Extra Notes Flashcards
Which vitamin, if taken in high doses, can be teratogenic?
Vitamin A is teratogenic in high doses
The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggestive of which condition
Autoimmune hepatitis
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 cutaneous manifestation of sarcoidosis
Most frequently affects the nose, cheeks, lips, ears, and digits
Not normally itchy or painful but can be disfiguring.
The gene encoding which protein is mutated in familial hypercholesterolaemia
The gene encoding the low-density lipoprotein (LDL) receptor
What is the abnormality that can be seen in this erect chest x-ray
Pleural plaques - seen as irregular lesions bilaterally
Pleural plaques are a consequence as an exposure to what substance?
Pleural plaques are a consequence of asbestos inhalation and develop over 2 to 4 decades from exposure
Fever, abdominal pain, hypotension during a blood transfusion
What is the diagnosis
Acute haemolytic reaction
Positive Coombs direct test indicates antibodies bound to red cell antigens, in keeping with an acute haemolytic reaction.
The radial nerve is most susceptible to damage from a fracture where in the arm?
Fracture of the shaft of the humerus.
What is the treatment for non-shockable rhythm
Adrenaline
When should adrenaline be used in shockable rhythms?
Adrenaline should be given after the third shock, and then during alternate cycles.
When should Amiodarone be used in shockable rhythms?
Should be given after the third shock, and another dose considered after five shocks.
What is the main ECG abnormality seen with hypercalcaemia
Shortening of the QT interval
SSRIs such as sertraline are major risk factors for what GI condition?
Duodenal ulcers
A history of Painful shin rash and cough is suggestive of what condition?
Sarcoidosis
What is the most significant issue with mechanical heart valves when compared to bioprosthetic valves?
- Arrhythmias
- Infective endocarditis
- Limited lifespan
- Early failure after surgery
- Thrombus formation
Thrombus formation
Which of his medications may be contributing to weight gain?
a) Metformin
b) Losartan
c) Clopidogrel
d) Gliclazide
e) Simvastatin
d) Gliclazide - Sulfonylureas
Define Dressler’s syndrome
Acute pericarditis that occurs several weeks following MI
Public health act 2008 part 2 is for what
Nortifiable diseases and notifiable organisms
Responsibility to notify upon a clinical suspicion of an infection
At what stage should you notify public health about a notifiable disease
Responsibility to notify upon a clinical suspicion of an infection
What is the incubation period
The period between a patient being exposed to developing symptoms
Name the 3 types of post exposure prophylaxis
Antibiotics
Vaccination
Immunoglobulins
Describe the audit cycle
1) Identify the issues
2) Obtain or define standards
3) Collect data
4) Compare performance with standards
5) Implement change
6) Re-audit
What are the four classical presentation of Meniere’s disease
Recurrent attacks of vertigo
Hearing loss
Tinnitus
Sensation of aural fullness
What are the components of the GCS
Motor response - 6
Verbal response - 5
Eye opening response - 4
If a patient is:
opening eyes to speech
Confused
Able to follow motor commands
What is their GCS
eyes to speech (E - 3/4), is confused (V - 4/5), and is able to follow motor commands (M - 6/6) => GCS = 13
How long after treating hypogylcaemia should the BM be rechecked
10-15 minutes
Which process might alcohol metabolism inhibit, preventing the liver from transforming non-carbohydrate substrates to glucose and therefore worsening hypoglycaemia?
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.
Following an epsode of severe hypoglycaemia. What is the driving regulations
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
What bedside tests are important to do in a patient with symptoms of T1DM (but not formal diagnosis)
Urinary HCG - to rule out pregnancy
Urinalysis
Blood glucose
Define osmolality
How concentrated the blood is
What is the equation for osmolarity
Osmolarity = 2[Na+] + Glucose + Urea
Name the cations that are found in the blood
Cations are positive ions
Most important
- Sodium
- Potassium
Others
- Calcium
- Magnesium
- Proteins
Name the anions that are found in the blood
Anions are negative ions
Most important
- Chloride
- Bicarbonate
Others
- Sulphates
- Phopshates
- Negatively charged protein - noteably albumin
How is the equation used to calculate the anion gap
Net charge is 0
Anion Gap = (Na+ + K+) - (Cl- + Bicarb)
Note: K+ is sometimes omitted as the value is so low
What is the normal level of anion gap
8-16 mmol/L
An elevated anion gap strongly suggests what
metabolic acidosis
What are the causes of high anion gap metabolic acidosis
Addition of organic acid e.g. high lactate, ketones
Decrease in hydrogen excretion e.g. renal
These decrease the bicarb in the equation
What are the causes of normal anion gap metabolic acidosis
“CAG”
C - Chloride excess
A - Acetazolamide/Addison’s disease
G - GI loss of bicarb
How does albumin levels affect the anion gap
Hypoalbuminaemia leads to an underestimation of the anion gap i.e. masking a high anion gap
What is the main target of treatment in DKA
Acidosis not hyperglycaemia
Why during period of sickenss patients have an increased insulin requirement despite not eating and drink as much as they would
Hormones e.g. cortisol raise the blood glucose level leading to an increase in insulin demand
What questions make up the AMT4 assessment
- Patients DoB
- Patient age
- Where they are
- What year it is
What scoring system is used in pneumonia
CURB-65 - marker of severity and prognosis
What are the components of the CURB-65 scoring
C - Confusion
U - high Urea (>7 mmol/L)
R - Respiratory rate (> 30 breaths/min)
B - Blood pressure (low)
65: Age >= 65
When should patients be placed on a varialbe rate insulin infusion
If they are fasting for more than 12 hours and miss two or more meals
Metformin is contra-indicated in what level of creatinine
Creanintine < 150 umol/L
Which bronchus is foreign objects likely to go down and why?
Right main bronchus as it is wider, shorter and more vertical than the left.
A low phosphate and high PTH and calcium level indicates what type of hyperparathyroidism
Primary hyperparathyroidism
as opposed to secondary (which would have a low calcium level) or tertiary (which would have a high phosphate level).
Patients with SVT who are haemodynamically stable and who do not respond to vagal manoeuvres, what is the next step of management
IV adenosine
Describe the pattern of administration of intravenous adenosine for the treatment of SVT
rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg
What is Whipple’s triad of symptoms and was condition is it a hallmark for
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
What is an adverse effect of calcium channel blockers such as amlodipine
Ankle swelling
What is a common adverse effect of ACE inhibitors
A dry cough
What is a side effect of thiazide-like diuretics such as indapamide
Sexual dysfunction
What are the 5 medications that should be started as secondary prevention following an MI
Dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
Which murmur am I referring to:
Ejection systolic louder on expiration
Aortic stenosis
Which murmur am I referring to:
Ejection systolic louder on inspiration
Pulmonary stenosis
Which murmur am I referring to:
pansystolic murmur louder on inspiration
Tricuspid regurgitation
Which murmur am I referring to:
pansystolic murmur louder on expiration
mitral regurgitation
Which murmur am I referring to:
Early diastolic murmur
aortic regurgitation
Which murmur am I referring to:
Mid-late diastolic murmur
mitral stenosis
Which medication will improve symptoms of heart failure but have no effect on overall mortality?
Diuretics e.g. furosemide
For poorly controlled angina despite maximum beta-blocker therapy, what medication should be added.
A long-acting calcium-channel blocker such as amlodipine
Diltiazem and verapamil are rate-limiting calcium-channel blockers and must not be combined with beta-blockers.
Why?
They can cause severe bradycardia and heart failure.
Which antifungal treatment interacts with warfarin and thus careful monitoring of INR is required
Fluconazole
Hypothermia can cause what ECG changes
J waves on ECG
Thiazide diuretics can cause which two electrolyte abnormalities
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
