Exam Docs Flashcards
what drug does azothioprine interact with to cause a pancytopenia
allopurinol
interaction between azothioprine and allopurinol
pancytopenia
interaction between statin and clarithromycin
clarithromycin increases effect of station - rhabdomyolysis
interaction between methotrexate and trimethoprim
both folate antagonists - synergistic antifolate effects - pancytopenia
can u inform DVLA about pt if they refuse to do so
yes - only if you have persuaded them to stop driving and made efforts. If they continue to drive u can inform DVLA
conversion of oramorph to syringe driver morphine
divide by 2
antiemetic for drug induced n+v
- dopamine antagonist (metoclopramide) or haloperidol
antiemetic for motility disorders
- metoclopramide (its a prokinetic)
or - domperidone (if at high risk of EPSEs)
antiemetic for raised ICP/movement related nausea
cyclizine
antiemetic for multifactorial n+v
levomopromazine
conversion of oral morphine to oral oxycodone
divide by 2
oral morphine to SC oxycodone
divide by 4
oral codeine to oral morphine conversion
divide by 10
breakthrough dose
1/6th of total daily dose of morphine
conversion oral tramadol to oral morphine
divide by 10
oral morphine to SC diamorphine
divide by 3
acute heart failure Tx
‘PODMAN’
position oxygen diuretic (furosemide 40mg stat) morphine anti-emetic nitrate
chronic heart failure Mx
- ACEi + Beta-Blocker
- Spironolactone
- Ivabradine
- Digoxin or Hydralazine/Isosorbide mononitrate
(Loop Diuretic - furosemide for symptom relief)
HTN Mx in preg
- labetalol
- methydopa
- nifedipine
Mx of recently healed venous ulceration
graduated compression stocking
Mx of enlarging ulcer in elderly pt with normal pulse and no venous problems
biopsy - suspected marjolin’s ulcer or SCC
Mx of a multifactorial ulcer with ABPI of 2.1
toe brachial index (more accurate ABPI as diabetic pts have calcification of the crural vessels)
Dx of a leg ulcer with brown patches
venous leg ulcer (haemosiderin staining)
J waves on ECG
hypothermia
U waves ECG
hyperkalaemia
hypocalcaemia presentation
tetany
effect of autonomic neuropathy on ECG
sinus arrhythmia
aortic dissection causing inferior MI, 1st line tx?
CT
what is used to monitor response to pneumonia Tx
CURB65 score
CXR appearance of atypical pneumonia
patchy consolidation, often bilateral
emphysema with hyper expanded chest - apex beaT?
loss of apex beat
reversal of warfarin if major bleed
prothrombin complex and vit K
reversal of warfarin if minor bleed
vit K
reversal of warfarin if INR > 8 and no bleeding
stop warfarin and give Vit K
reversal of warfarin if INR 6-8 and no bleeding
withold warfarin and restart when INR <5.0
INR therapeutic range
between 2 and 3 (ideal 2.5)
initial Ix for ?pancreatic ca
abdo US
gold standard diagnostic = CT
causes of oesophageal candidiasis
steroid inhalers
immunosuppression
Ix for IBS
clinical diagnosis
do bloods to rule out other causes - FBC/ESR/CRP/coeliac screen
Ix for IBD
- stool study - faecal calprotectin
- ?UC - flexible sigmoidoscopy
?Crohn’s - colonoscopy
Dx altered bowel habit - mass in elderly man with wt loss
colorectal ca
Dx altered bowel habit - constipation and bleeding with fleshy lumps palpable
haemorrhoids
Dx altered bowel habit - loose stools after ciprofloxacin
c. diff
Dx altered bowel habit - pain with passing stool and exquisitely tender PR
anal fissure
Ix for addisons diagnosis
short synacthen test
cause of proteinuria with Hx of recurrent UTI
reflux nephropathy
Ix of reflux nephropathy
MCUG
Mx complicated UTI
amox + gent
stepdown Tx complicated UTI
co-trimoxazole
Mx mild/mod CAP
amoxicillin PO
Mx severe CAP
co-amoxiclav + doxycycline
Mx CAP in HDU/ICU or NBM
co-amoxiclav + clarithromycin
Mx non severe HAP
amoxicillin PO
Mx severe HAP
amox + gent
Mx non-severe aspiration pneumonia
amox + met
Mx severe aspiration pneumonia
amox + met + gent
Mx giardiasis
metronidazole
Mx amoebiasis
metronidazole
Mx campylobacter
mild - no Tx
severe - erythromycin
Mx E.coli 0157
no abx!
does everyone with salmonella get Abx?
no - only if:
> 50 y
immunocompromised
have cardiac valve disease
Abx Mx of salmonella
ciprofloxacin
cause of croup
parainfluenza
cause of bronchiolitis
RSV
GCS motor scoring
- obeys commands
- localises to pain
- withdraws from pain
- abnormal flexion to pain (decorticate)
- extension to pain (decerebrate)
- none
GCS verbal scoring
- orientated
- confused
- words
- sounds
- none
GCS eye scoring
- spontaneous
- to voice
- to pain
- none
biceps reflex
C5
triceps reflex
C7
brachioradialis reflex
C6
knee jerk reflex
L4
ankle reflex
S1
visual defect - pituitary tumour
bitemporal hemianopia
visual defect - optic neuritis
ipsilateral central scotoma
visual defect - occipital cortex strok
contralateral homonymous hemianopia with macular sparing
CSF results - idiopathic intracranial HTN
normal
CSF bacterial meningitis
cloudy appearance
low glucose
high protein
polymorphs
CSF viral meningitis
clear appearance
60-80% of plasma glucose
normal protein
lymphocytes
CSF TB meningitis
slightly cloudy - ‘fibrin web’
low glucose
high protein
lymphocytes
sudden shooting back pain while performing heavy lifting - Dx?
prolapsed disc
low-grade fever, local tenderness at L3 - Dx?
discitis
lorry drive, stiff and tender back pain - Dx?
mechanical back pain
hemiparesis with homonymous hemianopia with macular sparing - artery affected?
posterior cerebral artery
ataxia, decreased conscious level, facial muscle weakness, facial sensory loss - area affected?
pontine
nystagmus of right eye looking to right and failure of left eye to cross midline on looking to right - Dx?
internuclear ophthalmoplegia
internuclear ophthalmoplegia - sign of?
MS
Mx of DVT/PE in preg
LMWH - stop at onset of labour, continue for 3m postnatal
Dx of Downs at 16w gestation
amniocentesis
timing of amniocentesis
> 15w
timing of chorionic villus biopsy
11.5-15w
who performs amniocentesis
obstetrician
who review pt at 6/52 post-natal
GP
who repairs 2nd degree perineal tear
midwife
who repairs 3rd degree perineal tear
obstetrician
who performs any labour other than just a nroaml vag delivery
obstetrician
who performs normal vaginal deliveries
midwives
who performs epidurals and pudendal nerve blocks
anaesthetists
arcuate scotoma
glaucoma
pt with SNHL after being in intensive care for severe sepsis - cause?
aminoglycoside toxicity (gentamicin)
SNHL with notch at 4000Hz - Dx?
noise induced HL
how long must symptoms be present for Dx of PTSD
3m
how long must symptoms be present for Dx of depressive ep
2w
adjustment disorder
‘situational depression’
unable to cope with particular stress or life event
resolves once person is able to adapt
presentation of measles
rash in mouth - koplick spot’s
then rash starts behind ears and spread to whole body
presentation of scarlet fever
“strawberry tongue”
sandpaper texture rash - torso first, spares palms and soles
Mx scarlet fever
penicillin V for 10d, can go back to school after 24h
presentation of rubella
maculopapular rash starts on face and spread to whole of body
child has an itchy, red rash and has a brother with asthma - Dx?
infantile eczema
purplish lesions on elbows in elderly man - Dx?
lichen planus
++ itch with ongoing Ix for GI problems - Dx?
dermatitis herpetiformis
T2DM with urinalysis of 2+ protein - what Ix to do next?
urinary albumin:creatine ratio
normal: <3.5 female, <2.5 male
Ix for addisons
short synacthen test
pt with HbA1c of 66 - what do u start them on
metformin
pt started on new diabetic drug, developed diarrhoea - what caused it
metformin
old man, acute exacerbation (breathless), is already on inhalers for asthma, CXR shows hyperinflation, ECG - sinus tachy, bilateral wheeze - next Ix?
peak flow
Mx primary spontaneous pneumothorax <2cm or asymptomatic
discharge
Mx primary spontaneous pneumothorax >2cm or symptomatic
needle thoracocentesis (aspiration)
if this fails - chest drain
Mx secondary spontaneous pneumothorax 0-1cm and aysymptomatic
give O2 and admit for 24h
Mx secondary spontaneous pneumothorax 1-2cm and asymptomatic
needle thoracocentesis (aspiration)
if this fails - chest drain
Mx secondary spontaneous pneumothorax if >2cm or symptomatic
chest drain
pt with bilateral LMN symptoms & loss of proprioception & vibration sense up to ankle. What tract
DCML
hemiparesis & hemisensory loss - what artery
anterior cerebral artery
presentation of CN III palsy
eye located down and out (they cannot adduct and elevate eye)
artery affected inferior MI
right coronary artery
artery affected anterior MI
left anterior descending
artery affected lateral MI
left circumflex
CXR appearance pulmonary oedema
ABCDE
Alveolar oedema (bats wings) B kerley B lines Cardiomegaly Dilated prominent upper lobe vessels Effusion
critical limb ischaemia definition
advanced chronic limb ischaemia:
chronic >2w ischaemic rest pain, necrosis or ulceration as a result of proven arterial disease
patient had anterior MI - they have congestive heart fialure symptoms, low Na and normal potassium - what sort of renal injury do they have?
renal hypoperfusion (pre renal aki)
sharp central chest pain worse on lying flat, relieved by leaning forward, had an infection - Dx?
pericarditis
pt with drooling and uvular deviation - Dx?
quinsy (peritonsillar abscess)
pt with all centor criteria present - Mx ?
penicillin 500mg
post-thyroidectomy, pt has hoarseness, what nerve has been affected?
recurrent laryngeal nerve (branch of vagus)
1st line Mx urge incontinence
- bladder training
- anti-muscarinics e.g. oxybutinin, tolteridine
- b3 agonists e.g. mirabegron
1st line Mx stress incontinence
pelvic floor exercises
what is the active 1st stage of labour
from 4cm - full dilation
GDM - lifestyle advice has been given (lost 3kg) but finger prick is still 8-14 - what do you start?
metformin
eclampsia 1st line Mx
magnesium sulphate 4g IV over 5-10mins
then infusion of 1g/hr.
continue Tx for 24h after last seizure
fishy smelling discharge, pH 5.5 - Dx?
bacterial vaginosis - give metronidazole
Mx for kid with facial non-infective eczema
hydrocortisone 1%
Mx oesophageal candidiasis
nyastatin suspension
Ix for HSP
U&Es (renal involvement)
kid who is overwght, snores, daytime somnolence and only breathes through their mouth - Dx?
adenoidal hypertrophy
rptd unilateral rhinorrhoea - Dx?
foreign body
Fhx of asthma, single crease on nose - Dx?
allergic rhinitis
achilles tendon rupture - Ix?
ultrasound
s/e of risedronate that means you need to discontinue the drug
oesophagitis or oesophageal ulcer
pt had painful red eye with nausea and headache - Ix?
check IOP (AACG?)
pt been to malawi - 2w later has swinging fevers and rigors - what Ix?
thick and thin blood film - ?malaria
pt presents with reactive arthritis (cant see, cant pee, cant climb a tree) - what Ix?
chlamydia screen
Mx if pt’s INR on warfarin is 6.1 and there is no bleed
omit warfarin and review INR
Mx if pt’s INR is 8.1 on warfarin and they have an active GI bleed with Hb 11.1 and plt 156
FFP
Ix for pt with back pain and high calcium
electrophoresis - ?multiple myeloma
male, smoker with loin pain, haematuria and abdo mass - Dx?
RCC
20y old who moved to UK from afghan recently, has # of pubic ramus.
high PTH, low Ca, high PTH - what next best Ix?
check Vit D level
Left side BC>AC
webers lateralises to the left
right side AC>BC
whats the problem?
left conductive deafness§
Mx drug induced parkonsonism
procyclidine
OD and dont know what - tinnitus, tachy, not hypotensive, sweating - what drug have they probably takne?
aspirin
pt with ascites - has fever and generalised abdo tenderness - Dx?
spontaneous bacterial peritonitis
35 y/o with 5y Hx of alternating diarrhoea and constipation - Dx?
IBS
pt 72h post-ip with generalised abdo tenderness, has not passed stool and no bowel sounds heard - Dx and Ix?
functional ileus
Ix - CT abdo/pelvis
CXR provided (squamous cell ca) + hyponatraemia - Dx?
SIADH
Most appropriate first Ix for PE
D dimers
pt with sinusitis, haemoptysis, urinary problems & cANCA
GPA
Mx otitis media
delayed Abx - amoxicillin
Ix to diagnose anaphylaxis
serum tryptase
pt on triple insulin in the day + lantus in the evening. they are preop. how do you change the lantus dose?
continue on original dose
biphasic insulin before lunch is low (BG=2.1), what do you change?
give lucozade and change morning dose
SIADH test
urine:serum osmolality
pt with symptoms of diabetes, fasting and OGTT done - fasting is normal (<6) and OGTT 8.5 - Dx?
impaired OGTT (pre DM)
pt with big jaw and teeth growing apart - what visual deformity is expected?
bitemporal hemianopia
34 yo female, never had children, has high LH and FSH, low oestradiol and no menses for 4m - Dx?
premature ovarian failure
53 y/o, hot flushes, sweats, amenorrhoea for 7m - what HRT do you give?
cyclical combined HRT
symptoms of a perimenopausal lady
hot flushes, has irregular periods
lady ovuatory, seems well, tried for 18m, male fit and well - what first Ix do you do for infertility?
semen analysis
lady 8w preg, os is open with POC visible, US shows non viable preg, doesnt want to watch and wait - what do you do?
give misoprostol
AXR given (dilated loops - small bowel - venae commintantes), Hx of abdo hysterectomy 15y ago, hernia fixation 2y ago - Dx?
obstruction due to adhesions
mother on methadone, what would u expect in baby
withdrawn and inactive baby
mother took alcohol in preg what symptoms expected in baby
agitated baby
pt post-hysterectomy, has numbness over medial thigh - what nerve is affected
obturator nerve
binge eating + compensating - Dx?
bulimia
pt cant look down and in - what CN
CN IV (eye floats upwards and head tilts)
kid with strabismus - if they close their right eye their left eye moves in - what do they have
left exotropia (the eye is out and you see inward movement) - divergent squint
pt with SCZ, has been changed from risperidone to olanzapine and has wt gain. Has tried other drugs and they dont work - who to refer to?
dietician
pt has vascular dementia and wants independence - who to refer to?
OT
old man wants to move into care home - who can help?
care home liason nurse
leg ulcer with ABPI of 1.1 - Mx?
compression stockings (ABPI is normal, therefore can do compression as probable venous)
diabetic foot ulcer over 1st MT, XR shows bone changes and is dischaging - Mx?
IV Abx - osteomyelitis
prostate ca - sudden onset bilateral leg weakness, saddle anaesthesia and urinary incontinence - Dx?
spinal cord compressoin
pt lifts up arm and has dimpling present - Dx?
breast ca
what do you warn a pt who is about to undergo XRT for prostate ca
rectal bleed? dysuria?
Tx for hodgkin’s lymphoma
biological chemo
pt with peripheral neuropathy - blood Ix show macrocytosis - what do you Tx with?
hydroxcobalamin (b12 deficiency)
kardex provided - problems with it?
furosemide @ 10pm
Penicillin allergy - stop co-amoxiclav
has rhabdo - stop statin
medication used to induce labour if cervix closed
misoprostal
post-coital bleeding in 8w preg lady?
cervical ectropion
severe RIF pain, bHCG -ve - Dx?
ovarian torsion
lady with Cu coil just inserted, has pain, septic on speculum has red cervix with discharge - Dx?
uterine perforation
regular narrow complex tachy. vagal manoeuvres have failed - what is the next step?
IV adenosine
ECG after burns. What is the cause for his ECG appearance?
hyperkalaemia
rate control of AF
bisoprolol
old man with PMR on steroids - cause of hyperlipidaemia?
corticosteroid Tx
47y/o male with MI, achilles tendon was thickened cause of hyperlipidaemia?
familial hypercholesterolaemia
lady with temporal epilepsy.
Pre-statin she has high cholesterol,
Post 80mg of atorvastatin she has only had a small reduction in lipids - cause?
drug-induced
Mx campylobacter diarrhoea
erythromycin
50 yo female with RUQ pain. USS showed thickened gallbladder and stones in cystic duct. Comes back for rv, pain free. What to Ix to do?
MRCP
AMA +ve - Dx?
PBC
16w old baby, fever and irritable lasting for 24h after immunisation which started 3h after immunisation. Precautions for next immunisation?
no precautions required
Extensive bowel cancer disease, cannot take PO. He has back pain which was controlled with max codeine before but now in pain (cannot take the meds orally). Normal renal function. What do you change this to?
CSCI morphine
pt with multiple stuck on keratotic lesions on her neck - first thing you would do?
reassurance (seborrhoeic keratosis)
whole fam have itch, mother has interdigital eczema, grandma has crusty itchy palms and 2y old has itchy palms and soles. Tx?
permethrin (scabies)
ECG most common in pulmonary embolism
sinus tachy
chronic counterpart of guillain barre syndrome
chronic inflammatory demyelinating polyneuropathy (CIDP) - develop over 6m
bells palsy Tx
steroids - oral pred
48y/o male with changes in behaviour (aggressive to wife), trouble with moving, disinhibited
picks disease
viral infection, hearing loss and vertigo - Dx?
labyrinthitis
guy in garden, suddenly dizzy and dropped tools and staggered home. nystagmus. headache started a while later. Dx?
cerebellar stroke
boxer, cannot look up nose
nasal septal haematoma
RTA, airbag hit face. face oedematous and eye painful. slowly losing vision
orbital haematoma
22 y/o post infection, noticed mass at lower 1/3 anteromedial aspect of SCM - Dx?
branchial cyst
plummer vinson syndrome
difficulty swallowing iron deficiency anaemia glossitis cheilosis oesophageal webs
causative agent of dendritic ulcer
herpes simplex
Mx dendritic ulcer
topical aciclovir
presentation of keratoconjunctivitis sicca
punctate lesion on conjunctiva and cornea
antidepressant medications taken in OD. pt is hyper-reflexic, tachycardic and pupils dilated. Tx?
IV sodium bicarb (TCA overdose)
pt hyperkalaemic - what HTN drug cant they be on
ACEi
teenager with DKA, BM 18 and is hypotensive what is your initial Tx?
IV fluids
mnemonic for brachial plexus nerves
my aunty raped my uncle
musculocutaneous axillary radial median ulnar
nerve roots muculocutaneous nerve
C5,6,7
nerve roots axillary nerve
C5,6
nerve roots radial nerve
C5-T1
nerve roots median nerve
C5-T1
nerve roots ulnar nerve
C8-T1
what does a ratio concentration of drug mean (e.g. 1:1000)
number of grams in mls of solution
e.g. 1g of adrenaline in every 1000mls of saline
what does a % solution of a drug mean
grams of drug per 100mls of solution
what does 1g = ? in mls
1 ml
what does 1 ml = ? in g
1g
