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Difficult Passmed- MLA > General 2 > Flashcards

General 2 Flashcards

1
Q

Mx of MRSA

A

IV Vancomycin and rifampicin

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2
Q

Chronic hep C with oedema, hypoalbuniaemia, proteinuria - what is this and ix

A

Chronic hep C is RF for membranoproliferazive glomerulonephritis
Urine dipstick to assess for proteinuria. If there is protienura then quantify with Urinary protein: creatinine ratio

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3
Q

Severe hypocalcaemia mx

A

10-20ml calcium gluconate in 50-100ml of 5% dextrose over 10mins with cardiac monitoring (as can lead to prolongation QT interval)

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4
Q

A 34-year-old man presents with a two-week history of a purple coloured rash on his lower limbs. He also reports approximately 5kg weight loss in the last two months. He is otherwise well, and his only significant past medical history is of recurrent episodes of sinusitis in the past year.

On examination, there is a widespread palpable purpuric rash on the anterior aspects of both legs. Examination and observations are otherwise normal.

Diagnosis and next best step in management?

A

Small vessel vasculitis - granulomatoosis with polyangiitis 9GPA)

Urine dipstick to exclude significant renal complications as can manifest with protienura an dhaematuria

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5
Q

Widespread erythema >90% skin and dehydration - what could this be

A

Erythroderma - emergency - dehydration is complication

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6
Q

A 40-year-old man with a history of recurrent right-sided otitis media presents with a one-month history of gradually worsening hearing loss in his right ear. He denies any other symptoms, and his past medical history is otherwise unremarkable.

On examination, otoscopy reveals chalky white patches on the tympanic membrane. Rinne’s test is negative on the right, and Weber’s test lateralises to the right ear.

Which of the following is the most likely diagnosis

A

tympana sclerosis

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7
Q

Mx steroid induced diabetes

A

If blood glucose levels >12 on two occasions in single 24h period then once daily short acting sulphonyluria like gliclazide is best treatment

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8
Q

Screening test for bushings syndrome

A

24 hour urine collecitoon - elevated cortisol

(High dose dex suppression test is used to differentiate between pituitary and ectopic causes)

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9
Q

A 35-year-old lady with a history of chronic pancreatitis presents with post-prandial vomiting and abdominal pain. She denies weight loss, fevers, pruritus and any family history of malignancy.

Her blood tests are significant for a cholestatic pattern of liver function tests.

Which of the following is the most likely diagnosis?

A

Pancreatic pseudocyst

Common cx of chronic pancreatitis

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10
Q

Acute limb ischaemia mx

A

Unfractionatwd heparin

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11
Q

How many days to withhold clopidogrel before surgery

A

7 days

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12
Q

Painless genital ulceration
Then weeks later with painful, inguinal and/or femoral lymphadenopathy (buboes)

Dx + mx

A

Lymphogranuloma centrum (LGV)
Doxycycline 3 weeks

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13
Q

Meigs syndrome

A

Pleural effusion , ascites, fibroma (benign ovarian tumour)

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14
Q

If failed anticoagulant with DOAC and rec DVTs then what mx

A

Warfarin

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15
Q

Lemeirre’s syndrome

A

Infective thrombophlebitis that can develop as result untreated bacterial throat infections in otherwise healthy young adults. Can lead to other further systemic complications like bacteraemia and septic emboli

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16
Q

HBP in IgA nephropathy mx

A

Rmaipril 1.25mg daily once

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17
Q

What Ix at bedside has a significant correlation with risk reps failure and need for intubation in GBS

A

Bedside spirometry

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18
Q

A 74-year-old male is referred to the falls clinic after he suffers three mechanical falls at home within two months. He has a past medical history that includes postural hypotension, urinary incontinence, recurrent chest infections and six months ago was diagnosed with Parkinson’s disease. He currently takes tamsulosin, co-benyldopa and has just finished a course of amoxicillin. On examination, you note that he has hypomimia, rigidity and bradykinesia with a very mild tremor.

What extra examination or test might help you with your diagnosis?

A

Test vertical gaze - likely parkinsons plus syndrome as symptoms autonomic instability and co-benyldopa hasn’t helped.
If they have lost vertical gaze would suspect progressive supra nuclear palsy

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19
Q

Cranial Nevre III (occulomotor nerve palsy) one of most common medication causes

A

Vasculopathic ischaemia

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20
Q

Mx lithium toxicity -

A

IV fluids mainstay treatment

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21
Q

Indications for steroids in Sarcoidosis

A

Pts with CXR stage 2 or 3 disease who are symptomatic. Pts with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require tx.
Hypercalcaemia
Eye, heart or neuro

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22
Q

mx severe hypocalcaemia

A

IV calcium gluconate

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23
Q

First line Tx in ethylene glycol poisoning (antifreeze)

A

Fomepizole

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24
Q

Types renal tubular acidosis

A

T1 (distal) - low potassoim, cx include renal stones
T2 - low potassium, cx include osteomalacia
T3 - low potassium, v rare
T4 - high potassium, caused by diabetes

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25
Q

Mx epistaxis

A
  1. Sit forward and pinch soft area at leats 20mins. If successful - naseptin
  2. cautery if visible source. If not then packing

If harm unstable or compromised then admit and if all fails then may need sphenopalatine ligation in theatre

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26
Q

A 2-year-old has a history of rectal bleeding. The parents notice that post defecation, a cherry red lesion is present at the anal verge.

A

juvenile polyps - usually hamartomas and this accounts for colour lesions. Although the lesions are not malignant, they are a marker for an underlying polyposis disorder

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27
Q

Which nerve affected in mid shaft humeral fracture

A

radial nerve wrist drop

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28
Q

What is the antiretroviral therapy for hIV

A

2 nucleoside reverse transcriptase inhibitors NRTI and protease inhibitor

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29
Q

Signs of raised ICP in meningitis

A

focal neuro signs
papilloedema
continuous or uncontrolled seizures
GCS</12

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30
Q

Ischaemic heart disease combined with presence of fusion and capture beats - what problem does this suggest

A

VT - use amiodarone

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31
Q

Which lobe brain is lip smacking, epigastric aura and automatisms

A

Temporal lobe

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32
Q

Salter Harris fractures

A
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33
Q

MOA alteplase

A

Activates plasminogen to form plasmin

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34
Q

If analgesia doesn’t help endometriosis then what next

A

COCP or POP

35
Q

ECG - Tall R waves V1-2 = type MI

A

Posterior MI

36
Q

A 70 year-old man, who is currently an inpatient after having a hip replacement develops urosepsis.
His past medical history includes ulcerative colitis and ischaemic heart disease. He is commenced on high-dose intravenous cephalosporin and gentamicin and after five days feels better with his observations returning to normal. However, on the fifth day he develops left-sided abdominal tenderness and diarrhoea. Sigmoidoscopy reveals yellow plaques. What is the most likely diagnosis?

A

Considering this patient has finished a course of high dose IV cephalosporins, his most likely diagnosis is pseudomembranous colitis. The most common cause of this is clostridium difficile infection, which can present on sigmoidoscopy with yellow plaques on the intraluminal wall of the colon.

37
Q

Perioral paraethesia, cramps, tetany and convulsions = what electrolyte disturbance

A

Hypocalcaemia

38
Q

First line test for small bowel overgrowth syndrome

A

Hydrogen breath test

39
Q

Ix choice for varicose veins/chronic venous disease and findings

A

Venous duplex US. retrograde venous flow

40
Q

What imaging modality is preferred in TIA

A

MRI (Inc diffusion weighted and blood sensitive sequences) same day as specialist assessment

(+urgen carotid doppler)

  • Ad CT shouldn’t be done unless clinical suspicion of alternative diagnosis that CT could detect
41
Q

What cancers is the COCP protective against and what does it increase the risk of

A

Increases risk breast and cervical

Protective against ovarian and endometrial

42
Q

Subacute combined degeneration of spinal cord - what deficit pattern do you expect:
Proprioception, vibration, muscles, reflexes

A

Loss proprioception, vibration sensation, muscle weakness and hyperreflexia

43
Q

Ecstasy poisoning signs / features

A

Agitation, anxiety, confusion, ataxia, achy, HTN, low sodium, hyperthermia (HIGH TEMP), rhabdomyolysis

44
Q

H.PYlori post eradication test

A

Urea breath test (8weeks after initial eradication tx)

45
Q

What’s CLO testing

A

rapid urease test in endoscopy to detect H.pylori

46
Q

Glasgow score for severity acute pancreatitis

A

‘PANCREAS’
Pao2<8
Age>55
Neutrophilia (WBC>15x10^9)
Ca <2
Renal function (urea>16)
Enzymes (LDH>600, AST>200)
Albumin <32
Sugar (BG>10)

47
Q

Which type of epilepsy is commonly ass with seizures in morning/following sleep deprivation in children

A

Juvenile myoclonic epilepsy

48
Q

Describe Finkelsteins test and positive then what is the affect

A

Examiner pulls thumb of patient in ulnar deviation and longitudinal traction.
In a patient with tenosynovitis this causes pain over radial styloid process and along length of extensor pollisis bravos and abductor policies longs

49
Q

High risk toxicity in paracetamol overdose - factors

A

Chronic alcohol, HIV, anorexia or P450 inducers

50
Q

WHta is a useful test of exocrine functioning in chronic pancreatitis

A

Faecal elastase

51
Q

What is thoracic outlet syndrome

A

Compression of brachial plexus, subclavian artery or vein at site thoracic outlet
Eg caused from cervical rib growing

Painless muscle wasting hand muscles, hand weakness, sensory symptoms…

52
Q

Flu like symptoms, RUQ pain, tender hepatomegaly, deranged LFTs

A

Hep A

53
Q

WHta is ovarian hyperstimulation syndrome a potential S/E of?

A

Gonadotropin therapy (ovulation induction)

54
Q

S/E Bisphosphonates

A

Oesophageal reactions
Osteonecrosis of the kaw
Increased risk atypical stress fractures
Acute phase respons
Hypocalcaemia

55
Q

Which pneumonia ass with cold sores

A

Strep pneumonia

56
Q

Causes raynauds

A

CT disorders - scleroderma, RA, SLE
Leukaemia
Type I cryolobulinaemia, cood agglutinins
use vibrating tools
Drugs - COCP, ergot
Cervical rib

57
Q

Most important cause ventricular tachycardia

A

Hypokalaemia (severe high potassium can also in certain things like structural heart disease but rare)
Then hypomagnesaemia

58
Q

A/E macrolides

A

Prolongation QT
GI
CHolestatic jaundice
P450 inhibitor
Azithromycin - hearing loss and tinnitus

59
Q

What drugs to avoid in breast feeding

A
60
Q

Ground glass hepatocytes on light microscopy can point to diagnosis of what? what type of hep B infection?

A

Chronic hep B infection

61
Q

SVT mx

A

6mg - 12mg- 18mg Adenosine

62
Q

Pseudogout reust on befringement

A

Weakly positive befringement rhomboid shaped crystals

63
Q

Raised total T3 and T4 but normal fT3 and fT4

Is this normal in pregnancy

A

Yes

Raised total T3 and T4 but normal fT3 and fT4 suggest high concentrations of thyroid binding globulin, which can be seen during pregnancy

64
Q

Prescribing in pts with renal failure - what to avoid

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

65
Q

What is likely to accumulate in CKD and therefore dose adjustment 0 which meds

A

most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids

66
Q

C peptide levels are low in which DM

A

T1DM

67
Q

Mild to moderate flare UC extending past left sided colon what to tx with

A

In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far

68
Q

If subarachnoid haemorrhage is suspected but a CT head done and normal then what next and when

A

If subarachnoid haemorrhage is suspected but a CT head done > 6 hours after symptom onset is normal, a lumbar puncture should be done to confirm or exclude the diagnosis in 4 hours

69
Q

Organophosphate poisoning symptoms

A

D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.

Mx = Atropine

70
Q

Rec UTIs after sex - what offered

A

Post coital Abx prophylaxis for single dose use

71
Q

Symptomatic bradycardia - mx

A

Atropine/transcutaneous pacing but if allergic/reaction to this first line then mx is adrenaline infusion

72
Q

Obese, young female with headaches / blurred vision think

A

Idiopathic intracranial HTN

73
Q

Takotsubo cardiomyopathy - what ECHO finding

A

Takotsubo cardiomyopathy is associated with apical ballooning of myocardium (resembling an octopus pot)

74
Q

MOA calcium resonieum in hyperkalaemia

A

Calcium resonium results in removal of potassium from the body, rather than shifting potassium between fluid compartments in the short-term

75
Q

HbA1c target for T2Dm : when lifestyle measures, when lifestyle and metformin and when on a drug that can cause hypoglycaemia

A

Lifestyle = 48
Lifestyle + metformin = 48
Any drug that can cause hypoglycaemia (gluclazide)= 53

76
Q

What ix is needed before commencing Herceptin (trastuzumab) for HER2 breast cancer

A

ECHO - as can cause cardiac toxicity

77
Q

Which organism causes gas gangrene

A

C.perfringens

78
Q

What can precipitate lithium toxicity

A

Dehydration, Renal Failure, Diuretics (thiazides), ACEi, ARBs, NSAIDs, metronidazole

79
Q

What is the mx lithium toxicity

A

dIGIBIND

80
Q

Which medication toxicity has yellow green vision

A

Digoxin

81
Q

What is this and the causes

A

Lived reticularis - purplish non blanching, reticulated rash caused by obstruction of capillaries resulting in swollen venules

Idiopathic
Polyarteritis nodosa
SLE
Cryglobulinaemia
Antiphospholipid syndrome
Ehlers dances syndrome
Homocystinuria

82
Q

Clinically unstable patients with suspected aortic dissection -which Ix

A

Transoeosphageal echo

83
Q

Meds that cause urinary retention

A

TCA, Anticholinergics, opioids, NSAIDs, disopyramide

84
Q
A

Saddle pulmonary embolism

Difficult Passmed- MLA (26 decks)

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