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Finals random > February > Flashcards

February Flashcards

1
Q

Key signs you want to look for in someone undergoing chemotherapy

A

Neutropenic sepsis - count less than 1 and features of sepsis (hypotension, tachycardia) with or without fever
Neutropenia less than 1
Less than 0.5
Febrile neutropenia

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2
Q

Who are at risk of neutropenic sepsis?

A 
Patients with haematological cancers
Chemotherapy patients
Transplant
Medications - sulfasalazine, carbimazole, cotrimoxazole
Myelofibrosis
Myelodysplasia
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3
Q

Key time frame in developing neutropenic sepsis when undergoing chemotherapy

A

Days 7 to 21

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4
Q

Which antibiotic to give in sepsis?

A

Tazocin

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5
Q

Which antibiotics will you administer with higher news score?

A

Tazocin and Gentamicin

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6
Q

Which antibiotic would you give in septic shock?

A

Meropenam

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7
Q

What indicates severe sepsis?

A

Multi organ failure - renal and liver function alongside neutrophils and CRP

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8
Q

What would you consider in escalating a patient in severe sepsis?

A 
Gentamicin
IV fluids
 HDU/ITU
Senior help
DNA CPR
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9
Q

Most common site of spinal cord compression

A

Thoracic spine

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10
Q

Cancers associated with spinal cord compression

A

Breast, prostate, lung

Any cancer spreading to bone

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11
Q

MRI is classic investigation for spinal cord compression. Why are patients placed on bed rest when investigating malignant spinal cord compression?

A

Instability of the spine is a concern

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12
Q

What is the biggest indicator of prognosis when diagnosed with malignant spinal cord compression?

A

If ambulatory at diagnosis
90% will stay ambulatory
If not, only 10% will return to mobile

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13
Q

Superior Vena cava obstruction

A 
Main causes malignant
Shortness of breath
Facial and arm swelling
Headaches
Dizziness
Fatigue
Weight loss

Fixed elevated JVP
Oedema
Peripheral cyanosis

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14
Q

Patient with cancer presents with confusion - possible causes

A

Hypercalcaemia

Brain mets

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15
Q

Treating hypercalcaemia

A 
Check PTH if cause unclear
Rehydration
Bisphosphonates
Calcitonin
Steroids if needed
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16
Q

Treating hypercalcaemia

A 
Check PTH if cause unclear
Rehydration
Bisphosphonates
Calcitonin
Steroids if needed
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17
Q

4 oncological emergencies

A

Neutropenic sepsis
Malignant spinal cord compression
Hypercalcaemia
Superior Vena Cava Obstruction

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18
Q

What are Aschoff bodies?

A

Granulomas with giant cells

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19
Q

In what condition would aschoff bodies be found?

A

Rheumatic heart disease

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20
Q

Which valve is most commonly affect in Rheumatic heart disease?

A

Mitral

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21
Q

What type of murmur is heard in rheumatic heart disease?

A

High pitched ,Holosystolic, loudest in apex, radiates to axilla
Indicates mitral

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22
Q

What is indicated by an Antistrepsylin O titres and what condition might you associate with it?

A

Exposure to streptococcus group A

Rheumatic heart disease - streptococcus pyogenes

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23
Q

How is Rheumatic heart disease diagnosed?

A

Need 2 major criteria

Or one major and 2 minor

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24
Q

Major criteria for rheumatic heart disease

A

erythema marginatum
Sydenham’s chorea: this is often a late feature
polyarthritis
carditis and valvulitis (eg, pancarditis)
The latest iteration of the Jones criteria (published in 2015) state that rheumatic carditis cannot be based on pericarditis or myocarditis alone and that there must be evidence of endocarditis (the clinical correlate of which is valvulitis which manifests as a regurgitant murmur)
subcutaneous nodules

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25
Q

Minor criteria for rheumatic heart disease

A

Pyrexia
Raised ESR or CRP
Arthralgia
Prolonged PR interval

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26
Q

Management of rheumatic heart failure

A

Oral penicillin V
Anti-inflammatories - NSAIDs
Manage any complications - heart failure

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27
Q

What condition is associated with Councilman bodies?

A

hepatitis C, yellow fever

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28
Q

What condition is associated with Mallory bodies?

A

Alcoholism

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29
Q

What condition is associated with Call-Exner bodies?

A

Granulosa cell tumour

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30
Q

What is associated with Schiller Duval bodies?

A

Yolk sac tumour

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31
Q

Management of Eisenmenger’s syndrome?

A

Heart-lung transplant

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32
Q

Features of Eisenmenger’s syndrome

A 
original murmur may disappear
cyanosis
clubbing
right ventricular failure
haemoptysis, embolism
CONGENITAL CONDITION - reversal of left to right shunt
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33
Q

Associations with Eisenmenger’s

A

ASD
VSD
PDA

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34
Q

Why is a loading dose of amiodarone required when attempting chemical cardioversion?

A

Long half-life is correct. Drugs with a long half-life are eliminated from the body slowly and only need a low maintenance dose to maintain appropriate therapeutic concentrations. However, this means that in the absence of a higher initial dose, it would take a long time for these drugs to reach a steady-state concentration.

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35
Q

Adverse effects of amiodarone

A 
thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
'slate-grey' appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval
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36
Q

Key feature of left-sided heart failure

A

Paroxysmal nocturl dyspnoea

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37
Q

What is paroxysmal nocturnal dyspnoea?

A

Sudden waking at night SOB

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38
Q

Signs of right-sided heart failure

A

Raised JVP
Ankle oedema
Hepatomegaly

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39
Q

Systemic vascular resistance =

A

Cardiac output divided by Mean Areterial Pressure

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40
Q

Which drugs reduce the antihypetensive effects of ACEi?

A

NSAIDs

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41
Q

What is Brugada syndrome?

A

Autosomal dominant cause of sudden cardiac death in the young

42
Q

What is Chaga’s disease?

A

Paraasytic disease occurs in South America causing ventricular damage

43
Q

What signs are associated with Hypertrophic Obstructive Cardiomyopathy? HOCM

A

Exertional dyspnoea
Syncope
Chest pain

44
Q

What is the leading cause of sudden cardiac death in young patients?

A

HOCM

45
Q

ECG taken on admission reveals sinus rhythm, with generalised deep Q waves and widespread T waves. There is evidence of left ventricular hypertrophy. What does this ECG indicate when young patient presents with exertional dyspnoea, syncope and chest pain?

A

HOCM

46
Q

Name an adverse effect of thiazide diuretics

A

Hyponatraemia

47
Q

Features of heart block

A 
syncope
heart failure
regular bradycardia (30-50 bpm)
wide pulse pressure
JVP: cannon waves in neck
variable intensity of S1
48
Q

Contraindications of nicorandil

A

Left ventricular heart failure (pulmonary oedema)

49
Q

Why does nicorandil complicate the management of acute pulmonary oedema?

A

Causes hypotension

50
Q

Adverse effects of nicorandil

A

headache
flushing
anal ulceration

51
Q

Mechanism of action of nicorandil

A

Potassium channel activaton

vasodilation is through activation of guanylyl cyclase which results in increase cGMP.

52
Q

In which condition is nicorandil used to medicate?

A

Angina

53
Q

Mainstay therapy for acute pulmonary oedema?

A

Oxygen
Nitrates
Morphine
Furosemide

54
Q

Most common cause of secondary hypertension?

A

Renal disease

55
Q

What is indicated by a continuous machine like murmur in a newborn?

A

Patent ductus arteriosus

56
Q

Symptoms of peripheral arterial disease

A 
Asymptomatic
Claudication (leg cramping relieved at rest)
Leg pain at rest
Ulceration
Gangrene
57
Q

Signs of peripheral arterial disease

A 
Absent leg and foot pulses
Cold white legs
Atrophic skin
Arterial ulcers
Long capillary filling time
58
Q

First line investigation of peripheral arterial disease

A

Ankle Brachial Pressure Index ABPI

59
Q

Investigations for peripheral arterial disease

A

ABPI
Imaging - Colour duplex ultrasound
MR/CT angiography if considering intervention

60
Q

Management of peripheral arterial disease

A

Risk factor modification e.g. smoking cessation, treat hypertension and high cholesterol, prescribe clopidogrel
Supervised exercise programs to increase blood flow
Percutaneous transluminal angioplasty
Surgical reconstruction i.e. bypass graft using the saphenous vein
Amputation

61
Q

Signs of transposition of the great arteries

A 
cyanosis
tachypnoea
loud single S2
prominent right ventricular impulse
'egg-on-side' appearance on chest x-ray
62
Q

Management of transposition of great arteries

A

Maintain ductus arteriosus with prostaglandin

Surgical correction

63
Q

Equation to calculate pack years

A

Number of cigarettes per day / 20 x Years of smoking

64
Q

In pleural effusion to determine whether fluid is transudate or exudate the aspiration must be compared to serum levels. What conditions could cause a low glucose in the pleural fluid?

A

Infection
Empyema
Rheumatoid arthritis
Malignancy

65
Q

Causes of transudates

A

Cirrhosis
Cardiac failure
Nephrotic syndrome
Constrictive pericarditis

66
Q

Causes of exudates

A

Pneumonia
Malignancy
Mesothelioma
Rheumatoid arthritis

67
Q

A CT chest was performed and reported as showing, “Enhancing, circumferential, nodular left pleural thickening involving the mediastinal pleura associated with reduced left lung volume”. What is the likely diagnosis and what question in the history would indicate its likelihood?

A

Mesothelioma

Asbestos - occupational exposure

68
Q

Complication of lung biopsy?

A

Pneumothorax

69
Q

What investigation is reuqired prior to ultrasound guided biopsy of lung?

A

Spirometry

Full blood count - platelets

70
Q

Factors increasing fluid overload

A 
Heart failure
Cirrhosis
Chronic Kidney disease (CKD)
Perpheral Vascular Disease
Diabetes
Pregnancy
Elderly
Malnourished
71
Q

Mediastinal widening on chest X-ray, ST elevation in leads II, III, and aVF - diagnosis?

A

Aortic dissection

72
Q

Patient presents with hypertension, tearing chest pain and aortic regurgitation - what is the diagnosis?

A

Aortic dissection

73
Q

Key finding of aortic dissection on CT

A

False lumen of descending aorta

74
Q

Broca’s area is supplied by which artery?

A

Middle cerebral

75
Q

Mechanism of action in calcium channel blockers eg amlodipine

A

Blocks opening of voltage depending calcium channels in smooth muscle decreasing peripheral vascular resistance

76
Q

Hydralazine mechanism of action

A

Elevates cGMP leading to relaxation of arterioles more so than veins

77
Q

Which substance reduces absorption of ACE inhibitors

A

Antacids

78
Q

Mechanism of action of dipyridamole

A

Non specific phosphodiesterase inhibitor. Inhibits uptake of adenosine

79
Q

Indication of dipyridamole

A

Anti platelet

Taken with aspirin in ischaemic stroke and TIA

80
Q

Drugs that interact with warfarin

A

Cytochrome p450 inhibitors

Eg NSAIDS, SSRIs, amiodarone and antibiotics

81
Q

Name a cause of pulsatile hepatomegaly

A

Tricuspid regurgitation

82
Q

What is Antiphospholipid syndrome and what does it provoke?

A

Autoimmune, hypercoagulable condition - promotes arterial and venous blood clots

83
Q

Pregnancy related complications of antiphospholipid syndrome?

A

Still birth
Miscarriage
Preterm delivery
Severe pre-eclampsia

84
Q

Diagnostic criteria for Antiphospholipid syndrome

A

One event

2 positive blood tests spaced 3 months apart

85
Q

Which anitbodies are positive for antiphospholipid syndrome?

A

Lupus anticoagulant
Anti-cardiolipin
anti-B2-glycoprotein

86
Q

What other autoimmune disease can antiphospholipid syndrome occur secondary to?

A

Systemic Lupus Erythematosus

87
Q

Rapid organ failure and generalised thrombosis due to antiphospholipid syndrome is known as

A

Catastrophic Antiphospholipid Syndrome

88
Q

How is antiphospholipid syndrome treated?

A

Using anticoagulants eg heparin (warfarin teratogenic)

89
Q

Aflatoxin is a carcinogen associated with which cancer?

A

Hepatocellular carcinoma

90
Q

Analine dyes are a carcinogen associated with which cancer?

A

Bladder cancer

91
Q

Vinyl chloride is a carcinogen associated with which cancer?

A

Hepatic angiosarcoma

92
Q

Asbestos is a carcinogen associated with which cancer?

A

Mesothelioma

Bronchial carcinoma

93
Q

Nitrosamines are carcinogens associated with which cancer?

A

Oesophageal

Gastric

94
Q

Crisis management for sickle cell disease

A 
Analgesia
Rehydrate
Oxygen
Antibiotics
Blood transfusion
Exchange transfusion - if neurological complications
95
Q

Long-term management for sickle cell disease

A

Hydroxyurea- increase HbF levels - prevent painful crises

Pneumococcal polysaccharide vaccine every 5 years- according to NICE CKs

96
Q

Causes of iron-deficiency anaemia

A 
Menorrhagia
Gastro-intestinal bleed (e.g. cancer)
Malabsorption (e.g. coeliac disease)
Physiological change (e.g. pregnancy)
Diets (vegetarian/vegan)
Hookworm
97
Q

Management of iron deficiency anaemia

A

Oral Ferrous sulphate
Take 3 months after corrected to replenish stores
Diet

98
Q

Side effects of iron supplements

A

Nausea
Abdo pain
Diarrhoea
Constipation

99
Q

A man presents with abdominal pain and is found to have splenic atrophy. Which condition is he likely to have?

A

Coeliac disease

100
Q

Treatment for Non-Hodgkin’s lymphoma

A 
R-CHOP chemotherapy regime
Rituximab
Cyclophosphamide
doxorubicin
Vincristine
Prednisolone

Finals random (5 decks)

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