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Day 2 Flashcards

1
Q

How is an anion gap calculated?

A

(sodium + potassium) - (bicarbonate + chloride)

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2
Q

What is a normal anion gap?

A

8-14 mmol/L

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3
Q

What causes raised anion gap metabolic acidosis?

A
  • lactate : shock, hypoxia
  • ketones: DKA, alcohol
  • urate: renal failure
  • acid poisoning: salicylates, methanol
  • 5-oxoproline : chronic paracetamol use
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4
Q

Causes of a normal anion gap or hyperchloraemic metabolic acidosis

A
  • GI bicarbonate loss: diarrhoea
  • Renal tubular acidosis
  • Drugs: acetazolamide
  • ammonium chloride injection
  • addisons disease
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5
Q

Renal dysfunction can cause a raised?

A

serum natriuretic peptide

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6
Q

What is BNP?

A

Hormone produced by left ventricular myocardium in response to strain

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7
Q

What are the effects of BNP?

A
  • vasodilation
  • diuresis and natriuretic
  • suppresses sympathetic tone and RAAS system
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8
Q

What is the most common cause of superior vena cava obstruction?

A

Small cell lung cancer

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9
Q

What are the features of superior vena cava obstruction?

A
  • dyspnoea
  • swelling of face, neck and arms
  • headache
  • visual disturbance
  • pulseless JVP distension
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10
Q

If a woman vomits within 3 hours of taking levonorgestrel or ulipristal acetate what should she do?

A

Take a 2nd dose of emergency contraception ASAP

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11
Q

Levonogestrel and ulipristal are effective for how many hours?

A 
L= 72
U = 120
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12
Q

Which form fluids is indicated in patients with severe hyponatraemia?

A

Hypertonic saline if less than 120mmol/L

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13
Q

What is the preferred term for trochanteric bursitis?

A

Greater trochanteric pain syndrome

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14
Q

Which drugs can cause SIADH?

A

Carbamazepine, sulfonylureas, SSRIs, tricyclics

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15
Q

How is SIADH characterised?

A

Hyponatraemia secondary to dilutional effects of water retention

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16
Q

How is SIADH managed?

A
  • correction done slowly to prevent pontine myelinolysis
  • fluid restriction
  • demeclocycline
  • ADH receptor antagonists
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17
Q

Which antibiotic should patients with ascities and protein >15g/L be given?

A

Oral ciprofloxacin or norfloxacin as prophylaxis against SBP

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18
Q

How is SBP managed?

A

IV cefotaxime

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19
Q

What antibiotics should be avoided with statins?

A

Macrolides- erythrymycin P450 inhibtor

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20
Q

The gold standard for stopping oral contraceptive pill prior to surgery is…..

A

one month

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21
Q

What are common first presentations of hereditary haemochromatosis?

A

Lethargy and arthralgia

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22
Q

How to confirm diagnosis of haemochromatosis?

A

Serum ferritin

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23
Q

What is 1st line for ank spon?

A

Exercise regimes and NSAIDs

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24
Q

What is the first-line investigation for suspected osteoporotic vertebral fracture?

A

X-ray of spine

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25
Parainfluenza
croup
26
respiratory syncitial virus
bronchiolitis
27
bordetella pertussis
whooping cough
28
Management of angina
1. aspirin and statin 2. sublingual GTN 3. B-blocker, CCB (CCB= verapamil or diltiazem if used as monotherapy) (CCB + B-blocker= nifedipine)
29
How does biliary atresia present?
In the first few weeks of life with jaundice, appetite and growth disturbance - high conjugated bilirubin - hepatomegaly - raised GGT
30
Investigation of narcolepsy
Multiple sleep latency EEG
31
What is associated with narcolepsy
HLA-DR2 | Low levels of orexin
32
Patients with polymyalgia rheumatica typically respond dramatically to _____, failure to do so should prompt consideration of an alternative diagnosis
Patients with polymyalgia rheumatica typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis
33
Antidote for TCA overdose
IV bicarbonate
34
what does any change in vision with thyroid eye disease require?
Referral to eye casualty
35
What must be ruled out before starting azathioprine
thiopurine methyltransferase deficiency (TPMT) before treatment - they need it to metabolise azathioprine
36
What is the investigation for a patient on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA?
CT head
37
What pattern is asbestosis on PFT?
Restrictive
38
What is lynch syndrome?
Autosomal dominant | get colonic and endometrial cancer at young age
39
what is kartagener's syndrome?
The primary problem is of immotile cilia syndrome. When associated with situs inversus Kartagener's syndrome is diagnosed.
40
What tends to be the presenting feature of MEN ii
medulary carcinoma of thyroid
41
What autoantibodies are found in schirmers?
Anti-RO and anti La
42
Suspected PE in pregnant women with a confirmed DVT
treat with LMWH first then investigate to rule in/out
43
Which systolic murmur is louder with inspiration?
Tricuspid regurgitation
44
What is takotsubo cardiomyopathy?
apical ballooning of myocardium (resembling an octopus pot)
45
asthma PEFR < 33%
ITU
46
What can falsely lower BNP?
ACEi, aldosterone antagonists, angiotensin-II receptor antagonists, B-blocker and diuretics
47
What ECG sign is seen in mitral stenosis?
P Mitrale (left atrial hypertrophy)
48
What is the first line investigation in suspected primary hyperaldosteronism?
Plasma aldosterone/renin ratio
49
COPD categories
All post bronchodilator <0.7 Stage 1= FEV1 >80 Stage 2= 50-79 Stage 3= 30-49 Stage 4= >30
50
How does Kaposi's sarcoma present?
Raised purple lesions
51
What can cause membranous glomerulonephtopathy in patients with wilsons disease?
penicillamine
52
What is FSGS associated with?
Heroin and HIV
53
What kind of lung cancer causes cushings syndrome?
Small cell lung carcinoma secreting ACTH
54
How to treat otitis externa in diabetics?
Ciprofloxacin to cover pseudomonas
55
What must be ruled out in status epilepticus?
Hypoxia and hypoglycaemia
56
What should be offered to patients with reduced ejection fraction heart failure?
Annual influenza vaccine and once-only pneumococcal vaccination
57
What medication causes orang tears/urine?
Rifampicin
58
What is used to control rate in AF?
Beta- blockers
59
What is containdicated by nitrates and nicorandil?
PDE 5 inhibitors | sildenafil
60
What do patients who will be taking long term hydrocychoroquine require?
Baseline ophthalmologic examination
61
What is the first step in infant resus?
Dry baby
62
Poorly controlled hypertension, already taking a calcium channel blocker - add ....
an ACE inhibitor or an angiotensin receptor blocker or a thiazide-like diuretic
63
Acute dystonia secondary to antipsychotics is usually managed with
procyclidine
64
Pregnant women with a UTI should be treated with an antibiotic for....
7 days
65
What are the features of ank spon?
the 'A's - Apical fibrosis - Anterior uveitis - Aortic regurgitation - Achilles tendonitis - AV node block - Amyloidosis
66
Post-void volumes
50
67
What can occur in chronic myeloid leukaemia?
thrombocytosis
68
Cushings syndrome causes what findings on blood gas?
Hypokalaemic metabolic alkalosis | Excess aldosterone which increases acid and potassium excretion in the kidney
69
All patients with non-ST elevation myocardial infarction should receive ....
300mg aspirin
70
Dysphagia affecting both solids and liquids from the start
achalasia
71
Patients with a BMI that classifies them as morbidly obese (> 40) are grade ASA ....
III
72
What is the treatment for wilsons disease?
Penicillamine (chelates copper)
73
What is trousseau's sign?
inflating the blood-pressure cuff to a level above the systolic blood pressure for 3 minutes or more. This causes the patient's hand to spasmodically contract (hypocalcaemia)
74
Chvostek's sign is seen in hypocalcemia; what is it?
tapping over the facial nerve causes twitching of the facial muscles
75
What causes subdural haemorrhage?
Damage to bridging veins between cortex and venous sinuses
76
ADPKD is associated with
hepatomegaly

Finals Revision (29 decks)

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