February Flashcards
Pulmonary oedema is an indication for what in a patient with acute kidney injury?
Haemodialysis
Proliferative diabetic retinopathy is treated with…
Panretinal laser photocoagulation
What are the main features of secondary syphilis and when does it occur?
Secondary features - occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy, rash on trunk, palms and soles buccal ‘snail track’ ulcers (30%) condylomata lata (painless, warty lesions on the genitalia)
Stop sertraline when?
6 months after RESOLUTION
Common symptoms of early lymes disease?
Symptoms include joint pains, facial nerve palsy, palpitations, headaches and fever.
What rash is caused by Borrelia burgdorferi?
Erythema migrans (Bulls eye rash)
When to perform HIV testing:
Testing for HIV in asymptomatic patients should be done at 4 WEEKS AFTER SUSPECTED EXPOSURE.
If this result is NEGATIVE offer a repeat test at 12 weeks
What is the screening performed for all diabetic patients to assess for nephropathy?
All diabetic patients require annual screening for albumin:creatinine ratio (ACR) in early morning specimens.
Smoking cessation in pregnancy give?
NRT
Pregnant women who smoke: nicotine replacement therapy should be offered, varenicline and bupropion are contraindicated
What iron studies are seen in iron deficiency anaemia?
Low transferrin saturation, low ferritin, high TIBC
Low transferrin saturation can be thought of as fewer binding spots taken up by iron, low ferritin can suggest less iron has been stored, and a high TIBC means there are more binding spots free for iron to take up, therefore suggesting low iron in the body.
Treatment for oesophageal varicies:
Variceal band ligation is the NICE recommended method of stopping oesophageal variceal bleeding. Sengstaken tube and TIPSS is recommended if this fails. Propranolol is used as bleeding prophylaxis.
Contralateral homonymous hemianopia with macular sparing and visual agnosia which artery is occluded?
Posterior cerebral artery
First line test for acromegaly?
Serum IGF-1 levels are now the first-line test for acromegaly
Gonorrhoea tx
Intramuscular ceftriaxone is the treatment of choice for Gonorrhoea
PE treatment if pregnant?
LMWH
Apixaban is teratogenic
How does hypophosphataemia present?
May result in significant muscle weakness, including myocardial muscle (→ cardiac failure) and the diaphragm (→ respiratory failure).
Cardiac Dysfunction: Hypophosphatemia can impair myocardial contractility, leading to heart failure. It may also cause arrhythmias due to its role in maintaining normal cellular electrophysiology.
Respiratory Failure: Phosphate is essential for ATP production, necessary for respiratory muscle function. Severe hypophosphatemia can lead to muscle weakness, including the diaphragm and intercostal muscles, potentially resulting in acute respiratory failure.
Neurological Complications: These can range from confusion and seizures to coma, attributable to disturbed ATP metabolism in the central nervous system.
Haematological Effects: Reduced 2,3-diphosphoglycerate levels in erythrocytes affect oxygen release from haemoglobin, leading to tissue hypoxia. Hypophosphatemia can also result in hemolysis.
Rhabdomyolysis: Phosphate depletion impairs ATP production in muscles, which can lead to muscle breakdown and rhabdomyolysis.
Patients with GORD being considered for fundoplication surgery require what first?
Oesophageal pH and manometry studies
Antibiotic treatments for meningitis?
Less than three months or over 50yrs = IV cefotaxime + amoxicillin
3months - 50yrs give IV cefotaxime (or ceftriaxone).
If two pills are missed, between days 8-14 of the cycle, no emergency contraception is required, as long as the previous 7 days of COCP have been taken correctly
If two pills are missed, between days 8-14 of the cycle, no emergency contraception is required, as long as the previous 7 days of COCP have been taken correctly
If a patient with a STEMI is too far from a PCI centre how should the be managed?
Fibrinolysis (with streptokinase) + fondaparinux.
Fibrinolysis is given immediately with fibrinolytic agents e.g. streptokinase. An antithrombin like fondaparinux is given with fibrinolysis.
Severe campylobacter infection give…
Clarithromycin
Adverse effects of tamoxifen:
Menstrual disturbance: vaginal bleeding, amenorrhoea
Hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
Venous thromboembolism
Endometrial cancer
Hydroxychloroquine - may result in a severe and permanent retinopathy
Hydroxychloroquine - may result in a severe and permanent retinopathy
H.pylori is associated with what haematological malignancy?
MALT lymphoma: this is a cancer that arises from the mucosal-associated lymphoid tissue. It is a response to chronic Helicobacter pylori infection.
Coeliacs disease is associated with what haematological malignancy?
EATL: Coeliac disease increases the risk of developing enteropathy-associated T cell lymphoma
Anti-GBM disease typically presents with what?
Anti-GBM disease typically presents with haemoptysis + AKI/proteinuria/haematuria
TB diagnosis
Sputum culture
Chvostek’s sign =
Hypocalcaemia, tapping over parotid (CN7) causes facial muscles to twitch
Reducing dietary sodium is a key intervention in patients with ascites
Reducing dietary sodium is a key intervention in patients with ascites
When is Tamsulosin recommended for use in kidney stones?
NICE recommend these are considered for distal ureteric stones less than 10 mm in size
Renal stones management:
Simplified first-line NICE guidance (please see guidelines for more details) NICE
Renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
Uretic stones
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
Hba1c range for pre-diabetes
prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)
Reducing dietary sodium is a key intervention in patients with ascites + alcohol cessation.
Reducing dietary sodium is a key intervention in patients with ascites + alcohol cessation.
CML tx
Imantinib
Assessing correlation
Correlation
parametric (normally distributed): Pearson’s coefficient
non-parametric: Spearman’s coefficient
Treatment for vaginal vault prolapse
The treatment for vaginal vault prolapse is sacrocolpoplexy
Primary hyperparathyroidism is most commonly due to what?
A solitary adenoma`
A wide-based gait with loss of heel to toe walking =
Ataxic gait
Most common location of an ectopic
97% are tubal, with most in ampulla
Thiazide diuretics cause what electrolyte abnormalities?
Hyponatraemia
Hypokalaemia
Hypercalcaemia
Infectious diseases case: fever on alternating days, think what…?
Malaria
Sepsis ABG shows what?
Metabolic acidosis with a raised anion gap.
Patients who have sepsis often have a raised serum lactate due to the hypoperfusion of their peripheries. This gives them a metabolic acidosis with a raised anion gap.
Explain the most common inherited bleeding disorder:
The most common inherited bleeding disorder is Haemophilia A which is caused by a deficiency in factor VIII.
Treat what first in folate and B12 deficiency?
B12
The vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord
Publication bias
When studies with negative results aren’t published.
Urinary 5-HIAA is the investigation of choice for…
Carcinoid tumours
- Usually occurs when metastases are present in the liver and release serotonin into the systemic circulation. Presents with flushing diarrhoea and bronchospasm.
Cocaine causes chest pain give what?
Benzodiazepines + GTN
Causes of drug induced lupus?
Most common causes
Procainamide
hydralazine
Less common causes
isoniazid
minocycline
phenytoin
Rates of breast cancer screening:
Every 3 years for women 50-70yrs
Tx for type A aortic dissection
Labetalol + surgery
Extra renal manifestations of ADPKD:
liver cysts (70% - the commonest extra-renal manifestation): may cause hepatomegaly
berry aneurysms (8%): rupture can cause subarachnoid haemorrhage
cardiovascular system: MITRAL VALVE PROLAPSE, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
cysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary
Management of TIA on a patient on warfarin:
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be admitted immediately for imaging to exclude a haemorrhage
Red eye - glaucoma or uveitis?
glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush
Whooping cough tx
Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days
Peripheral arterial disease with critical limb ischaemia: high-risk patients with short segment stenosis are more suited to endovascular revascularization rather than open bypass.
- what’s the cut off?
> 10cm stenosis
High risk of pre-eclampsia give what when?
A woman at moderate or high risk of pre-eclampsia should take aspirin 75-150mg daily from 12 weeks gestation until the birth.
DVLA advice post MI rules?
Cannot drive for 4 weeks
One week for successfully treated by angioplasty.
What murmur is seen in HOCM?
- what are it’s features?
HOCM may present with ejection systolic murmur, louder on performing Valsalva and quieter on squatting
What is meant by a ‘subcapital fracture’
A subcapital fracture is the commonest type of intracapsular fracture of the proximal femur.
What determines severity in tetralogy of fallot?
Tetralogy of Fallot: the severity of the right ventricular outflow tract obstruction (pulmonary stenosis) determines the degree of cyanosis and clinical severity.
What bloods are seen in antiphospholipid syndrome?
Antiphospholipid syndrome: (paradoxically) prolonged APTT + low platelets
What anaesthetic agent is preferred in haemodynamically unstable patients?
Ketamine
Dry ARMD tx
High dose of beta-carotene, vitamins C and E, and zinc can be given to slow deterioration of visual loss.
Anti-veg F for wet amd only!!!!
IgA deficiency increases the risk of anaphylactic blood transfusion reactions
IgA deficiency increases the risk of anaphylactic blood transfusion reactions
Mild rosacea give…
Brimonidine gel
For patients with rosacea with predominant flushing but limited telangiectasia, consider prescribing brimonidine gel.
PSC is associated with what antibodies?
PSC is associated with anti-neutrophil cytoplasmic antibodies (ANCA) and anti-smooth muscle cell antibodies.
Limited systemic sclerosis antibodies…?
Limited (central) systemic sclerosis = anti-centromere antibodies
Key features of polymyalgia rheumatic:
- features
- inv
-management
- Stiff and painful but 5/5 power!
- Raised ESR, normal CK!
- Pred - should have dramatic responseH
Haemochromatosis monitoring
Ferritin and transferrin saturation
Why does a varicocele develop in RCC?
Left sided varicocele (due to occlusion of left testicular vein)
Haematuria 2ww guidelines
Aged >= 45 years AND:
unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection
Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test
Management of a ‘septated ovarian cyst’
Complex (i.e. multi-loculated) ovarian cysts should be biopsied with high suspicion of ovarian malignancy.
COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features, do what?
→ add a LABA + LAMA
Disproportionate microcytic anaemia - think
Beta-thalassaemia trait
Raised HbA2
ECG finding for cardiac tamponade
cardiac tamponade will have a phenomenon called ‘electric alternans’- beat to beat variation in electrical amplitude.
Posterior MI ECG presentation?
Posterior MI typically present on ECG with tall R waves V1-2
Restless leg syndrome tx
Restless leg syndrome - management includes dopamine agonists such as ropinirole
A 19-year-old lady is admitted with lower abdominal pain. On examination she is diffusely tender. A laparoscopy is performed and at operation multiple fine adhesions are noted between the liver and abdominal wall. Her appendix is normal.
- diagnosis?
This is Fitz Hugh Curtis syndrome in which pelvic inflammatory disease (usually Chlamydia) causes the formation of fine peri hepatic adhesions.
Indications for steroids in sarcoidosis
Indications for corticosteroid treatment for sarcoidosis are: parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement.
Liver disease + ANA/SMA/LKM1 antibodies, raised IgG levels =
Auto-immune hepatitis
What is considered a normal anion gap?
10-18mmol
Pathophysiology of seborrhoeic dermatitis
Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population.
Treatment of seborrhoeic dermatitis:
Scalp disease management
First-line treatment is ketoconazole 2% shampoo
over the counter preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) may be used if ketoconazole is not appropriate or acceptable to the person.
Face and body management
Topical antifungals: e.g. ketoconazole
Topical steroids: best used for short periods
Difficult to treat - recurrences are common
Baby under 3 months old needs what inv?
Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present
Management of thyrotoxic crisis
Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone
BRCA2 mutation is associated with what cancer in men?
Prostate
Pepperpot skull is a characteristic X-ray finding of
Hyperparathyroidism
Management of primary hyperaldosteronism
Spironolactone
Growth failure, tachycardia and tachypnoea in the context of weak femoral pulses think
CoA
What is TACO and what is TRALI and how to differentiate them?
Transfusion-associated circulatory overload (TACO) - pulmonary oedema + HYPERtension = slow / stop transfusion, consider oxygen and furosemide.
Transfusion-related acute lung injury (TRALI) - Hypoxia, pulmonary infiltrates on chest x-ray, fever, HYPOtension = oxygen and escalate.
When to use CPAP or BIPAP in an exacerbation of COPD?
CPAP maintains open airways and supports oxygenation through constant air pressure delivery but does not assist in carbon dioxide removal as effectively as BiPAP, which mimics natural breathing patterns and thus aids both in oxygenation and CO2 elimination. CPAP is more suited for managing type 1 respiratory failure—defined by a PaO2 less than 8 kPa with normal PaCO2 levels—as seen in conditions such as acute heart failure or moderate-to-severe obstructive sleep apnoea.
This patient exhibits respiratory acidosis, characterised by a pH of less than 7.35 and a PaCO2 greater than 6 kPa, alongside type 2 respiratory failure, indicated by normal or reduced PaO2 with a PaCO2 exceeding 6 kPa. Given that these conditions have persisted despite optimal medical management, non-invasive ventilation (NIV) is warranted. The patient’s current ventilatory support is inadequate for the elimination of excess CO2. BiPAP is the most frequently utilised form of NIV for acute exacerbations of chronic obstructive pulmonary disease (COPD), as it prevents the rebreathing of exhaled gases, facilitates the reduction of CO2 retention, and more effectively ameliorates acid-base disturbances compared to continuous positive airway pressure (CPAP). Thus, BiPAP stands as the preferred modality for managing type 2 respiratory failure in this context. A pH below 7.25 would necessitate consideration for either intubation or admission to a high-dependency unit (HDU); however, this patient’s clinical parameters do not indicate such measures.
Severe cellulitis tx
Severe cellulitis should be treated with co-amoxiclav, cefuroxime, clindamycin or ceftriaxone
What type of ovarian pathology leads to Meig’s syndrome?
Fibroma
Meigs’ syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion
Most common organism that causes SBP?
Spontaneous bacterial peritonitis: most common organism = E. coli
Slapped cheek = organism
Parvovirus B19
Inv for palps?
- Initial bloods and ECG
- Holter monitor
Coa presentation
- murmur?
Coarctation of the aorta: acute circulatory collapse at 2 days of age when the duct closes- heart failure & absent femoral pulses. Systolic murmur heard under the left clavicle and over the back.
Superficial thrombophlebitis tx
Compression stockings
Intravenous drug users with infective endocarditis and back pain.
- what’s causing the back pain?
Discitis
Treatment for seborrhoeic dermatitis?
Seborrhoeic dermatitis - first-line treatment is topical ketoconazole
(SD is caused by an inflammatory reaction to Malassezia furfur).
There are two main tests used to compare two sets of observations. What are they and when is each used?
Non-normally distributed data → Wilcoxon signed-rank test
Normally distributed data → Paired t-test
Absence of blast cells indicates what with regards to haematological malignancies?
Absence of blast cells indicates this is not acute leukaemia.
How does kawasaki disease typically present?
Kawasaki disease is a systemic vasculitis that generally presents in the under 5s. Typical findings, as seen in this case, include an acute febrile illness lasting over 5 days, bilateral non-purulent conjunctivitis, unilateral cervical lymphadenopathy, a polymorphic rash, and mucosal erythema with a strawberry tongue. Swelling of the hands and feet can occur in the acute stage with desquamation in the second week. Coronary aneurysms can develop in up to one-quarter of untreated patients.
How can carcinoid syndrome affect the heart?
Carcinoid syndrome can affect the right side of the heart. The valvular effects are tricuspid insufficiency and pulmonary stenosis.
TIPS!
What is Kocher’s criteria?
Likelihood of septic arthritis in children:
Inability to bear weight - 1 point
Fever > 38.5ºC - 1 point
White blood cell count (WCC) > 12 10^9/L - 1 point
Erythrocyte sedimentation rate (ESR) > 40 mm/hr - 1 point
What is topical chloramphenicol?
Eye drop antibiotic - given in cases of abraison.
Overdose with a wide QRS suspect…
Tricyclic overdose - give IV sodium bicarb
When should statins be taken?
Statins should be taken at night as this is when the majority of cholesterol synthesis takes place. This is especially true for simvastatin which has a shorter half-life than other statins.
How is Boerrhaaves syndrome diagnosed?
CT contrast swallow is the investigation of choice for suspected Boerhaave’s syndrome.
How is Boerrhaaves syndrome treated?
Treatment is with thoracotomy and lavage, if less than 12 hours after onset then primary repair is usually feasible, surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin.
Approach to insulin in DKA?
Start FIXED-rate insulin, continue regular long-acting insulin, and stop regular short-acting insulin
A rare but recognised complication of corticosteroid therapy is steroid psychosis
A rare but recognised complication of corticosteroid therapy is steroid psychosis
PLS check what pulses?
Paediatric BLS: In an infant, the appropriate places to check for a pulse are the brachial and femoral arteries.
Describe the rash seen in dermatitis herpetiformis.
- you struggle to identify it from photos
Itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
- manage with gluten free diet and dapsone.
Subclinical hyperthyroidism is associated with what?
Atrial fibrillation
Osteoporosis
Dementia
Avoid what antiemetic in bowel obstruction?
Avoid metoclopramide in bowel obstruction
Cholangiocarcinoma tumour marker?
Ca 19-9
Unfractionated heparin does what?
Activates antithrombin III
Abdominal pain, constipation, neuropsychiatric features, basophilic stippling =
Lead poisoning
What are the features of juvenile myoclonic epilepsy?
Juvenile myoclonic epilepsy is classically associated with seizures in the morning/following sleep deprivation.
