FPE MED18 Flashcards
Features of complete heart block (4)
Syncope
Heart failure
Wide pulse pressure
Bradycardia
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.
Management of heart block (4)
Atropine
Transcutaneous pacing
Transvenous pacing.
Permanent implantable pacemaker.
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.
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
List 4 other causes of loss of consciousness (apart from orthostatic hypotension)
Aortic stenosis
Dehydration
Hypoglycaemia
TIA/Stroke
Seizures
List 4 malignanct causes of cervical lymphadenopathy
Lymphoma
Leukaemia
Nasopharyngeal carcinoma – SSC
Gastric cancer (supraclavicular)
List 4 causes of lumps in the neck (apart from lymphoma)
Branchial cyst
Cystic hygroma
Thyroglossal cyst
Dermoid cyst
Lipoma
What are 2 B symptoms
> 10% weight loss in the past 6 months
Night sweats
Temperature >38 degree celsius
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
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.
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
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
List 4 types of prolapses
Uterocecole
Cystourethrocele
Vault prolapse
Uterine prolapse
Rectocele
Cystocele
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)
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
4 symptoms of prolapses
Heaviness in the abdomen
Urinary incontinence - frequency, urgengy, retention
Bowel incontinence - constipation
Altered sexual experience
Investigations for someone presenting with incontinence
3 day bladder diary
Urine dipstick - to rule out infection
Urodynamic studies
List four signs of Parkinson’s
Rigidity
Bradykinesia/Akinesia
Shuffling gait
Tremor
Why would you use L-dopa and carbidopa instead of dopamine?
Carbidopa prevents levodopa being broken down in the peripheral nervous system.
Why do patients with Parkinson’s get choreiform movements?
Due to fluctuating levels of dopamine and continued loss of dopamine producing cells
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.
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
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)
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
