Everything Flashcards
Most common organisms in infective endocarditis and associations?
- Saph aureus (most common) → western world + IVDUs
- Strep viridans (20% cases) → poor dental hygiene
- Staph epidermidis → indewlling lines, prosthetic valve (initially, then staph aureus after 2 months)
- Strep bovis → colorectal cancer
Infective endocarditis - gold standard investigations?
- TOE
- Cultures
Does asymptomatic AF need treatment?
- Not usually
- Do CHADSVASC
How do you treat a patient who is shocked but fluid overloaded?
Inotropes → Noradrenaline
Treatment for Torsade de Pointes?
Magnesium IV
Investigation for unstable aortic dissection?
TOE
Investigation for stable aortic dissection?
CT Angio
How does posterior MI present on ECG?
- ST Depression
- Tall R waves in V1-2
What are the stages of postpartum thyroiditis?
- Thyrotoxicosis
- Hypothyroidism
- Normal
Treat symptoms (eg. with propranolol)
Which strains of HPV cause warts?
6 + 11
Which strains of HPV cause cervical cancer?
16 + 18
What impact does epidural anaesthesia have on BP?
Reduces BP in induced labour
Pleural Effusion: When should a chest drain be placed?
All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnostic pleural fluid sampling
- if the fluid is purulent or turbid/cloudy a chest tube should be placed to allow drainage
- if the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed
When do you use NIV (BiPAP)?
- IECOPD
- T2RF
- Respiratory acidosis
What is infective exacerbation COPD prophylaxis?
Azithromycin
When do use CPAP?
- T1RF
- Pulmonary oedema
- Acute HF
What is important to give in acute life-threatening asthma?
Magnesium > theophylline
(O SHIT ME, but magnesium first)
What happens to the trachea in lung collapse?
It’s pulled towards the white out, ie. towards the collapsed lung
Types of aphasia
Myasthenia gravis vs Lambert-Eaton
- Myasthenia → normal reflexes, anti-AChR abs
- LEMS → areflexia, movement improves symptoms, anti-VGCC abs
Management for ascending cholangitis?
ERCP
Which pneumonia organism in IVDUs?
Staph aureus (also for influenza infection)
Osteomalacia bloods?
- Low calcium + phosphate
- Raised ALP
- Low vit D
Sx → bone pain, fractures, muscle tenderness
Paget’s bloods?
Everything normal except raised ALP
What are associations of PBC?
- Sjogren’s
- Rheumatoid
- Systemic sclerosis
- Thyroid disease
What are associations of PSC?
- IBD (UC > Crohn’s)
- HIV
Features of neuroleptic malignant syndrome?
- Pyrexia
- Muscle rigidity
- HTN, tachycardia, tachypnoea
- Agitated + Confused
Ix → raised CK, AKI, leukocytosis
Which analgesics should be avoided in those who have resp disease undergoing major surgery?
Opioids
How do you manage epistaxis?
- Minor bleeding → silver nitrate + cautery
- Profuse bleeding → anterior pack
What do the results of high-dose dexamethasone suppression test indicate?
- ACTH + Cortisol suppressed? → pituitary
- Just cortisol suppressed? → adrenal
- Neither suppressed? → ectopic
In whom is primary hyperparathryoidism commoner in?
Older females
Which diabetic drug should you suspend during intercurrent illness?
- Metformin
- Risk of lactic acidosis
What is the treatment for alcoholic ketoacidosis?
IV Thiamine + 0.9% Saline
Investigation for PSC?
- MRCP
- Shows beaded appearance
In which part of the gut is ischaemic colitis most common in?
Splenic flexure
Investigations for haemochromatosis?
- Transferrin sats > 50-55%
- Low TIBC
- MRI
Which investigation for pancreatitis?
USS
Clinical features of lymphogranuloma vereneum?
Proctitis + Lymphadenopathy
What should you do if a pt presents with unexplained petechiae and hepatosplenomegaly?
Urgent specialist assessment for leukaemia
Investigation for chlamydia?
NAAT
Parvovirus B19
- Slapped cheek syndrome
- Features → red cell aplasia, anaemia + low reticulocyte count
Clinical features of myeloma?
- Hypercalcaemia
- Proteinuria
- Impaired renal fxn
- Lower back pain
Treatment for non-displaced scaphoid fracture?
Cast 6-8 wks
What is Todd’s paresis?
Focal seizures leading to post-ictal weakness
Treatment for cervical myelopathy?
Neurosurgery
Treatment of acute ischaemic stroke < 4.5hrs?
Thrombolysis + thrombectomy
Eye palsies
- LR6
- SO4
- Rest 3
Which nerve supplies the triceps reflex?
- Radial nerve
- C7
Features of idiopathic intracranial HTN?
- Obese young females
- Headaches
- Blurred vision
How does blepharitis present?
Bilateral grittiness worse in morning
Treatment for whooping cough?
Oral clarithromycin
Features of HUS?
- MAHA
- Thrombocytopenia
- Acute renal failure
Features of HSP?
- Purpuric rash - bum + legs
- NO anaemia or thrombocytopenia
- Can lead to nephritis (haematuria + proteinuria)
Asthma - should you do peak flow if <5 yrs old?
- No, just bronchodilator test
- Spacer is also better for asthma exacerbations in children than nebs
What are rolandic seizures?
- Centrotemporal region
- Saliva, grunting, slurred speech
How do you treat terminal restlessness in palliative care?
Midazolam syringe driver
TCA overdose
- QRS Prolongation
- Rx → IV bicarb
Features of delirium tremens?
- Confusion
- Visual hallucinations
- Tachycardia
- Pyrexia
Wernicke’s encephalopathy
- Thiamine deficiency
- Sx → nystagmus / ophthalmoplegia / ataxia
- Rx → thiamine
What is Korsakoff’s ?
- Leads on from Wernicke’s
- Characterised by anterograde and retrograde amensia and confabulation
What is minimal change disease associated with?
- Atopy
- Hodgkin’s lymphoma
Testicular torsion or epididymitis?
Prehn’s sign → in torsion, the elevation of the testis does not ease the pain compared to epididymitis
Rx epidydmo-orchitis?
- IM ceftriaxone + oral doxycyline
Arterial vs venous ulcers
- Arterial → toes, heel, painful, cold, low ABPI
- Venous → ankle, painless, brown pigment, oedema
Investigations for acute pancreatitis?
- Lipase > amylase
- Diagnosis can be made clinically + based on above
- Early USS important, otherwise contrast CT
Investigations for chronic pancreatitis?
- Faecal elastase (if imaging inconclusive)
- CT > AXR
The one investigation of choice for pancreatic cancer?
- High res CT
- Demonstrates ‘double duct’ sign (simulatenous dilatation of common bile and pancreatic ducts)
Which 3 features characterise acute liver failure?
- Jaundice
- Confusion
- Coagulopathy
Bloods for refeeding syndrome?
- Hypophosphataemia
- Hypokalaemia
- Hypomagnesaemia
- Abnormal fluid balance
Most common causes of liver cirrhosis (3)
- NAFLD / NASH
- Alcohol
- HCV + HBV
Investigation of choice for liver cirrhosis?
Fibroscan aka transient elastography
Ascites treatment?
- Fluid restrict + low salt diet
- Spironolactone
Treatment for hepatic encephalopathy?
Lactulose
PBC
- Non-caseating granulomas
- Middle aged females
- Ix → AMA, IgM
Rx → symptom management, ADEK, ursudeoxycholic acid, transplant
Wilson’s investigation (1) + treatment (1)?
- Ix* → Reduced serum caeruloplasmin
- Rx* → penicillamine
Budd-chiari triad?
- RUQ pain
- Hepatomegaly
- Ascites
Screening for HCC?
- Ultrasound
- AFP
Only for high risk groups
Who needs surgery for bowel obstruction?
- Closed loop obstruction
- Obstructing neoplasm
- Strangulation/perforation → sepsis, peritonitis
- Failure of conservative Mx (up to 72hr)
CAP Abx
- Mild or Moderate → Amoxicillin
- Severe → Co-amoxiclav + clarithromycin
Types of lung cancer
- Small cell → SIADH, ACTH, central, LEMS
- Squamous cell → PTHrP, hilar
- Adenocarcinoma → small airways
Lofgren’s syndrome is a specific presentation of sarcoidosis.
What’s the Lofgren’s triad?
- Ertyhema nodosum
- Bilateral hilar lymphadenopathy
- Polyarthralgia
Gold standard diagnosis of sarcoidosis?
- Histology from biopsy
- Done by bronchosocopy w/ USS guided biopsy of mediastinal lymph nodes
- Shows non-caseating granulomas + epithelioid cells
Industrial lung diseases
- Coal-workers pneumoconicosis → progressive dyspnoea, chronic bronchitis / CXR: upper zone fibrotic masses
- Silicosis → quarrying, sand-blasting / upper zone reticular shadowing + egg shel calcification of hilar nodes
- Asbestosis → demolition, ship building / basal fibrosis, pleural plaques / CXR: pleural effusions / do biopsy
Brain abscess features
- Headche
- Fever
- Focal neurology
Labyrinthitis vs Vestibular neuronitis?
Both present after viral illness, associated w/ vertigo, nausea and vomiting and both treated w/ prochlorperazine
- Lab → hearing loss, faster onset, associated w/ ramsay-hunt syndrome
- Vest → no hearing loss
Systemic sclerosis antibodies
- Scleroderma → ANA
- Diffuse → anti-scl70
- Limited → anti-centromere
Hip # Management
- Displaced intracapsular → arthroplasty
- Undisplaced intracapsular → internal fixation + cannulated screw
- Intertrochanteric → DHS
- Subtrochanteric → intramedullary nail
Urethral trauma
- Bulbar rupture (most common) → retention / perineal haematoma / bloody meatus
- Membranous rupture → prostate displaced upwards
Ix → ascending urethrogram
What is the most common benign intracranial tumour?
Meningioma
Most common type of malignant brain tumour?
Astrocytoma
In which brain tumours is raised ICP common earlier on in?
Posterior fossa tumours
Myotomes
Management of neutropenic sepsis?
- Abx immediately → Tazocin
- Do not wait for WBC
- G-CSF in some patients
Which diabetic drug in CKD?
Gliptins (DPP4 inhibitor)
Shoulder pathologies according to age?
- 40-70 → adhesive capsulitis
- > 70 → rotator cuff tear or glenohumeral OA
Subacromal bursitis features
- Occupational or athletic hx of lifting/moving things
Urge (OAB) incontinence treatment
- Bladder training 6 weeks
- Anticholinergics → oxybutynin, tolterodine, darifenacin
- Mirabegron
- Botulinum toxin A injections
- Sacral nerve stimulation + agumentation cystoplasty
CTG: Baseline bradycardia and tachycardias
- Bradycardia indicates (severe) fetal distress due to placental abruption/uterine rupture/fetal hypoxia
- Tachycardia indicates prematurity / hypoxia / fetal distress / maternal pyrexia / exogenous b-agonists
CTG: Decelerations
- Early → physiological
- Late → fetal distress
- Variable → cord compression, oligohydramnios
