Finals Flashcards
Acute pancreatitis Investigations
USS abdo for cause
then CT Abdo with contrast
Which nerves are affected by vestibular schwannoma
CN V VII VIII
Vomiting ABG
High Cl, Low K, Metabolic alkalosis, raised anion gap
Difference between Fe def anaemia and chronic disease anaemia
TIBC high in Fe def, TIBC low in chronic disease
CNIII Palsy
Surgical mx if pupil unreactive –> CT head
Medical if reactive pupil
When is a GLP-1 mimetic used
T2DM when pt is obese and on dual/triple therapy
Pre-diabetic and obese
eGFR that Metformin is CI
<30, use sulfonylurea instead
Mx of inguinal hernia in infant
Surgery ASAP
Crohn’s Mx
Acute - Pred, Biologics 2nd
Maintenance - Azathioprine or Mercaptopurine
Anorexia Changes
Everything low except G and C
High GH, Glucose, Saliva Glands
High Cortisol, CHolesterol, Carotinaemia
CKD Dx
Urinary ACR –> need early morning sample
Elevating the testis - Torsion vs Epidimitis
Torsion - pain NOT relieved
Epididimitis - pain RELIEVED
Most common cause of Viral Encephalitis
HSV
Htn + ACR > 30
Ramipril / ACEi
Cirpofloxacin s/e
Lowers seizure threshold
AAA presentation
Abdo pain, ? mimic renal colic
Hypotension and shocked, + abdo guarding
Pericarditis 1st line Mx
Ibuprofen + colchicene
OGT in pregnancy
24 - 28 wks
Mesenteric Adenitis
Inflamed lymph nodes in mesentery. Similar sx to appendicitis but follows viral infection. ?enlarged lymph nodes
Neuroleptic Malignant Syndrome
Sx - Pyrexia, muscle rigidity, autonomic lability (htn, tachy HR and RR)
Raised CK
Mx: sop antipsychotic, give IV fluid and dantrolene
Trastuzumab use
HER2 positive
Monoclonal Ab targets HER2 receptors
Tamoxifen
ER/PR positive disease
SERM - 1st line in men or pre-menopausal women
Risk: clot, endometrial Ca, osteoporosis
Anastrozole / Letrozole
ER/PR positive
Aromatase Inhibitor - used 1st line in post-menopausal women
S/E - menopausal sx, osteoporosis, MSK pain
AML
Dx >75yr
Film - Auer rods, myeloid blast cells
ALL
Dx - 2-5yr
Film - Blast cells
Philadelphia chromosome
CML
Dx >65 yr
Philadelphia Chromosome
Splenomegaly
3 phases -
Chronic (last 5yrs, asymptomatic),
Accelerated (abnormal blast cells take up high proportion of blood = anaemia + thrombocytopenia),
Blast = V high proportion of blast cells = severe pancytopenia
CLL
Dx >55yr
Film - smear or smudge cells
Richter’s transformation - CLL progresses to high-grade lymphoma
Temporal lobe focal seizure
Aura, racing feeling in stomach, writhing movements
Cataplexy
Transient loss of tone / collapse with strong emotion
Extradural Haematoma bleed in which vessel
Middle Meningeal Artery
Lymphogranuloma Vereneum
MSM
Proctitis
Lymphadenopathy
Cellulitis commonest organism
Strep Pyogenes
Thrombophlebitis Mx
NSAID
Gilbert’s
Isolated high Bili in response to physiological stress
Anal Fissure Mx
Stool softener, diltiazem topical, botox, GTN
Total Anterior Circulation Stroke
Unilateral weakness or sensory defecit in face +/- arm +/- leg
AND homonomous hemianopia
AND higher cerebral dysfunction
Lacunar stroke
Pure motor hemiparesis or pure sensory hemiparesis or ataxic hemiparesis or dysarthria-clumsy hand, sensorimotor
Posterior Stroke
Brainstem or cerebellar syndrome, LOC, isolated HH
Weber’s Syndrome
Midbrain Stroke, Ipsilateral CN III palsy + contralateral hemiparesis
Posterior Inferior Cerebellar Artery
(Wallenburg / Lateral Medullary Syndrome)
Ipsilateral facial pain and temperature loss
Contralateral limb / torso pain and temp loss
Ataxia and nystagmus
Anterior Inferior Cerebella Artery
Ipsilateral facial paralysis and deafness
Plus
Ipsilateral facial pain and temperature loss
Contralateral limb / torso pain and temp loss
Ataxia and nystagmus
Wellen’s
Resolved CP
Deep T wave inversion in V2-V3
Critical LAD stenosis
Bifasicular block
RBBB with L Axis deviation
Trifasicular block
RBBB + L axis deviation + 1st degree heart block (prolonged PR)
Pneumothorax
Primary - >2cm or sx then needle aspirate, <2cm or no sx d/c
Secondary - >2cm drain, 1-2cm aspirate, <1cm O2 and admit 24hr
Granulomatous Polyangitis
Kidney, Respiratory and ENT problems
cANCA positive
Transudate vs Exudate effusion
Transudate <30g/L protein
Exudate >30g/L protein
Antibodies in hepatitis - acute or chronic infection
IgM = Acute, IgG = chronic
Sister Mary Joseph Nodule
Gastric ca. metastasises to the peri-umbilical LN
HNPCC and FAP genes
HNPCC - MSH2 MLH1
FAP - APC
MALT
H.Pylori and Lymphoma
EATL
Enteropathy associated T-cell lymphoma –> associated with coealic
Difference between Haemolytic crisis, Aplastic crisis, Sequestrian crisis SickleCell
Aplastic - reduced reticulocytes, high WBC, low RBC, Parvovirus infection
Sequestrian - increased reticulocytes, Blood pools in organs due to sickling, high reticulocytes compensate for RBC loss
Haemolytic - rare, jaundice, pain, low RBC, splenomegaly
Alcoholic Hepatitis Bloods
High CRP, High WCC
High Bilirubin, AST > ALT
Massive PE and hypotension management
THrombolysis
Hereditary Spherocytosis
AD condition
Neonatal jaundice, chronic sx, gallstones, splenomegaly
Electrical Alternans
ALternation of QRS amplitude associated with cardiac tamponade
Hypocalcaemia
Muscle cramps and paraesthesia
Trousseau sign (flex of wrist on BP monitoring)
QT prolonged
Peripheral Arterial disease Meds
Atorvastatin and Clopidogrel
Achalasia Mx
Heller Cardiomyotomy
Bladder Cancer Mx
TURBT
Intravesical treatment - BCG or mitomycin C
Rotator Cuff Muscles
Supraspinatus - abduction
Infraspinatus - ext rotation
Teres minor - ext rotation + adduction
Subscapularis - int rotation + adduction
DKA resolution
pH >7.3
Ketones <0.6
Bicarb >15
Kleinefelter and Kallman
Klinefelter (47XXY)= High LH low testosterone
Kallman (failed migration of GnRH neurons)- anosmia, low-norm LH & FSH, low testosterone
Phaechromocytoma
Give Phenoxybenzamine before B-Blocker
Sx: palpitations, tremor, headache
Ix: Htn ++, high urinary metanephrines
Quadrantopia
PITS - parietal inferior, temporal superior
COCP and cancer
Protective against ovarian and endometrial
Increased risk cervical and breast cancer
SIADH
hyponatraemia, hypo-osmolar serum, hyperosmolar urine, high urinary sodium
ASpirin OD
Resp alkalosis
then metabolic acidosis
Ix to Diagnose and monitor liver cirrhosis
Transient Elastography
Acute Interstitial Nephritis
Allergic picture
Fever, rash, arthralgia
Sterile pyuria, White cell casts in urine, Eosinophila
Autoimmune haemolytic anaemia
Raised unconj. bilirubin
Raised LDH
Mycoplasma pneumonia infection with anaemia