Day 1 Flashcards
What level must the injury occur to cause autonomic dysreflexia?
Above T6 Level
What are the signs of autonomic dysreflexia?
Extreme hypertension
Flushing & sweating
Agitation
Haemorrhagic stroke
How is autonomic dysreflexia treated?
Removal/control of stimulus and treatment of life threatening hypertension and/or bradycardia
What can thiazide diuretics cause?
Hypercalcaemia and hypocalciuria
How do thiazide diuretics work?
Inhibiting sodium reabsorption in the beginning of the distal convoluted tubule by blocking NA-Cl symporter
Which drugs can cause urinary retention?
- tricyclic antidepressants e.g. amitriptyline
- anticholinergics
- opioids
- NSAIDs
- disopyramide
What would you expect with an ABPI of 1.0-1.2
Normal
What would you expect with an ABPI of <0.9
Severe disease, refer urgently
ABPI >1.2
Calcified, stiff arteries
ABPI 0.3
Critical limb ischaemia
ABPI 0.5
Hyperaemic changes and ulceration
Steps for managing asthma
- 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
What is the most common renal tumour?
Renal adenocarcinoma
Where does renal carcinoma affect?
Renal parenchyma
Where does transitional cell carcinoma affect?
urothelial surfaces
How do renal adenocarciomas affect other systems?
Cannon ball mets in lungs causing haemoptysis
What is bechet’s syndrome?
Auto-immune inflammation of vessels.
- oral ulcers
- genital ulcers
- anterior uveitis
Elderly female with unquenchable thirst and inappropriately raised PTH
solitary adenoma causing primary hyperparathyroidism
Management of an acute anal fissure (< 1 week)
-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
Management of a chronic anal fissure
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
Depigmentation + loss of sensation
Leprosy
The vast majority of cases of bacterial endocarditis are caused by….
gram positive cocci.
INR > 8.0 (minor bleeding) -
stop warfarin, give intravenous vitamin K 1-3mg, repeat dose of vitamin K if INR high after 24 hours, restart when INR < 5.0
Kallman’s syndrome -
LH & FSH low-normal
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.
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.
Kleinfelter would show
High FSH & LH with low testosterone
Meningitis in children < 3 months
give IV amoxicillin in addition to cefotaxime to cover for Listeria
Meningitis in children > 3 months
IV cefotaxime
3rd generation OCP _____ risk of VTE
Increases
hormone replacement therapy: the risk of VTE is _____ in women taking oestrogen + progestogen preparations compared to those taking oestrogen-only preparations
higher
Ciclosporin can cause
Nephrotoxicity
How does ciclosporin work?
Decreases clonal proliferation of T cells by reducing IL-2 release, binds to cyclophilin forming a complex which inhibits calcineurin
What can cyclizine precipitate?
Fall in Cardiac Output
How does cyclizine work?
H1-receptor
The person with epilepsy may qualify for a driving licence if they have been free from any seizure for ____
1 year
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)
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.’
Offer ______ if sodium valproate is unsuitable
Offer lamotrigine if sodium valproate is unsuitable
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.’
ITP is a type _ immune reaction
2- antibody mediated
defective B cells produced IgM or IgG antibodies that directly attack host antigens
How to monitor standard heparin
APTT
How to monitor LMWH
Anti-factor Xa
Minimal change disease nearly always presents as ……
nephrotic syndrome
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
Osteoarthritis pain management
paracetamol + topical NSAIDs (if knee/hand) first-line
10 weeks pregnant, hypertensive, potassium 2.9
Primary hyperaldosteronism
Small testes and precocious puberty indicate
Adrenal cause of symptoms
What is precocious puberty?
development of secondary sexual characteristics before 8 years in females and 9 years in males
An astrocytoma or any other form of brain tumour would cause central precocious puberty and this would cause …….
bilateral testicular enlargement
Testotoxicosis would cause advanced development in all areas and would be associated with a history of …….
sexual aggression during childhood
A sex cord-gonadal stromal tumour would cause …..
unilateral enlargement of the affected testicle
An idiopathic cause of precocious puberty would cause ….
advanced development in all areas of pubertal development and thus the testicles would be enlarged.
The ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicates
extracapsular breast implant rupture.
Following referral to ENT, patients with sudden-onset sensorineural hearing loss …..
are treated with high-dose oral corticosteroids
How does carbamazepine work?
Carbamazepine is a P450 enzyme inductor
Be wary of COCP use
The major risk factors for SIDS are:
prone sleeping parental smoking bed sharing hyperthermia and head covering prematurity
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
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
Emergency treatment of croup
high-flow oxygen
nebulised adrenaline
_______are first-line in patients with benign prostatic hyperplasia
Alpha-1 antagonists
_____ is the most common cause of type 2 necrotising fasciitis
Streptococcus pyogenes
Hepatocellular carcinoma is commonly diagnosed with ……
imaging and an elevated alpha fetoprotein
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
If fibrinolysis is given for an ACS, an ECG should be repeated after _______
60-90 minutes
Panic attacks can result in respiratory…..
Alkalosis with low CO2, normal O2 and normal HCO3. Hypocalcaemia can develop secondary to this.
Pyridostigmine is a….
long-acting acetylcholinesterase inhibitor
reduces the breakdown of acetylcholine in neuromuscular junction,
temporarily improving symptoms of myasthenia gravis
After an initial negative result when testing for HIV in an asymptomatic patient, offer…..
a repeat test at 12 weeks
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.
…….are the treatment of choice for allergic bronchopulmonary aspergillosis
Oral glucocorticoids
Spinal cord transection after trauma can present with ______
neurogenic shock
Spinal shock refers to the …..
loss of sensation, motor paralysis, and hyporeflexia seen after some SCIs
In hyperkalaemia the first priority is to
stabilise the myocardium with intravenous calcium gluconate.
6 months - 6 years adrenaline dose for anaphylaxis….
150 mcg (0.15ml 1 in 1,000)
At what age would the average child acquire the ability to crawl?
9 months
________commonly presents desaturation on exertion and often Chest x-ray appears normal
Pneumocystis jiroveci
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.
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.
______ are recommended for superficial thrombophlebitis
Compression stockings
Hypomagnesaemia: IV magnesium is usually given if …..
<0.4 mmol/L or tetany, arrhythmias, or seizures
In 2018 NICE updated their rheumatoid arthritis guidelines. They now recommend ……
disease-modifying antirheumatic drug (DMARD) monotherapy with a short-course of bridging prednisolone.
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
When dealing with heart failure not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy, a widened QRS complex favours ______
cardiac resynchronisation therapy
important side effects of thiazide-like diuretics such as indapamide
Sexual dysfunction
Blood stained nipple discharge is most likely to be associated with a ____
papilloma
Notching of the inferior border of the ribs is present in around 70% of adults with ________
coarctation of the aorta
Acute tubular necrosis occurs secondary to _______.
nephrotoxic agents ofr renal ischaemia.
Lewy body dementia typically presents with _____- in contrast to other forms of dementia
fluctuating cognition
Thiazides can _____ glucose tolerance
worsen
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
Side effects of ACEi
cough + hyperkalaemia
Genital ulcers
painful: ?
painless: ?
painful= herpes much more common than chancroid
painless= syphilis more common than lymphogranuloma venereum
_____ is a common causative agent for ascending cholangitis
e. coli
Globus pharyngis (also known as globus hystericus) is the_____.
persistent sensation of having a ‘lump in the throat’, when there is none.
_______ may be a useful investigation in clinically unstable patients with a suspected aortic dissection
Transoesophageal echocardiography (TOE)
If patients have persistent myocardial ischaemia following fibrinolysis then …….
PCI should be considered
______ is an adverse effect that is associated with thiazide diuretics.
Hyponatraemia
When prescribing fluids, the potassium requirement per day is ….
1 mmol/kg/day
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
Children under 3 months with a suspected UTI should be …..
referred to specialist paediatrics services
Cushing’s syndrome ____
hypokalaemic metabolic alkalosis
_________ are typically spared in motor neurone disease
Eye movements
Gentamicin adverse affects
ototoxicity + nephrotoxicity
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
Infertile men are ….. testicular cancer
three times more likely to develop
………. are first-line treatment for prolactinomas, even if there are significant neurological complications
Dopamine agonists (e.g. cabergoline, bromocriptine)
