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Finals: Medicine > Extra Notes > Flashcards

Extra Notes Flashcards

1
Q

Which vitamin, if taken in high doses, can be teratogenic?

A

Vitamin A is teratogenic in high doses

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2
Q

The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggestive of which condition

A

Autoimmune hepatitis

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3
Q

Facial rash:

Raised purple plaque of indurated skin

Affects the tip of the nose and the skin around the right nostril

Neither itchy or painful

What is the diagnosis

A

A cutaneous manifestation of sarcoidosis

Most frequently affects the nose, cheeks, lips, ears, and digits

Not normally itchy or painful but can be disfiguring.

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4
Q

The gene encoding which protein is mutated in familial hypercholesterolaemia

A

The gene encoding the low-density lipoprotein (LDL) receptor

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5
Q

What is the abnormality that can be seen in this erect chest x-ray

A

Pleural plaques - seen as irregular lesions bilaterally

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6
Q

Pleural plaques are a consequence as an exposure to what substance?

A

Pleural plaques are a consequence of asbestos inhalation and develop over 2 to 4 decades from exposure

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7
Q

Fever, abdominal pain, hypotension during a blood transfusion

What is the diagnosis

A

Acute haemolytic reaction

Positive Coombs direct test indicates antibodies bound to red cell antigens, in keeping with an acute haemolytic reaction.

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8
Q

The radial nerve is most susceptible to damage from a fracture where in the arm?

A

Fracture of the shaft of the humerus.

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9
Q

What is the treatment for non-shockable rhythm

A

Adrenaline

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10
Q

When should adrenaline be used in shockable rhythms?

A

Adrenaline should be given after the third shock, and then during alternate cycles.

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11
Q

When should Amiodarone be used in shockable rhythms?

A

Should be given after the third shock, and another dose considered after five shocks.

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12
Q

What is the main ECG abnormality seen with hypercalcaemia

A

Shortening of the QT interval

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13
Q

SSRIs such as sertraline are major risk factors for what GI condition?

A

Duodenal ulcers

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14
Q

A history of Painful shin rash and cough is suggestive of what condition?

A

Sarcoidosis

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15
Q

What is the most significant issue with mechanical heart valves when compared to bioprosthetic valves?

  1. Arrhythmias
  2. Infective endocarditis
  3. Limited lifespan
  4. Early failure after surgery
  5. Thrombus formation
A

Thrombus formation

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16
Q

Which of his medications may be contributing to weight gain?

a) Metformin
b) Losartan
c) Clopidogrel
d) Gliclazide
e) Simvastatin

A

d) Gliclazide - Sulfonylureas

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17
Q

Define Dressler’s syndrome

A

Acute pericarditis that occurs several weeks following MI

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18
Q

Public health act 2008 part 2 is for what

A

Nortifiable diseases and notifiable organisms

Responsibility to notify upon a clinical suspicion of an infection

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19
Q

At what stage should you notify public health about a notifiable disease

A

Responsibility to notify upon a clinical suspicion of an infection

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20
Q

What is the incubation period

A

The period between a patient being exposed to developing symptoms

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21
Q

Name the 3 types of post exposure prophylaxis

A

Antibiotics

Vaccination

Immunoglobulins

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22
Q

Describe the audit cycle

A

1) Identify the issues
2) Obtain or define standards
3) Collect data
4) Compare performance with standards
5) Implement change
6) Re-audit

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23
Q

What are the four classical presentation of Meniere’s disease

A

Recurrent attacks of vertigo

Hearing loss

Tinnitus

Sensation of aural fullness

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24
Q

What are the components of the GCS

A

Motor response - 6

Verbal response - 5

Eye opening response - 4

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25
Q

If a patient is:

opening eyes to speech

Confused

Able to follow motor commands

What is their GCS

A

eyes to speech (E - 3/4), is confused (V - 4/5), and is able to follow motor commands (M - 6/6) => GCS = 13

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26
Q

How long after treating hypogylcaemia should the BM be rechecked

A

10-15 minutes

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27
Q

Which process might alcohol metabolism inhibit, preventing the liver from transforming non-carbohydrate substrates to glucose and therefore worsening hypoglycaemia?

A

The metabolism of alcohol influences the intracellular redox state of hepatocytes, inhibiting key stages of gluconeogenesis.

gluconeogenesis is the transformation of non-carbohydrate into glucose

This increases the chance, and severity of, hypoglycaemia.

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28
Q

Following an epsode of severe hypoglycaemia. What is the driving regulations

A

Patient should inform the DVLA

However a single episode of severe hypoglycaemia in the past 12 months should not prevent the patient from driving a car

29
Q

What bedside tests are important to do in a patient with symptoms of T1DM (but not formal diagnosis)

A

Urinary HCG - to rule out pregnancy

Urinalysis

Blood glucose

30
Q

Define osmolality

A

How concentrated the blood is

31
Q

What is the equation for osmolarity

A

Osmolarity = 2[Na+] + Glucose + Urea

32
Q

Name the cations that are found in the blood

A

Cations are positive ions

Most important

  • Sodium
  • Potassium

Others

  • Calcium
  • Magnesium
  • Proteins
33
Q

Name the anions that are found in the blood

A

Anions are negative ions

Most important

  • Chloride
  • Bicarbonate

Others

  • Sulphates
  • Phopshates
  • Negatively charged protein - noteably albumin
34
Q

How is the equation used to calculate the anion gap

A

Net charge is 0

Anion Gap = (Na+ + K+) - (Cl- + Bicarb)

Note: K+ is sometimes omitted as the value is so low

35
Q

What is the normal level of anion gap

A

8-16 mmol/L

36
Q

An elevated anion gap strongly suggests what

A

metabolic acidosis

37
Q

What are the causes of high anion gap metabolic acidosis

A

Addition of organic acid e.g. high lactate, ketones

Decrease in hydrogen excretion e.g. renal

These decrease the bicarb in the equation

38
Q

What are the causes of normal anion gap metabolic acidosis

A

“CAG”

C - Chloride excess

A - Acetazolamide/Addison’s disease

G - GI loss of bicarb

39
Q

How does albumin levels affect the anion gap

A

Hypoalbuminaemia leads to an underestimation of the anion gap i.e. masking a high anion gap

40
Q

What is the main target of treatment in DKA

A

Acidosis not hyperglycaemia

41
Q

Why during period of sickenss patients have an increased insulin requirement despite not eating and drink as much as they would

A

Hormones e.g. cortisol raise the blood glucose level leading to an increase in insulin demand

42
Q

What questions make up the AMT4 assessment

A
  • Patients DoB
  • Patient age
  • Where they are
  • What year it is
43
Q

What scoring system is used in pneumonia

A

CURB-65 - marker of severity and prognosis

44
Q

What are the components of the CURB-65 scoring

A

C - Confusion

U - high Urea (>7 mmol/L)

R - Respiratory rate (> 30 breaths/min)

B - Blood pressure (low)

65: Age >= 65

45
Q

When should patients be placed on a varialbe rate insulin infusion

A

If they are fasting for more than 12 hours and miss two or more meals

46
Q

Metformin is contra-indicated in what level of creatinine

A

Creanintine < 150 umol/L

47
Q

Which bronchus is foreign objects likely to go down and why?

A

Right main bronchus as it is wider, shorter and more vertical than the left.

48
Q

A low phosphate and high PTH and calcium level indicates what type of hyperparathyroidism

A

Primary hyperparathyroidism

as opposed to secondary (which would have a low calcium level) or tertiary (which would have a high phosphate level).

49
Q

Patients with SVT who are haemodynamically stable and who do not respond to vagal manoeuvres, what is the next step of management

A

IV adenosine

50
Q

Describe the pattern of administration of intravenous adenosine for the treatment of SVT

A

rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg

51
Q

What is Whipple’s triad of symptoms and was condition is it a hallmark for

A

1) hypoglycaemia with fasting or exercise
2) reversal of symptoms with glucose
3) recorded low BMs at the time of symptoms

Hallmark for an insulinoma

52
Q

What is an adverse effect of calcium channel blockers such as amlodipine

A

Ankle swelling

53
Q

What is a common adverse effect of ACE inhibitors

A

A dry cough

54
Q

What is a side effect of thiazide-like diuretics such as indapamide

A

Sexual dysfunction

55
Q

What are the 5 medications that should be started as secondary prevention following an MI

A

Dual antiplatelet therapy (aspirin plus a second antiplatelet agent)

ACE inhibitor

beta-blocker

statin

56
Q

Which murmur am I referring to:

Ejection systolic louder on expiration

A

Aortic stenosis

57
Q

Which murmur am I referring to:

Ejection systolic louder on inspiration

A

Pulmonary stenosis

58
Q

Which murmur am I referring to:

pansystolic murmur louder on inspiration

A

Tricuspid regurgitation

59
Q

Which murmur am I referring to:

pansystolic murmur louder on expiration

A

mitral regurgitation

60
Q

Which murmur am I referring to:

Early diastolic murmur

A

aortic regurgitation

61
Q

Which murmur am I referring to:

Mid-late diastolic murmur

A

mitral stenosis

62
Q

Which medication will improve symptoms of heart failure but have no effect on overall mortality?

A

Diuretics e.g. furosemide

63
Q

For poorly controlled angina despite maximum beta-blocker therapy, what medication should be added.

A

A long-acting calcium-channel blocker such as amlodipine

64
Q

Diltiazem and verapamil are rate-limiting calcium-channel blockers and must not be combined with beta-blockers.

Why?

A

They can cause severe bradycardia and heart failure.

65
Q

Which antifungal treatment interacts with warfarin and thus careful monitoring of INR is required

A

Fluconazole

66
Q

Hypothermia can cause what ECG changes

A

J waves on ECG

67
Q

Thiazide diuretics can cause which two electrolyte abnormalities

A

Hypercalcaemia - high calcium level in the blood

hypocalciuria - low calcium level in the urine

Thiazide diuretics work by blocking the Na-Cl symporter in the distal convoluted tubule. This indirectly also leads to hypercalcaemia

68
Q
A

Finals: Medicine (91 decks)

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