Extras Flashcards
Microcytic Anaemia
Lead Poisoning
Confirmed decreased temp. What do you get with hypothermia (<32 degrees) characteristically?
J-waves on ECG
(also known as Osborn wave, camel-hump sign, late delta wave, hathook junction, hypothermic wave,[1] K wave, H wave)
30yo with Hodgkins. Gets mantel radiotherapy. What cancer is she most likely to get?
Lung
- secondary cancer depends on location of radiotherapy = mantle (chest = lung or breast in women under 30)
- neck = thyroid
- chemo = blood cancers
Woman, 24hrs of eye pain, now presents with complete paralysis of L eye (no movements) ptosis, and loss of sensation in division 1 of trigeminal nerve. What is the cause?
Internal carotid sinus aneurysm in cavernous area (CN3, 4, 5 (1 and 2) and 6)
Girl, aspirin o/d, takes large amount, 5 hr ago, is in abdo pain, tinnitus and vomiting. >500mg in blood (above treatment level). pH is 7.00. What do you wanna do?
IV NaHCO3
If someone has cellulitis, what do you need to cover?
Strep A = Necrotising fascitis = strep pyogenes
HIV low CD4 count [70], he can’t swallow, and he has retrosternal chest pain. How do you treat this complication of HIV?
Fluconazole (candidiasis)
HF. Shes already on metoprolol, ACE-I, spironolactone and diuretic. What do you do relieve her angina?
Digoxin
- 1st: β-B + ACEi + loop diuretic
- 2nd = spironolactone
- 3rd = digoxin
- 4th = cardiac resynchronisation
What opens at 2nd part of duodenum at major ampulla?
CBD (bile duct and pancreatic duct)
coeliac diagnosis?
Duodenal biopsy
4/12 old child. Unwell, coughs until vomits. Increased RR and temp etc. Which organism?
Bordatella pertussis
Had OGD, multiple ulcers in duodenum and gastric. PPI for 8/52 and H pylori –ve. They still have ulcers on repeat OGD. Cause?
Gastrinoma
Levodopa/Carbidopa/Benserazide?
Stops peripheral metabolism of levodopa
Levodopa changes into dopamine in the brain, helping to control movement.
Carbidopa prevents the breakdown of levodopa in the bloodstream so more levodopa can enter the brain
Pregnant lady with essential hypertension. How do you control it?
Methyldopa
Cisplatin side effect?
irreversible sensorineural hearing loss = vestibular neuropathy
Hirsuitism. Drug?
Phenytoin
Microdeletion on chromosome 22q11. Non-mendelian inheritance. Affects T-lymphocytes?
DiGeorge
18 yo with priapism (painful erection) and leg ulcers
sickle cell disease
Haemophilia A has minor op. Treatment?
Factor 8
Emergency angiography: 3 vessel disease. Treatment?
CABG
Mesothelioma suspected. Diagnosis?
USS guided pleural biopsy
Ophthalmia Neonatorum. Cause?
- gonococci (n. gonorrhoeae) typically manifests in the first 5 days
- chlamydia trachomatis produces conjunctivitis 3 days to 2 weeks after delivery.
lateral epicondylitis
- tennis elbow
- The lateral humeral epicondyle is the bony origin for wrist extensors.
- Injury to the wrist extensors causes lateral epicondylitis
medial epicondylitis
- golfer’s elbow
- The medial humeral epicondyle is the bony origin for wrist flexors.
- Injury to the wrist flexors causes medial epicondylitis (golfer’s elbow).
Pregnant UTI. Mx?
Cephalexin
thionamides
inhibiting the TPO enzyme - its involved in the synthesis of the T4
Management of thyroid storm?
Propranolol, antithyroid drugs, Lugol’s iodine and hydrocortisone sodium succinate
e. g. potassium iodide (= lugol’s iodine) and thionamides
* Inhibit proteolytic cleavage of T3 and T4
Iodine reduces the synthesis ofthyroid hormone
Malaria management?
-
P falciparum is: 1st line IV artesunate
- 2nd line Doxy + Quinine or ACT
- Non falciparum is ACT 1st line or chloroquine 1st line.
- Vivax or Ovale add in primaquine to get rid of the hypnozoites in the liver
propylthiouracil
- helps to prevent peripheral conversion of T4 into T3
- but MAIN mechanism of proylthiouracil is that it inhibits TPO
PPI s/e?
C difficile
- erythematous raised patches
- adherent keratotoic scales
- follicular plugging
- atrophic scarring
Discoid Lupus
Pulse in co-arctation of the aorta?
Radio-Femoral delay
Patient with symptoms and blood results suggestive of HIV encephalitis.
How would you treat him?
sulfadiazine and pyrimethamine (toxoplasma
gondii)
Young female undergoes cervical screening. 6 weeks later her results
show “moderate dyskariosis” and “viral wart”. You are a GP (i think?). What
would you do next?
Consistent with CIN II. Refer for urgent colposcopy(within 2 weeks)
Patient presents in A&E with a 3 day history of pyrexia and rigors. There
is no other finding on examination. What would you culture:
a. CSF
b. blood
c. sputum
d. urine
e. faeces
Urine
(urosepsis = rigors)
42 y/o male returns from Thailand. He has a 2 week history of painless
genital ulceration. Which investigation is required?
treponeme-specific antibody test
The direct fluorescent antibody test for T pallidum is easier to perform than dark-field microscopy. It detects antigen and, thus, does not require the presence of motile treponemes. It is the most specific test for the diagnosis of syphilis when lesions are present.
19 y/o female, has smelly, foamy, yellow-green vaginal discharge with
petechia on cervix. Partner is asymptomatic. How would you treat her?
metronidazole (treatment for this woman with Trichomonas
Vaginalis)
Children Asthma managment?
- SABA
- SABA + ICS
- SABA + ICS + LTRA
- SABA + ICS + LABA
- SABA + MART
A 65 y/o male smoker is due for elective THR. How would you reduce
risk of thromboembolic disease?
LMWH + TED Stockings
Kussmaul’s sign
- paradoxical rise in jugular venous pressure (JVP) on inspiration
- constrictive pericarditis
- restrictive cardiomyopathy
pseudomembranous colitis
C Diff
An old male has a 2 year history of chest pain (heartburn?) after eating
food. This has been controlled with antacids until recently when he has
found that antacids have a “reduced effect”. He is likely to have?
GORD (a?, i think he still has GORD and needs PPI/H2-blockers now
etc?)
Recurrent UTI. Ix?
Cystoscopy should be performed to exclude bladder pathology and to detect urethral narrowing
A 50 y/o female with heart failure suffers from urinary incontinence.
This is pronounced when she coughs or laughs. Reduction of diuretic therapy
has made no difference to her incontinence. [In the question you are
informed that she is not pregnant, nor does she have any pelvic masses.]
She also states that she experiences incontinence when standing from a
lying/sitting (?) position. What is the likely diagnosis?
Genuine Stress Incontinence
An old male with diabetes present complaining of hand pain at night
relieved by shaking etc. What is the likely cause?
Carpal Tunnel Syndrome
An old lady with rheumatoid arthritis presents with gradual reduction in
visual acuity. What is the likely cause?
steroid induced glaucoma
Which one of the following finding would support PCOS as opposed to
Cushings syndrome?
increased serum free testosterone levels
A patient has chronic renal failure. Which one of the following is not a
feature?
a. polycythaemia
b. pruritus
c. hyperpigmentation
d. polyuria
polycythaemia
What drug decreases admissions and mortality in HF?
ACE-I
Neuropathic Ulcer
tend to occur on the sole of the foot or over pressure points
COPD on 60% Oxygen. Increased PaCO2. What do you do?
Decreased FiO2
Zollinger-Ellison?
- gastrin secreting tumour = gastrinoma
- increased gastric acid
- recurrent peptic ulcers
- MEN1
- abdo pain, heartburn (pyrosis), diarrhoea
Woman, getting radiotherapy to breast, develops fixed mass in upper outer quadrant of L breast?
Fat Necrosis
ARF vs CRF?
Best way to differentiate is renal ultrasound - most patients with CRF have bilateral small kidneys
Exceptions
- autosomal dominant polycystic kidney disease
- diabetic nephropathy
- amyloidosis
- HIV-associated nephropathy
Other features suggesting CRF rather than ARF
hypocalcaemia (due to lack of vitamin D)
Baby with lichenification to extensor services. Family have asthma and hayfever. Whats diagnosis?
Atopic Dermatitis (eczema)
Bladder outflow obstruction diagnosed on ultrasound. Next appropriate step?
Catheterise
uy has arm#, has plaster cast put on. Hrs later arm is blue. What do you do?
Cut plaster cast all the way
70yo Woman with RA has been on pred for 7 months. On 10mg pred. What SINGLE thing do you do to protect her from osteoporosis?
bisphosphonates
Day 2 post op from bowel surgery. Has been having good urine output (20-30ml per hr). BP: 160/70, Now past 2hrs no urine output, what do you do?
Flush Catheter
69yr old lymphadenopathy, fevers, night sweats. Biopsy: homogenous lymphocytes/lymphoid cells?
NHL
stony dull percussion
pleural effusion
Had cataract surgery prev. Gradual loss of vision like curtain coming down. Now reduced to hand movements in L eye?
Retinal Detachment
Old man at home now presents with bleeding gums and is badly dressed. Diagnosis?
Scurvy
Vitamin C Deficiency
