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From Papers Flashcards

1
Q

Shocked patient with evidence of fluid overload - next step?

A

Vasoconstriction - adrenaline

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2
Q

Terminal restlessness treatment

A

Midazolam by prn subcutaneous injections / continuous subcutaneous infusion via a syringe driver.

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3
Q

Early parkinsons brain area affected

A

Temporal lobe

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4
Q

treatment of the choice in patients with prolonged QRS complexes following a tricyclic antidepressant overdose.

A

Intravenous sodium bicarbonate

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5
Q

Diabetic nephropathy - best HTN management

A

ACE-I

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6
Q

PF diagnostic test

A

High resolution CT Chest

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7
Q

Typical features of delirium tremens

A

confusion, visual hallucinations, tachycardia and pyrexia on the background of heavy alcohol use

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8
Q

Chronic Alcoholic withdrawal management

A

Consider offering a benzodiazepine or carbamazepine. - Chlordiazepoxide for example

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9
Q

Delirium tremens management

A

oral lorazepam as first-line treatment

If symptoms persist or oral medication is declined, offer parenteral lorazepam or haloperidol

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10
Q

Alcoholic withdrawal seizures mx

A

quick-acting benzodiazepine (such as lorazepam)

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11
Q

Wernicke’s encephalopathy mx

A

Offer prophylactic oral thiamine (B1)

If presenting acutely ill or in an emergency setting, offer parenterally

Oral thiamine should follow parenteral

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12
Q

Helping chronic excess alcohol use

A

acamprosate ( to reduce cravings) with psychological interventions

Disulfiram for unpleasant reaction

naltrexone for reducing cravings

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13
Q

dilutional hyponatraemia cause

(Inappropriately concentrated Urine)

A

SIADH

ADH stimulates synthesis of aquaporin-2 in the apical membrane of the collecting duct which promotes water absorption

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14
Q

PE but also high bleeding risk mx

A

Unfractionated heparin - reversible

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15
Q

First line renal stone IVx

A

unenhanced CTKUB

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16
Q

classical presentation of diverticulitis

A

change in bowel habit, left iliac fosa pain and features of infection (ie pyrexia)

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17
Q

Cataplexy

A

classically presents with loss of skeletal muscle tone with strong (usually postive) emotions

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18
Q

De Quervain tendinopathy

A

The diagnosis of de Quervain tendinopathy usually has a history of atraumatic radial wrist pain with tenderness and enlargement at the first dorsal compartment over the radial styloid and pain at the radial styloid with active or passive stretch the thumb tendons over the radial styloid in thumb flexion (the Finkelstein test).

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19
Q

DMII patient with no CHF or hepatic failure Hx but Renal failure

A

A thiazolidinedione like pioglitazone

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20
Q

DMII ED treatment

A

phosphodiesterase‑5 inhibitor

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21
Q

CKD raised phosphate treatment

A

calcium acetate or r sevelamer carbonate

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22
Q

Diabetic CKD with proteinuria

A

if ACR >3 ACE or ARB titrated to highest tolerated dose

Then add SGLT2 inhibitor if ACR >3

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23
Q

Iron overload

A

Venesection or DFO (Deferoxamine, Iron chelator)

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24
Q

Lupus symptoms (aside form joint swelling)

A

Mouth ulcers
Hair loss
Photosensitive rash
Dry eyes
Chest Pain
Headaches

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25
Q

Lupus Signs

A

Pallor
Discoid rash
Alopecia
Raynauds
Dry pulmonary crackles

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26
Q

Why do SLE patients miscarry?

A

Concurrent APS

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27
Q

Two drugs/class for treating SLE

A

Hydrochloroquinine - DMARD
Prednisolone - Glucocorticoid

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28
Q

Management of hypercalcaemia

A

Fluids (IV)
Pemindronate - Bis

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29
Q

Symptoms of Cauda Equina

A

Saddle paraesthesia
Leg weakness or numbness
Sudden onset back pain
Urinary retention
Bowel control loss
Loss of deep tendon reflexes
Loss of rectal tone

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30
Q

Cauda equina Ivx

A

MRI spine

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31
Q

Plaque psoriasis features

A

Salmon pin, well demarcated
Extensor surfaces
silver scale
Itchy

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32
Q

What is RF?

A

Autoantibody against Fc portion of IgG

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33
Q

Is RF diagnostic of RA?

A

No, 70% not
Anti-CCP more specific
Need joint involvement pattern

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34
Q

Psoriatic vs RA

A

Psoriatic is RF -ve
Psoriatic is generally assymetrical
Psoriatic has DIPJ involvement - less common in RA
Pitting of finger nails/toe nails in psoriatic
Presence of psoriasis

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35
Q

Gout RF

A

Obesity
CKD
High protein diet
Metabolic syndromes

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36
Q

Gout triggers

A

Alcohol
Seafood
Infection
Starvation
Dehydration
Trauma
Surgery

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37
Q

3 acute treatments for gout

A

NSAIDs
Colchicine
Steroids
Coxib

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38
Q

How do glucocorticoids work as anti-inflammatory

A

Up-regulate anti-inflammatory proteins (ransactivation)

Prevents translocation of pro-inflammatory factors into the nucleus (Trans-repression)

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39
Q

Define osteoporosis

A

Bone density 2.5 sd below young adult mean

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40
Q

RF osteoporosis

A

Smoking, alcohol, low BMI, age, menopause, low activity

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41
Q

Wedge fracture detection

A

Xray or CT

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42
Q

Diagnosis or osteoporosis?

A

DEXA
Dual-Energy X-ray Absorptiometry

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43
Q

Attachment of tendon/ligament to bone

A

Enthesis

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44
Q

Name of inflammation of an entire digit

A

Dactylitis

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45
Q

Anatomical area inflamed in inflammatory arthritis?

A

Synovium

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46
Q

Hormones affecting Calcium regulation in serum.

A

PTH - raises
1,25-dihydroxy-vitamin D3 - raises by absorption and resorption
Calcitonin - decreases, opposing PTH

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47
Q

Bisphosphonate effects

A

Suppresses osteoclasts
Suppresses osteoclast progenitor

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48
Q

Hip pain in runner differentials

A

Femoral Acetabular impingement
Trochanteric bursitis
OA
RA
Gluteal tendinopathy
Labral tear

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49
Q

Daily calcium requirement

A

1g

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50
Q

Drugs causing raised uric acid

A

Thiazides
Aspirin
Cyclosporin
Levodopa

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51
Q

Allopurinal affects which enzyme?

A

Xanthine oxidase

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52
Q

Cause of avascular necrosis of head of femur?

A

Blood supply interrupted within femoral head capsule

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53
Q

Common osteoporotic fracture places?

A

Spine - vertebral crush fracture
Forearm

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54
Q

Vitamin D metabolism

A

Vitamin D - hydroxylation - Liver and then kidneys - 1,25-dihydroxyvitamin D3

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55
Q

Allopurinal MOA

A

Allopurinal - Oxypurinol - Decreased xanthine oxidase activity - hypoxanthine and xanthine not converted to Uric acid

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56
Q

Immediate management of fracture

A

Realign
Stabilise
Analgesia
Orthopaedic opinion

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57
Q

Priority assessment in fractures

A

Vascular supply to distal areas
Need for surgical intervention
Open or closed

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58
Q

Physeal fracture classification

A

Salter Harris

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59
Q

Salter Harris classification

A

SALTER
Straight Across
Above
Lower
Two/Through
Erasure of growth plate

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60
Q

Fibula fractures classification

A

Weber A- below the syndesmosis (Stable)
Weber B- At the level of syndesmosis (variable stability)
Weber C- above syndesmosis always unstable requiring ORIF

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61
Q

Loss of sensation in arm - patchy - loss of brachial reflex etc

A

Cervical rediculopathy
Cervical crush fracture
RSI
Previous humeral head fracture

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62
Q

Anaemia found in SLE

A

Normocytic and normochromic

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63
Q

Renal impairment in Lupus - Findings and name

A

Lupus nephritis

Reduced eGFR
Proteinuria
Blood
Red cell casts

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64
Q

Histological cause for Lupus nephritis

A

Membranoproliferative glomerulonephritis

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65
Q

Advantages of a box splint

A

Realignment
Pain reduction
Protects vasculature

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66
Q

Explain mechanism of compartment syndrome

A

Due to bleeding and local swelling there is microvascular and venous congestion, this leads to tissue hypoxia, cell death and more protein release, cause more fluid to extravasate further increasing compartmental pressure and it continues in a cycle.

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67
Q

Bones where fractures include significant risk of avascular necrosis

A

scaphoid bone, the femoral head, the humeral head and the talus, navicular and fifth metatarsal in the foot

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68
Q

Principles of fracture management

A

Mechanical Alignment
Relative stability

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69
Q

Mechanical Alignment methods

A

Closed reduction via manipulation of the limb
Open reduction via surgery

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70
Q

Relative stability methods

A

External casts (e.g., plaster cast)
K wires
Intramedullary wires
Intramedullary nails
Screws
Plate and screws

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71
Q

Early fracture complications

A

Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung)
Haemorrhage leading to shock and potentially death
Compartment syndrome
Fat embolism (see below)
Venous thromboembolism (DVTs and PEs) due to immobility

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72
Q

Late fracture complications

A

Delayed union (slow healing)
Malunion (misaligned healing)
Non-union (failure to heal)
Avascular necrosis (death of the bone)
Infection (osteomyelitis)
Joint instability
Joint stiffness
Contractures (tightening of the soft tissues)
Arthritis
Chronic pain
Complex regional pain syndrome

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73
Q

Fat embolism criteria

A

Gurd’s major and minor criteria

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74
Q

Signs of bulimia

A

Russel sign - Callous on back of hands
Parotid enlargement
Poor dental Hygiene

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75
Q

Electrolyte imbalance on Bulimia

A

Hypokalaemia

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76
Q

Symptoms of hypokalaemia

A

Weakness
Muscle pain
Constipation
Paralysis of limbs/GI muscles/ Resp Muscles
Tetany

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77
Q

Therapies for Bulimia

A

Counselling
Cognitive herapy
Behavioural therapy
Fluoxetine
Support group
Psychodynamic therapy

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78
Q

Staining test result for TB

A

Acid Fast Bacilli

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79
Q

Peripheral neuropathy TB drug

A

Isoniazid

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80
Q

Brain lobe affected in psychosis, and neurotransmitter

A

Dopamine
Temporal lobe - amygdala sits there

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81
Q

Opiate withdrawal neurotransmitter

A

GABA

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82
Q

Opiate withdrawal symptoms

A

nausea, vomiting, muscle aches, sweating, yawning, lacrimation, runny nose, anxiety, dilated pupils, blurred vision, tachycardia, HTN, goosebumps.
Cramps
GI disturbance

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83
Q

Galactorrhoea after antipsychotic - mechanism

A

Reduced dopamine means prolactin is less opposed

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84
Q

Post partum depression scale

A

Edinburgh post Natal Depression scale

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85
Q

PHQ9 function

A

Monitors depression severity

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86
Q

HAD9 function

A

Hospital anxiety and depression scale

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87
Q

Paracetamol overdose managent

A

Activated Charcoal is <1 hour
Gastric Lavage if <4 hour
NAC 150mg/kg in 200 ml 5% dex over 1 hr IV, if 4 hours after ingestion
Give NAC without delay if staggered dose or >15 hours since ingestion
Rash after NAC? Chlorphenamine

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88
Q

delusions seen in Paranoid schizophrenia

A

Persecutory delusions, paranoid delusions, delusions of reference

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89
Q

Delusions seen in depressive psychosis

A

nihilistic-Cotard syndrome, hyperchondriasis. Delusion of poverty

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90
Q

First rank symptoms of Schizophrenia

A

auditory hallucinations, thought broadcast, thought insertion, thought withdrawal and delusional perception

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91
Q

Term given for stiffness after antipsychotic

A

Acute Dystonia

92
Q

Dystonia treatment

A

Procyclidine

93
Q

Tests before Lithium presciption

A

ECG, TFTs, U&Es, GFR, pregnancy test

94
Q

Symptoms of lithiu toxicity

A

dizziness, nystagmus, coarse tremor, ataxia, hyperrflexia, confusion, slurred speech

95
Q

Lithium toxicity management

A

stop lithium, fluid therapy, normalise UO. Dialysis if severe.

96
Q

Lithium CI

A

renal disease, heart disease, thyroid disease, Addison’s.

97
Q

Features of OCD

A

Recognised as patient’s own thoughts, acts are repeated, acts are not inherently enjoyable

98
Q

Treatment for OCD

A

CBT, exposure therapy

99
Q

Definition of Wernicke’s

A

Ataxia, ophthalmoplegia, confusion (due to B1 defiency)

100
Q

Definition of korsakoff’s

A

Amnesia, confabulation

101
Q

Definition of Delirium tremens

A

Seizures due to acute alcohol withdrawal, peaks at 72 hours, tremor seizures, hallucinations.

102
Q

Parkinsons disease pathology

A

Loss of dopaminergic neurons in the substantia nigra, with lewy body inclusions

103
Q

Upper limb symptoms of PD

A

Resting tremor, cog-wheel rigidity, pill-rolling tremor

104
Q

Treatments for PD

A

Co-careldopa, pramipexole

105
Q

Drugs CI in pD

A

Metoclopramide, haloperidol

106
Q

What does disulfiram act on?

A

Acetaldehyde Dehydrogenase

107
Q

Neuroleptic Malignant Syndrome presentation

A

Recent antipsychotic medication
Over the course of hours develops sweats, disorientation, temperature

Treat with Dantrolene

108
Q

Serotonin syndrome presentation

A

Hyperreflexia, sudden onset, temperature etc - treat with benzo

109
Q

SSRI mechanism

A

Blockade of the re-uptake of serotonin (5-HT), Downregulate the number of 5-HT receptors, Pre-frontal cortex

110
Q

TCA overdose features

A

Tachcardyia; Dilated pupils; Enlarged bladder

111
Q

Three drugs and drug classes for depression

A

Ssris – citalopram
SNRIs – venlafaxine
MOAB inhibitors - seligiline

112
Q

Symptoms of mania

A

Grandiose delusions, excessive spending, loss of inhibitions, decreased need for sleep, start multiple projects, high energy, reckless behaviour

113
Q

Li side effects in normal limits

A

Nausea, weight gain, acne, hypothyroid, fine tremor

114
Q

Li side effects outside normal limits

A

Coarse tremor, dizziness, seizures, ataxia, slurred speech, confusion, hyperreflexia

115
Q

Peak timings for alcohol withdrawal symptoms

A

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

116
Q

Short synactin test role

A

Tests ability of adrenal cortex to produce cortisol in response to ACTH (<200 is adrenal insufficiency)

Incremental rise - level over 600 by 30 min

117
Q

MS eye nerve affected

A

Optic nerve

118
Q

MS eye symptoms

A

Pain, worse with eye movement, red desaturation

(classic triad of reduced vision, eye pain on movement and impaired colour vision)

119
Q

MS pupil signs

A

decreased pupillary light reaction in affected eye- RAPD or Marcus gunn pupil

120
Q

MS Fundus signs

A

Swollen optic disc, disc pallor

121
Q

MS Episode treatments

A

Methylprednisolone

Beta interferon with glatiramer acetate or Fingolimod for further episodes

122
Q

Lymph node affected in quinsey

A

Jugulodigastric lymph nodes

123
Q

Most common visual field defect in macula degeneration

A

Central scotoma

124
Q

Microbial causes of sore throat

A

Group a B-haemolytic strep (strep pyogenes), strep pneumoniae, staph aureus
Ebstein Barr Virus

125
Q

Muscles controlling hearing

A

Tensor tympani and stapedius

126
Q

Ramsey Hunt syndrome - causative organism

A

Varicella Zoster virus. Within the dorsal root ganglion cells of the facial nerve

127
Q

Retinal detachment - examinations and their signs

A

B-Scan (ultrasound)= bright reflective layers is the retina detached from eye wall
slip lamp examination=schafters sign, pigmented particles in anterior compartment, Bullous separation of the retina
Ocular coherence tomography= photoreceptor layers separated from RPE (retinal pigmented epithelia )

128
Q

Signs of anterior uveitis

A

Cell and Flare (turbidity in aqueous humour), Keratic Precipitates, Hypopyon

129
Q

Anterior uveitis treatment

A

Steroid eye drop – Prednisolone or Dexamethasone
Mydriatic eye drop (draws iris away from lens by dilating) Phenylephrine, Atropine
(helps with pain)

130
Q

Anterior uveitis causative organism

A

Herpes Simplex

131
Q

Artery in amurosis fugax

A

Central retinal artery

132
Q

Cause of amurosis fugax

A

Thromboembolus of central retinal artery

133
Q

Viral conjunctivitis symptoms

A

Gritty sensation, watery discharge, sticky in morning, swollen eyelids

134
Q

Viral conjunctivitis signs

A

Preauricular lymph node enlargement, serous fluid weeping from eye

135
Q

Intersusception Mx

A

Air insufflation

136
Q

Theophylline drug type/uses

A

phosphodiesterase inhibiting drug

The main actions of theophylline involve:

relaxing bronchial smooth muscle
increasing heart muscle contractility and efficiency (positive inotrope)
increasing heart rate (positive chronotropic)[4]
increasing blood pressure
increasing renal blood flow
anti-inflammatory effects
central nervous system stimulatory effect mainly on the medullary respiratory centre

Also counters adenosine

137
Q

severe end of a spectrum of skin disorders

A

Toxic epidermal necrosis, SJS, erythema multiforme

138
Q

Threadworm Tx

A

Mebendazole

139
Q

Features of Pellagra (Vitamin B3 Deficiency)

A

4 Ds

Diarrhoea
Dermatitis
Dementia
Death

140
Q

Causes of Pellagra

A

Niacin deficiency
Isoniazid

141
Q

Rosacea treatment

A

mild/moderate: topical metronidazole
severe/resistant: oral tetracycline

142
Q

Causes of COPD Bacterial exacerbations

A

H.Influenzae, Pneumococcus

143
Q

Ipratropium Bromide mechanism

A

Anti-cholinergic

144
Q

Legionella pneumophila treatment

A

Erythromicin, clarithromycin, doxycycline and rifampicin

145
Q

Septic shock parameters

A

Hypotension (systolic < 90mmhg, mean arterial pressure (MAP) <65mmhg), despite resuscitation, with evidence of tissue hypoperfusion.
Tachycardic (HR>90bpm)
Oliguria (<400 mL/day or 15mL/h)
Prolonged capillary refill (>2seconds)
Tachypnoea (>20 cycles/min)
Raised blood lactate

146
Q

CURB-65 score results

A

0 or 1 - Outpatient care
2 Inpatient/observation admission
=/>3 Inpatient admission
4 or 5 - consider ICU

147
Q

Legionella pneumophila test

A

Urine antigen test

148
Q

Obstructive spirometry result

A

Reduced FEV1/FVC<0.7

149
Q

Asthma acute exacerbation treatment

A

O2 15L/min and sit up
Salbutamol 5mg NEB +/- Ipratropium 500 mcg and prednisolone 40mg/Hydrocortisone 200mg

Give NEB as O2 driven

150
Q

Questions to assess Asthma control

A

In the last 4 weeks has your asthma caused nocturnal waking?

In the last 4 weeks has your asthma caused you to get less done than usual/interfered with ADLs?

In the last 4 weeks how many times have you used your blue inhaler?

In the last 4 weeks how often have you had shortness of breath/symptoms of asthma?

151
Q

CAP Abx

A

Co-amoxiclav and clarithromycin

152
Q

Klebsiella pneumoniae tratment

A

Cefotaxime

153
Q

Angina prevention meds and mechanism

A

Beta blockers: bisoprolol 🡪 reduce force and rate of contraction 🡪 less O2 needed by heart myoctes.
CCBs 🡪 relax coronary arteries 🡪 increased blood flow to heart muscle.

154
Q

Classes of anti-arrythmic drugs:

A 
1 = Na channel blockers: lidocaine, procainamide 
2 = beta blockers: propranolol, metopralol 
3 = K channel blockers: amiodarone, dronedarone, ibutilide 
4 = Ca channel blockers: verapamil, diltiazem
155
Q

Peripheral vascular disease drug

A

naftidrofuryl oxalate

156
Q

State the ECG features that would raise your suspicion of left ventricular hypertrophy.

A

R wave in V5 or V6 of over 25mm, S wave in V1 or V2 of over 25 mm, Sum of S wave in V1 plus R wave in V6 of over 35mm

157
Q

STEMI criteria

A

clinical symptoms consistent with ACS (generally of ≥ 20 minutes duration) with persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads of:
2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3 in men over 40 years
1.5 mm ST elevation in V2-3 in women
1 mm ST elevation in other leads
new LBBB (LBBB should be considered new unless there is evidence otherwise)

158
Q

STEMI management algorithm

A
159
Q

NSTEMI/ Unstable angina algorithm

A
160
Q

Glycoprotein IIb/IIIa inhibitors

A

abciximab (abcixifiban) (ReoPro)

eptifibatide (Integrilin)

tirofiban (Aggrastat)

Glycoprotein IIb/IIIa inhibitors are frequently used during percutaneous coronary intervention

161
Q
A
162
Q

First line drug for ocular myasthenia gravis?

A

Pyridostigmine

163
Q

Cushing’s triad

A

widening pulse pressure

bradycardia

irregular breathing

May happen with high ICP

164
Q

histopathological of PD

A

lewy body inclusions, death of dopaminergic cells in substantia nigra

165
Q

CT result in PD

A

atrophy of substantia nigra/usually normal

166
Q

Motor neurone disease LMN signs (lower limb)

A

Hyporeflexia, flaccid weakness, fasciculations, wasting, Hypotonia (maybe – depends who you ask whether it’s a valid sign or not)

167
Q

Motor neurone disease UMN signs (lower limb)

A

Upgoing plantars, hypertonia, clonus, hyperreflexia, spastic weakness, spastic gait

168
Q

Pseudobulbar palsy vs bulbar palsy

A

A bulbar palsy is a lower motor neuron lesion of cranial nerves IX, X and XII. A pseudobulbar palsy is an upper motor neuron lesion of cranial nerves IX, X and XII.

169
Q

Pseudobulbar palsy symx

A

Facial muscle weakness, emotional lability, dysarthria (slowed or slurred speech), dysphagia (difficulty swallowing), dysphonia (vocal cord muscle spasms) and progressive immobility of the tongue

170
Q

Bulbar palsy symx

A

difficulty swallowing and a lack of a gag reflex to inability to articulate words and excessive drooling. Bulbar palsy is most commonly caused by a brainstem stroke or tumor.

171
Q

MS eye symptoms

A

Pain on eye movement, red desaturation, RAPD, central scotoma, retrobulbar pain

172
Q

Further episodes of MS prevention

A

beta interferon/Glatiramir Acetate/ fingolimod

173
Q

three cardinal signs of Parkinson’s

A

Rest tremor, bradykinesia, rigidity and loss of postural reflexes

174
Q

PD drug associated with personality/behavioural changes`

A

Bromocriptine - dopamine agonist

175
Q

non-infective causes of meningism

A

SLE, Behcets, malignancy, sarcoidosis, drugs-NSAIDS, Trimethoprim, Chemical meningitis

176
Q

neurofibrillary tangles in Alzheimer’s

A

Aggregates of TAU proteins within cells within the cerebral cortex

177
Q

Alzheimer’s disease drug

A

Donepezil, tacrine, rivastigmine, galantamine = Acetylcholinesterase inhibitors

memantine NMDA receptor antagonist

178
Q

Meningitis drug given in primary care

A

Benzylpenicillin

Intravenous (or intramuscular)

179
Q

Specific organism in bacterial meningitis

A

Group B Neisseria meningitidis (meningococcus)

180
Q

Meninigitis types prevented by vaccines

A

Haemophilus influenzaeB (HiB)

Meningitis C (Men C)

181
Q

Parkinsons drugs examples

A

Dopamine Replacement – levodopa

Dopamine agonist – pramipexol

MOA-B inhibitor – resigiline

182
Q

Define epileptic seizure

A

Paroxysmal event with behavioural, sensation, cognition changes due to excessive hypersynchronous neuronal changes

183
Q

4 symptoms with aura of temporal seizure

A

Dejavu, jamais vu, receptive dysphasia, automatisms(lip smacking), taste or smell hallucinations

184
Q

Features of brainstem death

A
  • fixed unresponsive pupils
  • no corneal reflex
  • no cough or gag reflex
  • no respiratory effort
  • no response to supraorbital pressure
  • absent oculovestibular reflexes
185
Q

Dysphasia areas

A

receptive aphasia (Wernicke’s aphasia) Wernicke’s speech area, Wernicke’s area is located in the temporal lobe.

Broca’s aphasia, also called expressive aphasia, inferior frontal gyrus

186
Q

Lower limb signs MS

A

Increased tone, extensor plantars, brisk reflexes, clonus, weakness

187
Q

Third nerve palsy signs

A

Eye pointing down and out, pupil dilated

188
Q

Kernig’s sign

A

pain when straightening knee with flexed hip, photophobia, papilloedema, nuchal ridigity

189
Q

Which abx Meningitis

A

Cefotaxime

190
Q

CSF viral vs bacterial

A

Bacterial - turbid, low glucose, high protein, neutrophils

Viral - clear, normal/low glucose, normal/high protein, lymphocytes

191
Q

TIA IVx

A

Carotid doppler, ecg and bloods already done)

192
Q
A
193
Q

Temporal lobe seizure

A

HEAD - Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing/plucking), Deja vu/Dysphasia post-ictal)

194
Q

Frontal lobe Seizure

A

motor - Head/leg movements, posturing, post-ictal weakness, Jacksonian march

195
Q

Parietal lobe

A

Sensory - Paraesthesia

196
Q

Occipital lobe

A

Visual - Floaters/flashes

197
Q

poorly controlled coeliac disease develops itchy vesicles on his elbows and buttocks

A

Dermatitis herpetiformis

198
Q

Erythema nodosum characteristic features:

A

symmetrical, erythematous, tender, nodules which heal without scarring

most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)

199
Q

Pretibial myxoedema characteristic features:

A

symmetrical, erythematous lesions seen in Graves’ disease

shiny, orange peel skin

200
Q

Pyoderma gangrenosum characteristic features:

A

initially small red papule

later deep, red, necrotic ulcers with a violaceous border

idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

201
Q

Necrobiosis lipoidica diabeticorum characteristic features:

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics

often associated with telangiectasia

202
Q

Cranial nerve reflexes

A
203
Q

Cholestasis pruritus Tx

A

cholestyramine

204
Q

Primary biliary cholangitis

A

IgM

anti-Mitochondrial antibodies, M2 subtype

Middle aged females

dry mouth is this patient is due to sicca syndrome

205
Q

L3 nerve root compression

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

206
Q

L4 nerve root compression

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

207
Q

L5 nerve root compression

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

208
Q

S1 nerve root compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

209
Q

peri-orbital and nasolabial scaly rash associated dandruff is a classical history for:

A

seborrhoeic dermatitis.

210
Q

General antifungals

A

For nails, consider terbinafine.

For yeast infections consider fluconazole.

For systemic fungal disease consider itraconazole.

211
Q

Which organism is more common in patients who have recently had influenza?

A

Preceding influenza predisposes to Staphylococcus aureus pneumonia

212
Q

URTI symptoms + amoxicillin → rash

A

Infectious mononucleosis glandular fever

213
Q

Whooping cough antibiotic therapy?

A

azithromycin or clarithromycin if the onset of cough is within the previous 21 days

214
Q

Adjuvant hormonal therapy for ER +ve breast cancer in post-menopausal women

A

anastrozole

215
Q

The three criteria for aneurysm surgery are:

A

An asymptomatic aneurysm larger than 5.5 cm in diameter.
• An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
• A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.

216
Q

AAA screening outcomes

A
217
Q

suspected TIA should have?

A

A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately (and be referred for specialist review within 24h)

218
Q

Alcohol withdrawal features/timing

A

symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety

peak incidence of seizures at 36 hours

peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

219
Q

Acute reactive arthritis first line

A

NSAIDs

Management

symptomatic: analgesia, NSAIDS, intra-articular steroids

sulfasalazine and methotrexate are sometimes used for persistent disease

symptoms rarely last more than 12 months

220
Q

c.diff management

A

First episode of Clostridium difficile infection

first-line therapy is oral vancomycin for 10 days

second-line therapy: oral fidaxomicin

third-line therapy: oral vancomycin +/- IV metronidazole

Recurrent episode

recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode

within 12 weeks of symptom resolution: oral fidaxomicin

after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin

Life-threatening Clostridium difficile infection

oral vancomycin AND IV metronidazole

specialist advice - surgery may be considered

221
Q

Myxoedemic coma is treated with?

A

Hydrocortisone and levothyroxine

222
Q

Thyrotoxic storm is treated with

A

beta blockers, propylthiouracil and hydrocortisone

223
Q

Intrahepatic cholestasis of pregnancy treatment

A

Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation

224
Q

Joint British Diabetes Societies (2013) Diagnostic criteria Diabetic ketoacidosis

A

Key points

glucose > 11 mmol/l or known diabetes mellitus

pH < 7.3

bicarbonate < 15 mmol/l

ketones > 3 mmol/l or urine ketones ++ on dipstick

225
Q

Patients with ascites secondary to liver cirrhosis, therapy

A

aldosterone antagonist like Spironolactone

226
Q

Human bites, like animal bites, should be treated with which abx?

A

Co-amoxiclav

227
Q

DVT management

A

Finals (18 decks)

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