma
15
Q
Where does transitional cell carcinoma affect?
A
urothelial surfaces
16
Q
How do renal adenocarciomas affect other systems?
A
Cannon ball mets in lungs causing haemoptysis
17
Q
What is bechet’s syndrome?
A
Auto-immune inflammation of vessels.
- oral ulcers
- genital ulcers
- anterior uveitis
18
Q
Elderly female with unquenchable thirst and inappropriately raised PTH
A
solitary adenoma causing primary hyperparathyroidism
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
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
21
Q
Depigmentation + loss of sensation
A
Leprosy
22
Q
The vast majority of cases of bacterial endocarditis are caused by….
A
gram positive cocci.
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
24
Q
Kallman’s syndrome -
A
LH & FSH low-normal
25
What causes kallmans?
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.
26
What causes Androgen insensitivity syndrome?
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.
27
Kleinfelter would show
High FSH & LH with low testosterone
28
Meningitis in children < 3 months
give IV amoxicillin in addition to cefotaxime to cover for Listeria
29
Meningitis in children > 3 months
IV cefotaxime
30
3rd generation OCP _____ risk of VTE
Increases
31
hormone replacement therapy: the risk of VTE is _____ in women taking oestrogen + progestogen preparations compared to those taking oestrogen-only preparations
higher
32
Ciclosporin can cause
Nephrotoxicity
33
How does ciclosporin work?
Decreases clonal proliferation of T cells by reducing IL-2 release, binds to cyclophilin forming a complex which inhibits calcineurin
34
What can cyclizine precipitate?
Fall in Cardiac Output
35
How does cyclizine work?
H1-receptor
36
The person with epilepsy may qualify for a driving licence if they have been free from any seizure for ____
1 year
37
If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity .....
medical treatment can be tried (e.g. IUS, tranexamic acid, COCP etc)
38
Offer _____ or _____ as first-line treatment to children, young people and adults with newly diagnosed focal seizures.'
Offer carbamazepine or lamotrigine as first-line treatment to children, young people and adults with newly diagnosed focal seizures.'
39
Offer ______ if sodium valproate is unsuitable
Offer lamotrigine if sodium valproate is unsuitable
40
Offer _______ or sodium valproate as first-line treatment to children, young people and adults with absence seizures.'
Offer ethosuximide or sodium valproate as first-line treatment to children, young people and adults with absence seizures.'
41
ITP is a type _ immune reaction
2- antibody mediated
| defective B cells produced IgM or IgG antibodies that directly attack host antigens
42
How to monitor standard heparin
APTT
43
How to monitor LMWH
Anti-factor Xa
44
Minimal change disease nearly always presents as ......
nephrotic syndrome
45
Prognosis of minimal change disease
- 1/3 have just one episode
- 1/3 have infrequent relapses
- 1/3 have frequent relapses which stop before adulthood
46
Osteoarthritis pain management
paracetamol + topical NSAIDs (if knee/hand) first-line
47
10 weeks pregnant, hypertensive, potassium 2.9
Primary hyperaldosteronism
48
Small testes and precocious puberty indicate
Adrenal cause of symptoms
49
What is precocious puberty?
development of secondary sexual characteristics before 8 years in females and 9 years in males
50
An astrocytoma or any other form of brain tumour would cause central precocious puberty and this would cause .......
bilateral testicular enlargement
51
Testotoxicosis would cause advanced development in all areas and would be associated with a history of .......
sexual aggression during childhood
52
A sex cord-gonadal stromal tumour would cause .....
unilateral enlargement of the affected testicle
53
An idiopathic cause of precocious puberty would cause ....
advanced development in all areas of pubertal development and thus the testicles would be enlarged.
54
The 'snowstorm' sign on ultrasound of axillary lymph nodes indicates
extracapsular breast implant rupture.
55
Following referral to ENT, patients with sudden-onset sensorineural hearing loss .....
are treated with high-dose oral corticosteroids
56
How does carbamazepine work?
Carbamazepine is a P450 enzyme inductor
| Be wary of COCP use
57
The major risk factors for SIDS are:
```
prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity
```
58
If a patient declines the offer of a chaperone then you should...
fully document this and their reasons for refusal but this does not mean you should not examine them
59
Croup management
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
Emergency treatment of croup
high-flow oxygen
| nebulised adrenaline
61
_______are first-line in patients with benign prostatic hyperplasia
Alpha-1 antagonists
62
_____ is the most common cause of type 2 necrotising fasciitis
Streptococcus pyogenes
63
Hepatocellular carcinoma is commonly diagnosed with ......
imaging and an elevated alpha fetoprotein
64
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) ______
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
If fibrinolysis is given for an ACS, an ECG should be repeated after _______
60-90 minutes
66
Panic attacks can result in respiratory.....
Alkalosis with low CO2, normal O2 and normal HCO3. Hypocalcaemia can develop secondary to this.
67
Pyridostigmine is a....
long-acting acetylcholinesterase inhibitor
reduces the breakdown of acetylcholine in neuromuscular junction,
temporarily improving symptoms of myasthenia gravis
68
After an initial negative result when testing for HIV in an asymptomatic patient, offer.....
a repeat test at 12 weeks
69
For resuscitation, the NICE guidelines advocate 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
.......are the treatment of choice for allergic bronchopulmonary aspergillosis
Oral glucocorticoids
71
Spinal cord transection after trauma can present with ______
neurogenic shock
72
Spinal shock refers to the .....
loss of sensation, motor paralysis, and hyporeflexia seen after some SCIs
73
In hyperkalaemia the first priority is to
stabilise the myocardium with intravenous calcium gluconate.
74
6 months - 6 years adrenaline dose for anaphylaxis....
150 mcg (0.15ml 1 in 1,000)
75
At what age would the average child acquire the ability to crawl?
9 months
76
________commonly presents desaturation on exertion and often Chest x-ray appears normal
Pneumocystis jiroveci
77
which blood product is most likely to cause an iatrogenic septicaemia with a Gram-positive organism?
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
which blood product is most likely to cause an iatrogenic septicaemia with a Gram-negative organism?
packed red cells as these are stored at 4 degrees.
79
______ are recommended for superficial thrombophlebitis
Compression stockings
80
Hypomagnesaemia: IV magnesium is usually given if .....
<0.4 mmol/L or tetany, arrhythmias, or seizures
81
In 2018 NICE updated their rheumatoid arthritis guidelines. They now recommend ......
disease-modifying antirheumatic drug (DMARD) monotherapy with a short-course of bridging prednisolone.
82
Joint aspirate in rheumatoid arthritis shows a ____ WBC count, predominantly ____. Appearance is typically ____ and _____ with absence of crystals
Joint aspirate in rheumatoid arthritis shows a high WBC count, predominantly PMNs. Appearance is typically yellow and cloudy with absence of crystals
83
When dealing with heart failure not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy, a widened QRS complex favours ______
cardiac resynchronisation therapy
84
important side effects of thiazide-like diuretics such as indapamide
Sexual dysfunction
85
Blood stained nipple discharge is most likely to be associated with a ____
papilloma
86
Notching of the inferior border of the ribs is present in around 70% of adults with ________
coarctation of the aorta
87
Acute tubular necrosis occurs secondary to _______.
nephrotoxic agents ofr renal ischaemia.
88
Lewy body dementia typically presents with _____- in contrast to other forms of dementia
fluctuating cognition
89
Thiazides can _____ glucose tolerance
worsen
90
Features of essential tremor and management
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
Side effects of ACEi
cough + hyperkalaemia
92
Genital ulcers
painful: ?
painless: ?
painful= herpes much more common than chancroid
painless= syphilis more common than lymphogranuloma venereum
93
_____ is a common causative agent for ascending cholangitis
e. coli
94
Globus pharyngis (also known as globus hystericus) is the_____.
persistent sensation of having a 'lump in the throat', when there is none.
95
_______ may be a useful investigation in clinically unstable patients with a suspected aortic dissection
Transoesophageal echocardiography (TOE)
96
If patients have persistent myocardial ischaemia following fibrinolysis then .......
PCI should be considered
97
______ is an adverse effect that is associated with thiazide diuretics.
Hyponatraemia
98
When prescribing fluids, the potassium requirement per day is ....
1 mmol/kg/day
99
Contraindications to thrombolysis
```
>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
Children under 3 months with a suspected UTI should be .....
referred to specialist paediatrics services
101
Cushing's syndrome ____
hypokalaemic metabolic alkalosis
102
_________ are typically spared in motor neurone disease
Eye movements
103
Gentamicin adverse affects
ototoxicity + nephrotoxicity
104
As per NICE guidelines; the following would warrant continuous CTG monitoring if any of the following are present or arise during labour;
> 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
Infertile men are ..... testicular cancer
three times more likely to develop
106
.......... are first-line treatment for prolactinomas, even if there are significant neurological complications
Dopamine agonists (e.g. cabergoline, bromocriptine)
