General Flashcards
1
Q
How might anaemia present
A
Breathlessness
Fatigue
Itching
Palpitations
2
Q
Symptoms of horners syndrome
A
Miosis
Ptosis
Anhydrosis
Enopthalmus
(Interruption to the sympathetic nerve supply)
3
Q
Causes of horners syndrome
A
Carotid artery dissection
Tumour in neck or chest - neuroblastoma& pancoast tumour.
Lesion in the midbrain/ brainstem/ upper spinal cord, neck or eye orbit
Growth of lymph nodes in neck
4
Q
Hypercalcemia symptoms
A
Constipation Delirium Bone pain Confusion Nausea and vomiting
5
Q
What are the investigations you would do for MS
A
MRI
LP
6
Q
What is MS
A
Chronic inflammatory immune related disease of the CNS
7
Q
What are the complications of peads constipation
A
Fissures Dehydration Pain Fissures Mega colon
8
Q
What is produced from the medulla of the adrenal gland
A
Catecholamines (fight and flight)
9
Q
What are the layers of the adrenal cortex
A
GFR
Glomerulosa
Fasciulata
Reticularis
10
Q
What are the two categories of causes of Cushing’s syndrome
A
ATCH dependent
ATCH Independent
11
Q
What are the ATCH dependent causes of cushings disease
A
Pit adenoma
Ectopic production of ATCH (SCLC)
12
Q
What are the ATCH independent causes of Cushing’s syndrome
A
Exogenous glucocorticoids I.e. steroids
Adrenal adenoma
13
Q
Commonest cause of Addison’s disease in the UK
A
AI
14
Q
Commonest cause of Addison’s disease world wide
A
TB
15
Q
What two key things are low in Addison’s disease
A
Low aldosterone
Low cortisol
Hyponatremia
Hypoglycaemia
16
Q
Symptoms of Addison’s disease
A
Fatigue Wt loss Abdo pain Diarrhoea Postural hypotension Fever
17
Q
Where might you see hyperpigmentation in a person with Addison’s disease
A
Buccal mucosa
Palmar creases
18
Q
What drug is indipamide
A
Thaidize like diuretic
19
Q
Why is hyoscine butlybromide used in colicky pain
A
It is an antimuscarinic sm relaxant
20
Q
What sort of drug is metaclopromide
A
Prokinetic antiemetic (promote bowel movements)
21
Q
What is the analgesic opioid of choice for syringe drivers
A
Diamorphine
22
Q
What is the leading cause of blindness In the UK?
A
Macular degeneration
23
Q
What is the finding on fundoscopy for ARMD
A
Drusen
24
Q
RFs for macular degeneration
A
Smoking Age FHX DM HTN
25
What is the most common cause of nephrotic syndrome
Minimal change syndrome
26
What are the features of nephrotic syndrome
Proteinuria
Oedema
Hypoalbuminaemia
27
4 causes of bilateral hydronephrosis
Bladder Ca
Urethral stricture/valve
Prostate enlargement
Retroperitonal fibrosis
28
Causes of unilateral hydronephrosis
Calculi
Renal pelvis tumour
Pelvic-uteric obstruction (congenital / acquired)
29
Treatment for primary sclerosing cholangitis
ECRP - symptom relief
Urodeoxycholic acid
Monitor for cholangio carcinoma
30
What viral hepatitis is most common world wide
Hep A
31
How is Hep A transmitted
Feacal oral
32
How are hep B/C/ E transmitted
Blood or bodily fluids
33
Treatment of AI hepatitis
Prednisalone
| Azothiaprine
34
What is raised in hepatic picture LFTs what conditions might this indicate
AST
ALT
(Transaminases)
Hepatitis & alcohol excess
35
What is raised in cholestatic bloods on LFTs
ALP
| Primary sclerosing cholangitis
36
Gold standard diagnostic test for primary sclerosing cholangitis
MRCP
37
What is NAFLD
Part of a metabolic syndrome
38
Tx of fibrosis in NAFLD
Pioglitazone
| Vit E
39
What chromosome is defective in Wilson’s disease
Chromosome 13
40
Investigations in Wilson’s disease
Slit lamp for Keyser - Flescher rings
Caeruloplasmin levels
24 urinary copper assay
41
What would positive HBsAg and positive HBcAb IgA indicate . What would be the next investigation
Active Hep B hepatitis
| Do HBV DNA for viral load and HBeAg
42
What would negative HBsAg and positive HBcAb IgG indicate
Previous infection
43
What would a high HBeAg indicate
Highly infective (acute phase of infection)
44
What does “HBV DNA” indicated
Viral load
45
What disease does Hep D require to occur
Hep B
46
Causes of Hepatitis
```
Alcoholic hepatitis
NAFLD
Viral
AI
Drug (paracetamol OD)
```
47
Symptoms of hepatitis
```
Jaundice / itching
N&V
Abdo pain
Muscle aches
Fever
Fatigue
```
48
Investigation in NAFLD
ELF Bloods
Fibrosis score
Fibroscan
49
What are the two scoring systems for cirrhosis
MELD
| Child-Pugh
50
What are the scoring systems for upper GI bleed
Glasgow-blatchford
| Rockall score
51
What most commonly causes HCC
Cirrhosis
52
What most commonly causes cholangiocarcinoma
10% primary sclerosing cholangitis
53
What is the most common disease to have with primary sclerosing cholangitis
UC
54
What is the medical treatment for HCC
Kinase inhibitors
55
What is the tumour market for HCC
Alpha fetoprotein
56
What is the tumour marker for cholangiocarcinoma
Ca19-9
57
What changes might you see on USS with alcoholic fatty liver
Hypoechoic
58
What changes might you see on USS with cirrhosis
Corkscrew a’s
Portal enlargement
Hepatomegally
Nodular surface
59
Abx for hepatic encephalopathy
Rifaximin
60
Tx for upper GI bleed from varicoses
```
Terlipressin
Abx
FFP / vit k (solve coag problems)
?CCU
? Endoscopy
```
61
What scoring system is used to see if someone withdrawing from alcohol needs intervention
CIWA-Ar
62
Screening tools for alcoholism
CAGE
| Audit
63
Tx for acute alcohol withdrawal ?delerium tremans
Chlordiazopoxide
| Pabrinex -> PO thiamine
64
Triad in wernickes encephalopathy
Abnormal ocular movements
Ataxia
Confusion
65
What are the two features of Korsakoff’s syndrome
Behavioural change
| Amnesia
66
What is torsade de points
Polymorphic VT
Due to long QT causing spontaneous afterdepolarisations of myocytes
Appears to twist round baseline
67
Types of SVT
AV nodal re-entrant tachyC
AV re-entrant tachyC (WPW)
Atrial tachyC
68
Treatment of SVT
Adenosine and vagal manoeuvres while on cardiac monitoring
69
Tx of stable VT
Amiodarone
70
What is the AV bundle equivalent in WPW called
Bundle of Kent
71
ECG changes in WPW
Short PR interval
Long QRS complex
Delta wave
72
Tx of WPW
Radio frequency ablation
73
What risk is there if you give antiarrhythmic medication in WPW if AF / A.flutter is present
Risk of polymorphic wide complex tachyC
74
Tx of unstable arrhythmia
3x synchronised shocks
| Amiodarone infusion
75
Tx of AF
Beta blocker
| RFA
76
Tx of paroxysmal SVT
RFA/CCB/BB
77
Tx of Atrial flutter
BB
Tx of underlying cause (thyrotoxicosis /HTN)
Anticoagulate based on CHADSVASC
78
How to give adenosine
In ACF as bolus (6mg-12mg-12mg)
| Warn Pt of asystole/Feeling of doom
79
Non shockable rhythms
Asystole
| PEA
80
Shockable rhythms
VT
| VF
81
What could be the causes of ventricular ectopics
Electrolyte abnorms
Anaemia
Thyroid
82
Drugs that cause long QT
```
Antipsychotics
Sotalol
Citalopram
Macrolide drugs
Flenicade
```
83
Management of long QT
Correct underlying cause
Magnesium infusion.
Shock if go into VT
84
Tx of stable VT
Amiodarone infusion
85
Antimuscarinic SEs
```
Inhibit parasympathetic :
Pupil dilation
Urinary retention
Dry eyes
Constipation
```
86
What is Cushing’s syndrome
Signs and symptoms of prolonged elevated cortisol . Maybe he causes by cushings disease or other.
87
What is cushings disease
Pituitary Adinoma (ATCH dependent) causing Cushing’s syndrome
88
What does G3 on MRC dysponea scale equate to
Breathless on the flat
89
What does G1 on MRC dysponea equate to
SOB w. Strenuous exercise
90
What is S4 of COPD severity scale
FEV1 <30% Predicted
91
First stage of COPD long term tx
```
SABA
OR SAAM (short acting antimuscarinic) = Ipratropium bromide
```
92
What is the second stage of COPD long term tx in a non asthmatic non steroid responsive patient
+ LABA &LAMA
93
What is the second stage in LR COPD management for a steroid responsive patient
ICS+ LABA
I.e. salmeterol & beclamethasone
= fostair / symbicort/ seretide
94
If someone is on both stages of COPD tx what additional tx are there
```
Home 02
Mucolytics (carbocystine)
Oral theophylline
Nebulisers
Prophylactic LR abx - azythromycin
```
95
What is the gold standard test for Cushing’s syndrome
Dexamethadone supression test
96
What is the gold standard test for adrenal insufficiency
Short synacthen test
97
What diagnosis is reached if Dex sup testing @8mg gives low cortisol and low ATCH
Pit adenoma
98
What diagnosis is reached if Dex sup testing @1mg gives low cortisol
Physiological response
| Rule out cushings disease
99
What diagnosis is reached if Dex sup testing @8mg gives low cortisol and high ATCH
Adrenal adenoma
100
What diagnosis is reached if Dex sup testing @8mg gives raised cortisol and raised ATCH
Ectopic ATCH
| Ie. SCLC
101
If cortisol is raised after 1mg of Dex @10pm the night before what is the next stage in testing
This is pathological
| Do 8mg dex suppression test
102
What is the diagnosis if a short synacthen test causes a cortisol increase less than double from baseline
Primary adrenal insufficiency ?addisons
103
What is the diagnosis if a short synacthen test causes a cortisol increase more than double from baseline
Normal
104
What is synacthen
Synthetic ATCH
105
What drug is used to replace aldosterone
Fludrocortisone
106
What HbA1c is the cut off for T2DM
48mmol/mol
107
What is the management of a single HbA1c over 48mmol/mol that is assymptomatic
Repeat bloods
108
What should a patient that is prone to COPD infective exacerbation have at home
Steroid & abx
109
A patient presents with ENT , resp and kidney symptoms what diagnosis should be considered
Granulomatous with polyangiitis (cANCA)
110
How many days should pred be given for in home management of infective exacerbation of COPD
5d
111
Management of Addinsonian crisis
HC IV 100mcg stat then 100mcg over 6hrs
Correct glucose
Fluids
Monitor electrolytes
Fluid balance
112
Why might someone present in addinsonian crisis
First presentation
Concurrent illness or trauma
Come rapidly off steroids
113
What abs would you look for in Addison’s disease
Adrenal cortex Abs
| 21 hydroxylase abs
114
What are the two methods of giving carbimazole
Block & replace
| Titrate
115
Hyperthyroidism that’s turned to hypothyroidism with fever and a tender neck might point to what diagnosis
De quervains thyroiditis
116
What is the tx for de quervains thyroiditis
NSAIDs
| Beta blockers when in hyperT
117
Tx options for hyper thyroidism
Carbimazole
Propylthiouracil
RI
Surgery
118
What is phenoxybenzamine
Alpha blocker used to tx pheochromocytoma
119
What is bromocriptine
Dopamine agonists used to treat acromegaly
120
What is pegvisomant
GH antagonist used in acromegaly
121
Most common cause of acromegaly
Pit adenoma
122
What would blood tests of high Ca+ and high PTH point to a diagnosis of
Parathyroid tumour
Or
Pit hyperplasia secondary to ca+ deficiency (tertiary hyper para T)
123
What would blood tests of low Ca+ and high PTH point to a diagnosis of
Secondary hyperparaT
Vit D deficiency
Or
Chronic renal disease
124
Test for diabetes insipidus
Water deprecation test
125
Two types of diabetes insipidus
Cranial
| Nephrogenic
126
Is plasma Na+ high or low in diabetes insipidus
High
127
Causes of nephrogenic diabetes insipidus
Lithium
Electrolyte abnormalities
Genetic mutation in gene that codes for ADHR
Intrinsic kidney disease
128
Caudal causes of diabetes insipidus
Brain tumour / trauma/ infection
Surgery/ RT
Idiopathic
129
Presentation of diabetes insipidus
Polyuria
Polydipsia
HyperNa+
Postural hypoT
130
Presentation of hyperaldosteronism
Non responsive HTN
HypoK+
Metabolic alkalosis
+/- Abdo mass
131
Criteria for AKI
Cr >/= 25micromol increase in 48hr
Cr >/= 50 in 7d
Urine <0.5ml/kg/hr >6hrs
132
Tx for AKI
Tx underlying cause
Hydrate
Stop nephrotixic drugs
Catheterise if obstruction
133
Nephrotixic drugs
ACEi
| NSAIDs Gent
134
Active TB tx
Rifampin 6m
Izoniazide 6m
Pyrazinamide 2m
Ethambutol 2m
135
Tx of latent TB
Isoniazide 6m
OR
R & I for 3m
136
What is the criteria for ordering urine sample in kids
Fever over 38
Not responding to current tx
Symps of uti
137
What is the best investigation for renal scaring in VUR
Scaring - DMSA
138
What test is used to diagnose VUR
Micturating cystourethrogram (MCUG)
139
How might VUR come to a doctors attention
Hydronephrosis on USS
Recurrent UTIs
Chronic pyleonephrosis / reflux nephropathy
140
Organic causes of constipation
```
Hirsprungs disease
Anorectal malformation
CF - meconium illeus
Coeliac
Drugs
Hypothyroidism
```
141
Tx for whooping cough
Clari (macrolide)
142
Management of <3m old with UTI
Hospital IV abx co-amox 5d
143
Management of over 3m well but pyelonephritis
Oral co—amox 7-10d
144
Management of Child >3m LUTI , well in slef
Trimethoprim 3d
145
How many organisms does there need to be on culture for a diagnosis of UTI
10^5
146
What is the most common and second most common bug responsible for UTI
E coli
| Klebsiella
147
What might a pseudomonas UTI bug indicate
Structural abnormality
148
What presentation would you expect with a MCA infarct
Homonymous hemianopia
Hemiparesis U>L
Hemisensory loss
+/- aphasia (LMCA)
149
What presentation would you expect with a ACA infarct
Urinary incontinence
L>U hemiparesis
Personality chance
150
What presentation would you expect with a PCA infarct
Visual changes
Sensory loss
memory issues
151
What presentation would you expect with a basilar / vertebral artery infarct
Cerebellar signs ipsilateral
| Ipsilateral CN palsy’s
152
Types of MND
Amylotrophic lateralising sclerosis (AML)
Primary lateralising sclerosis
Progressive bulbar palsy
Progressive muscular atrophy
153
Treatment of Bell’s palsy
Prednisalone 50mg 10d
154
Differentials for facial paralysis
```
Forehead involved = LMN
Ramsay hunt syndrome
Bell’s palsy
HIV
Lyme disease
Otitis media
MS
Acoustic neuroma
Parotid tumour
```
Forehead spared= UMN
Stroke
Tumour
155
Treatment for Ramsay hunt syndrome
Pred + acyclovir
156
Types of MND
Amylotrophic lateralising sclerosis (AML)
Primary lateralising sclerosis
Progressive bulbar palsy
Progressive muscular atrophy
157
Treatment of Bell’s palsy
Prednisalone 50mg 10d
158
Differentials for facial paralysis
```
Forehead involved = LMN
Ramsay hunt syndrome
Bell’s palsy
HIV
Lyme disease
Otitis media
MS
Acoustic neuroma
Parotid tumour
```
Forehead spared= UMN
Stroke
Tumour
159
Treatment for Ramsay hunt syndrome
Pred + acyclovir
160
Tx for RRMS
Methylprednisalone
| Cyclophosphamide
161
What is the triad in MS
Chariots triad
Nystagmus
Intention tremor
Dysarthria
162
What are the two key findings with a CNVI palsy
Conjugate lateral gaze palsy
| Intranuclear opthalmaplegia
163
What are the two investigations and findings for MS
LP- oligoclonal bands
| MRI - white matter plaques
164
What is a pyramidal pattern of weakness
Motor passes through the pyramidal tracts of medulla - cortocospinal - Extensors weaker than flexors in upper limb and opposite in lower limp
165
What is extrapyramidal disfunction
It involves subconscious movement I.e. basal ganglia I.e Parkinson’s disease
Drugs can mimic I.e. antipsychotics
166
Treatment dystonias
Antimuscarinics
167
Brown sequard results in
Contralateral loss of pain and temp
| Ipsilateral loss of proprioception & Ipsilateral weakness
168
Management of tetanus
Paracetamol for fever
IvIg to mop up toxins
Metronidazole
Muscle relaxant
169
When should you suspect b12 deficiency
Glove and stocking parasthesia distribution+ U&LMN signs
170
Investigations for B12 SADC
MRI spine
Bloods for anaemia
B12 and folate serology
NCS
171
What investigations would you do for ckd?
U&Es
Urine dip
ACR
+/- renal uss
172
What is required for a diagnosis of COPD
Proteinuria (A2/A3)
| EGFR <60 (not G1 or G2)
173
How do you measure urine protein?
albumin creatinine ratio
174
Complications of CKD
Anaemia
Renal bone disease
Cardiovascular disease
