FPE MED18 Flashcards by Hania Azraa

Features of complete heart block (4)

Syncope
Heart failure
Wide pulse pressure
Bradycardia

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Types of heart block and explain them (4)

First degree – prolonged PR interval
Second degree type 1: progressive prolongation and then drop.
Second degree type 2: consistently prolonged PR interval and then drop.
Third degree: no association between the p waves and the QRS complex.

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Management of heart block (4)

Atropine
Transcutaneous pacing
Transvenous pacing.
Permanent implantable pacemaker.

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Define orthostatic hypotension

A drop in BP (usually >20/10 mm Hg) within three minutes of standing.
“3, 2, 1 rule”
3 minutes, 20 drop in systolic, 10 drop in diastolic.

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List 4 medications that can cause falls

Acetylcholinesterase inhibitors
Antiarrhythmics
Anticholinergics
Antidepressant
Antihistamines
Antihypertensives
Antipsychotics
H2 blockers
Hypoglycaemics
Laxatives (in excess)
NSAIDs
Opioids
Polypharmacy
PPIs
Sedative hypnotics
Steroids

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List 4 other causes of loss of consciousness (apart from orthostatic hypotension)

Aortic stenosis
Dehydration
Hypoglycaemia
TIA/Stroke
Seizures

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List 4 malignanct causes of cervical lymphadenopathy

Lymphoma
Leukaemia
Nasopharyngeal carcinoma – SSC
Gastric cancer (supraclavicular)

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List 4 causes of lumps in the neck (apart from lymphoma)

Branchial cyst
Cystic hygroma
Thyroglossal cyst
Dermoid cyst
Lipoma

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What are 2 B symptoms

> 10% weight loss in the past 6 months
Night sweats
Temperature >38 degree celsius

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Describe this type of cell and describe it’s structure.

Reed-sternberg cell - large, abnormal lymphocytes (a type of white blood cell) that may contain more than one nucleus.
Mirror image cell

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Describe the staging of lymphoma and what additional tests must be done prior.

Ann Arbor staging (describe each stage)
CT, MRI, PET, Lymph node biopsy, LDH.

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What is an Odd’s ratio?

The odds ratio tells us how much higher the odds of exposure are among case-patients than among controls.
AD/CB

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List 2 immediate and 2 delayed reactions of blood transfusions

2 immediate: Anaphylaxis, acute haemolytic transfusion reaction, Acute GVHD, TACO, TRALI
2 delayed: Chronic GVHD and delayed haemolytic transfusion reaction

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List 4 types of prolapses

Uterocecole
Cystourethrocele
Vault prolapse
Uterine prolapse
Rectocele
Cystocele

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List 3 conservative and 3 non-conservative treatments for prolapses.

Conservative: weight loss, vaginal oestrogen cream, physiotherapy, vaginal pessaries.
Surgical: hysterectomy, mesh repair, posterior colporrhaphy (Rectocele)

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Name two examinations that must be completed when examining for prolapses.

Sims speculum examination
Cough test - to assess full descent of the prolapse
Dorsal and left lateral position to examine prolapse

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4 symptoms of prolapses

Heaviness in the abdomen
Urinary incontinence - frequency, urgengy, retention
Bowel incontinence - constipation
Altered sexual experience

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Investigations for someone presenting with incontinence

3 day bladder diary
Urine dipstick - to rule out infection
Urodynamic studies

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List four signs of Parkinson’s

Rigidity
Bradykinesia/Akinesia
Shuffling gait
Tremor

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Why would you use L-dopa and carbidopa instead of dopamine?

Carbidopa prevents levodopa being broken down in the peripheral nervous system.

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Why do patients with Parkinson’s get choreiform movements?

Due to fluctuating levels of dopamine and continued loss of dopamine producing cells

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Describe the pathophysiology of Parkinson’s.

Degeneration of dopamine neurons is particularly evident in a part of the substantia nigra called the pars compacta. Significantly, the loss of dopamine in the par’s compacta increases the overall excitatory drive in the basal ganglia,* disrupting voluntary motor control and causing the characteristic symptoms of PD.

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List 4 types of Parkinson’s medications and their mechanisms of action.

L-dopa - converted into dopamine in the brain
MAO-B inhibitors - sellegiline
COMT inhibitors - Tolcapone
Amantadine - MOA unknown.
Dopamine agonists - bromocriptine
Antimuscarinics - procyclidine

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Name 2 tests used for the screening of Down’s syndrome and the other conditions they test for.

Combined screening and quadrople testing
Patau’s (trisomy 13) and Edwards (trisomy 18)

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4 features of a good screening test

Inexpensive Sensitive Not harmful Easy to administer

List two features of Down's syndrome.

Single palmar crease Upslanting eyes Low set ears Flat face Epicanthic folds

How do VSDs cause tachypnoea?

Increased pulmonary blood flow leads to congestive heart failure causing tachynponea

Work out the maintence fluids to a 14 kg child.

1200ml

A child comes in with a barking cough, shortness of breath, tachycardia and poor feeding. A diagnosis of croup is made. What medication would you prescribe and at what dose? (Weight = 14kg)

Dexamethasone 0.15 mg/Kg = 2.1 mg

Name two viruses that cause croup.

Parainfluenza and RSV

How would you assess for the severity of croup?

Westley's croup severity score: Level of consciousness, cyanosis, stridor, air entry and retractions. <2 - mild 3-7 - moderate 8-11 - severe >12 - life threatening

List 2 symptoms of croup

Barking cough Fever Stridor Coryzal symptoms

List 2 medications used in severe croup

Dexamethasone, nebulised adrenalaine and nebulised budesonide

A male patient with a history of prostatic cancer presents to A&E with new onset lower back pain. What is your initial management of this patient?

Refer for urgent MRI within 24 hours Oral dex

List 3 findings you would see on MRI for spinal cord compression

Collapsed vertebral body Bone oedema Cord oedema

List two symptoms of metastatic spinal cord compression

Lower back pain Lower limb weakness Sensory loss and numbness

List 4 findings on examination of a patient with MSCC

Sensory loss Numbness Abnormal reflexes Urinary or stool incontinence Gait abnormalities

List 2 non-pharmacological management options for a patient with MSCC

Radiotherapy Vertebroplasty

List 2 non-medical teams you would refer a patient with MSCC to?

Community physiotherapy District nurses

List 4 questions you would ask a pregnant woman presenting with abdominal pain.

?Vaginal bleeding ?Location ?PMH ?Dysuria ?Abnormal discharge ?Duration

4 differentials of preterm labour

UTI Placental abruption Appendicitis Ovarian torsion Ovarian cyst

4 steps in management of pre-term labour

Foetal monitoring Tocolysis with nifedipine Maternal corticosteroids IV magnesium sulfate Delayed cord clamping

List two ways to monitor a pregnant woman after all basic testing.

CTG and urinary dipstick

How would you immediately management of airway?

Jaw thrust Head tilt, chin lift

How would you diagnose a pneumothorax

Chest x-ray

Immediate managemnet of a pneumothorax

<2cm - discharge >2 cm and SOB - aspiration Chest drain (tension) - Large bore cannula - fifth intercostal space mid-axillary line

What do you need to do after a insertion of a chest drain?

Prescribe analgesia

List the structures a chest drain must pass through

Skin Superficial fascia Intercostal muscles Parietal pleura

List 4 risk factors for epistaxis.

Haemophilia ITP Trauma Granulomatosis with polyangitis Foreign body insertion

List 4 local management options for a nosebleed

Leaning forward Pinching nasal labial folds Spit out any blood Ice pack

List 2 ways to resevere high INR from Vitamin K antagonist

Vitamin K Prothrombin complex

List 2 indications for warfarin use and its mechanism of action

Vitamin K antagonist Metallic heart valves and Atrial fibrillation

Describe a comple geriatric assessment

Name 4 frailty syndromes apart from falls.

DIIE Delirium Immobility Incontinence S/E of medications

List 4 causes of falls in the elderly.

Anaemia Sepsis Hypoglycaemia Medications Alcohol Seizures Stroke/TIA Dysarrythmias.

What is an advanced directive?

A document written at the time when a person is of sound mind that outlines an individual's preferences with respect to medical treatment should they later become unable to express those wishes directly.

List 2 things that a lasting power of attorney can do in terms of a patient's health and welfare.

Manage their medical and property and affairs

List two organisms causing otitis externa.

Acanthoemeba Staphylococcus aureus Pseudomonas aeruginosa

List two treatments of otitis externa other than antibiotics.

Canal debridgement Antifungal medications - clotrimazole First-line: topical antibiotic and steroid Failure to respond - refer to ENT

List four important aspects of antibiotic stewardship.

Educating staff Using the shortest duration of antibiotics based on evidence Promoting compliance Prescribing only when necessary

How would you differentiate between an UMN and LMN cause of facial nerve palsy?

Upper - forehead sparing

List two causes of UMN and LMN facial nerve palsies.

UMN - stroke, trauma, tumour LMN - ramsay hunt syndrome, MS, bell's palsy

Management of warfarin overdose