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February Flashcards

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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
Minor criteria for rheumatic heart disease
Pyrexia Raised ESR or CRP Arthralgia Prolonged PR interval
26
Management of rheumatic heart failure
Oral penicillin V Anti-inflammatories - NSAIDs Manage any complications - heart failure
27
What condition is associated with Councilman bodies?
hepatitis C, yellow fever
28
What condition is associated with Mallory bodies?
Alcoholism
29
What condition is associated with Call-Exner bodies?
Granulosa cell tumour
30
What is associated with Schiller Duval bodies?
Yolk sac tumour
31
Management of Eisenmenger's syndrome?
Heart-lung transplant
32
Features of Eisenmenger's syndrome
``` original murmur may disappear cyanosis clubbing right ventricular failure haemoptysis, embolism CONGENITAL CONDITION - reversal of left to right shunt ```
33
Associations with Eisenmenger's
ASD VSD PDA
34
Why is a loading dose of amiodarone required when attempting chemical cardioversion?
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.
35
Adverse effects of amiodarone
``` 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 ```
36
Key feature of left-sided heart failure
Paroxysmal nocturl dyspnoea
37
What is paroxysmal nocturnal dyspnoea?
Sudden waking at night SOB
38
Signs of right-sided heart failure
Raised JVP Ankle oedema Hepatomegaly
39
Systemic vascular resistance =
Cardiac output divided by Mean Areterial Pressure
40
Which drugs reduce the antihypetensive effects of ACEi?
NSAIDs
41
What is Brugada syndrome?
Autosomal dominant cause of sudden cardiac death in the young
42
What is Chaga's disease?
Paraasytic disease occurs in South America causing ventricular damage
43
What signs are associated with Hypertrophic Obstructive Cardiomyopathy? HOCM
Exertional dyspnoea Syncope Chest pain
44
What is the leading cause of sudden cardiac death in young patients?
HOCM
45
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?
HOCM
46
Name an adverse effect of thiazide diuretics
Hyponatraemia
47
Features of heart block
``` syncope heart failure regular bradycardia (30-50 bpm) wide pulse pressure JVP: cannon waves in neck variable intensity of S1 ```
48
Contraindications of nicorandil
Left ventricular heart failure (pulmonary oedema)
49
Why does nicorandil complicate the management of acute pulmonary oedema?
Causes hypotension
50
Adverse effects of nicorandil
headache flushing anal ulceration
51
Mechanism of action of nicorandil
Potassium channel activaton | vasodilation is through activation of guanylyl cyclase which results in increase cGMP.
52
In which condition is nicorandil used to medicate?
Angina
53
Mainstay therapy for acute pulmonary oedema?
Oxygen Nitrates Morphine Furosemide
54
Most common cause of secondary hypertension?
Renal disease
55
What is indicated by a continuous machine like murmur in a newborn?
Patent ductus arteriosus
56
Symptoms of peripheral arterial disease
``` Asymptomatic Claudication (leg cramping relieved at rest) Leg pain at rest Ulceration Gangrene ```
57
Signs of peripheral arterial disease
``` Absent leg and foot pulses Cold white legs Atrophic skin Arterial ulcers Long capillary filling time ```
58
First line investigation of peripheral arterial disease
Ankle Brachial Pressure Index ABPI
59
Investigations for peripheral arterial disease
ABPI Imaging - Colour duplex ultrasound MR/CT angiography if considering intervention
60
Management of peripheral arterial disease
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
Signs of transposition of the great arteries
``` cyanosis tachypnoea loud single S2 prominent right ventricular impulse 'egg-on-side' appearance on chest x-ray ```
62
Management of transposition of great arteries
Maintain ductus arteriosus with prostaglandin | Surgical correction
63
Equation to calculate pack years
Number of cigarettes per day / 20 x Years of smoking
64
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?
Infection Empyema Rheumatoid arthritis Malignancy
65
Causes of transudates
Cirrhosis Cardiac failure Nephrotic syndrome Constrictive pericarditis
66
Causes of exudates
Pneumonia Malignancy Mesothelioma Rheumatoid arthritis
67
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?
Mesothelioma | Asbestos - occupational exposure
68
Complication of lung biopsy?
Pneumothorax
69
What investigation is reuqired prior to ultrasound guided biopsy of lung?
Spirometry | Full blood count - platelets
70
Factors increasing fluid overload
``` Heart failure Cirrhosis Chronic Kidney disease (CKD) Perpheral Vascular Disease Diabetes Pregnancy Elderly Malnourished ```
71
Mediastinal widening on chest X-ray, ST elevation in leads II, III, and aVF - diagnosis?
Aortic dissection
72
Patient presents with hypertension, tearing chest pain and aortic regurgitation - what is the diagnosis?
Aortic dissection
73
Key finding of aortic dissection on CT
False lumen of descending aorta
74
Broca’s area is supplied by which artery?
Middle cerebral
75
Mechanism of action in calcium channel blockers eg amlodipine
Blocks opening of voltage depending calcium channels in smooth muscle decreasing peripheral vascular resistance
76
Hydralazine mechanism of action
Elevates cGMP leading to relaxation of arterioles more so than veins
77
Which substance reduces absorption of ACE inhibitors
Antacids
78
Mechanism of action of dipyridamole
Non specific phosphodiesterase inhibitor. Inhibits uptake of adenosine
79
Indication of dipyridamole
Anti platelet | Taken with aspirin in ischaemic stroke and TIA
80
Drugs that interact with warfarin
Cytochrome p450 inhibitors | Eg NSAIDS, SSRIs, amiodarone and antibiotics
81
Name a cause of pulsatile hepatomegaly
Tricuspid regurgitation
82
What is Antiphospholipid syndrome and what does it provoke?
Autoimmune, hypercoagulable condition - promotes arterial and venous blood clots
83
Pregnancy related complications of antiphospholipid syndrome?
Still birth Miscarriage Preterm delivery Severe pre-eclampsia
84
Diagnostic criteria for Antiphospholipid syndrome
One event | 2 positive blood tests spaced 3 months apart
85
Which anitbodies are positive for antiphospholipid syndrome?
Lupus anticoagulant Anti-cardiolipin anti-B2-glycoprotein
86
What other autoimmune disease can antiphospholipid syndrome occur secondary to?
Systemic Lupus Erythematosus
87
Rapid organ failure and generalised thrombosis due to antiphospholipid syndrome is known as
Catastrophic Antiphospholipid Syndrome
88
How is antiphospholipid syndrome treated?
Using anticoagulants eg heparin (warfarin teratogenic)
89
Aflatoxin is a carcinogen associated with which cancer?
Hepatocellular carcinoma
90
Analine dyes are a carcinogen associated with which cancer?
Bladder cancer
91
Vinyl chloride is a carcinogen associated with which cancer?
Hepatic angiosarcoma
92
Asbestos is a carcinogen associated with which cancer?
Mesothelioma | Bronchial carcinoma
93
Nitrosamines are carcinogens associated with which cancer?
Oesophageal | Gastric
94
Crisis management for sickle cell disease
``` Analgesia Rehydrate Oxygen Antibiotics Blood transfusion Exchange transfusion - if neurological complications ```
95
Long-term management for sickle cell disease
Hydroxyurea- increase HbF levels - prevent painful crises | Pneumococcal polysaccharide vaccine every 5 years- according to NICE CKs
96
Causes of iron-deficiency anaemia
``` Menorrhagia Gastro-intestinal bleed (e.g. cancer) Malabsorption (e.g. coeliac disease) Physiological change (e.g. pregnancy) Diets (vegetarian/vegan) Hookworm ```
97
Management of iron deficiency anaemia
Oral Ferrous sulphate Take 3 months after corrected to replenish stores Diet
98
Side effects of iron supplements
Nausea Abdo pain Diarrhoea Constipation
99
A man presents with abdominal pain and is found to have splenic atrophy. Which condition is he likely to have?
Coeliac disease
100
Treatment for Non-Hodgkin's lymphoma
``` R-CHOP chemotherapy regime Rituximab Cyclophosphamide doxorubicin Vincristine Prednisolone ```

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