General 2 Flashcards
Mx of MRSA
IV Vancomycin and rifampicin
Chronic hep C with oedema, hypoalbuniaemia, proteinuria - what is this and ix
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
Severe hypocalcaemia mx
10-20ml calcium gluconate in 50-100ml of 5% dextrose over 10mins with cardiac monitoring (as can lead to prolongation QT interval)
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?
Small vessel vasculitis - granulomatoosis with polyangiitis 9GPA)
Urine dipstick to exclude significant renal complications as can manifest with protienura an dhaematuria
Widespread erythema >90% skin and dehydration - what could this be
Erythroderma - emergency - dehydration is complication
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
tympana sclerosis
Mx steroid induced diabetes
If blood glucose levels >12 on two occasions in single 24h period then once daily short acting sulphonyluria like gliclazide is best treatment
Screening test for bushings syndrome
24 hour urine collecitoon - elevated cortisol
(High dose dex suppression test is used to differentiate between pituitary and ectopic causes)
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?
Pancreatic pseudocyst
Common cx of chronic pancreatitis
Acute limb ischaemia mx
Unfractionatwd heparin
How many days to withhold clopidogrel before surgery
7 days
Painless genital ulceration
Then weeks later with painful, inguinal and/or femoral lymphadenopathy (buboes)
Dx + mx
Lymphogranuloma centrum (LGV)
Doxycycline 3 weeks
Meigs syndrome
Pleural effusion , ascites, fibroma (benign ovarian tumour)
If failed anticoagulant with DOAC and rec DVTs then what mx
Warfarin
Lemeirre’s syndrome
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
HBP in IgA nephropathy mx
Rmaipril 1.25mg daily once
What Ix at bedside has a significant correlation with risk reps failure and need for intubation in GBS
Bedside spirometry
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?
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
Cranial Nevre III (occulomotor nerve palsy) one of most common medication causes
Vasculopathic ischaemia
Mx lithium toxicity -
IV fluids mainstay treatment
Indications for steroids in Sarcoidosis
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
mx severe hypocalcaemia
IV calcium gluconate
First line Tx in ethylene glycol poisoning (antifreeze)
Fomepizole
Types renal tubular acidosis
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
Mx epistaxis
- Sit forward and pinch soft area at leats 20mins. If successful - naseptin
- 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
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.
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
Which nerve affected in mid shaft humeral fracture
radial nerve wrist drop
What is the antiretroviral therapy for hIV
2 nucleoside reverse transcriptase inhibitors NRTI and protease inhibitor
Signs of raised ICP in meningitis
focal neuro signs
papilloedema
continuous or uncontrolled seizures
GCS</12
Ischaemic heart disease combined with presence of fusion and capture beats - what problem does this suggest
VT - use amiodarone
Which lobe brain is lip smacking, epigastric aura and automatisms
Temporal lobe
Salter Harris fractures
MOA alteplase
Activates plasminogen to form plasmin
If analgesia doesn’t help endometriosis then what next
COCP or POP
ECG - Tall R waves V1-2 = type MI
Posterior MI
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?
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.
Perioral paraethesia, cramps, tetany and convulsions = what electrolyte disturbance
Hypocalcaemia
First line test for small bowel overgrowth syndrome
Hydrogen breath test
Ix choice for varicose veins/chronic venous disease and findings
Venous duplex US. retrograde venous flow
What imaging modality is preferred in TIA
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
What cancers is the COCP protective against and what does it increase the risk of
Increases risk breast and cervical
Protective against ovarian and endometrial
Subacute combined degeneration of spinal cord - what deficit pattern do you expect:
Proprioception, vibration, muscles, reflexes
Loss proprioception, vibration sensation, muscle weakness and hyperreflexia
Ecstasy poisoning signs / features
Agitation, anxiety, confusion, ataxia, achy, HTN, low sodium, hyperthermia (HIGH TEMP), rhabdomyolysis
H.PYlori post eradication test
Urea breath test (8weeks after initial eradication tx)
What’s CLO testing
rapid urease test in endoscopy to detect H.pylori
Glasgow score for severity acute pancreatitis
‘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)
Which type of epilepsy is commonly ass with seizures in morning/following sleep deprivation in children
Juvenile myoclonic epilepsy
Describe Finkelsteins test and positive then what is the affect
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
High risk toxicity in paracetamol overdose - factors
Chronic alcohol, HIV, anorexia or P450 inducers
WHta is a useful test of exocrine functioning in chronic pancreatitis
Faecal elastase
What is thoracic outlet syndrome
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…
Flu like symptoms, RUQ pain, tender hepatomegaly, deranged LFTs
Hep A
WHta is ovarian hyperstimulation syndrome a potential S/E of?
Gonadotropin therapy (ovulation induction)
S/E Bisphosphonates
Oesophageal reactions
Osteonecrosis of the kaw
Increased risk atypical stress fractures
Acute phase respons
Hypocalcaemia
Which pneumonia ass with cold sores
Strep pneumonia
Causes raynauds
CT disorders - scleroderma, RA, SLE
Leukaemia
Type I cryolobulinaemia, cood agglutinins
use vibrating tools
Drugs - COCP, ergot
Cervical rib
Most important cause ventricular tachycardia
Hypokalaemia (severe high potassium can also in certain things like structural heart disease but rare)
Then hypomagnesaemia
A/E macrolides
Prolongation QT
GI
CHolestatic jaundice
P450 inhibitor
Azithromycin - hearing loss and tinnitus
What drugs to avoid in breast feeding
Ground glass hepatocytes on light microscopy can point to diagnosis of what? what type of hep B infection?
Chronic hep B infection
SVT mx
6mg - 12mg- 18mg Adenosine
Pseudogout reust on befringement
Weakly positive befringement rhomboid shaped crystals
Raised total T3 and T4 but normal fT3 and fT4
Is this normal in pregnancy
Yes
Raised total T3 and T4 but normal fT3 and fT4 suggest high concentrations of thyroid binding globulin, which can be seen during pregnancy
Prescribing in pts with renal failure - what to avoid
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
What is likely to accumulate in CKD and therefore dose adjustment 0 which meds
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
C peptide levels are low in which DM
T1DM
Mild to moderate flare UC extending past left sided colon what to tx with
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
If subarachnoid haemorrhage is suspected but a CT head done and normal then what next and when
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
Organophosphate poisoning symptoms
D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.
Mx = Atropine
Rec UTIs after sex - what offered
Post coital Abx prophylaxis for single dose use
Symptomatic bradycardia - mx
Atropine/transcutaneous pacing but if allergic/reaction to this first line then mx is adrenaline infusion
Obese, young female with headaches / blurred vision think
Idiopathic intracranial HTN
Takotsubo cardiomyopathy - what ECHO finding
Takotsubo cardiomyopathy is associated with apical ballooning of myocardium (resembling an octopus pot)
MOA calcium resonieum in hyperkalaemia
Calcium resonium results in removal of potassium from the body, rather than shifting potassium between fluid compartments in the short-term
HbA1c target for T2Dm : when lifestyle measures, when lifestyle and metformin and when on a drug that can cause hypoglycaemia
Lifestyle = 48
Lifestyle + metformin = 48
Any drug that can cause hypoglycaemia (gluclazide)= 53
What ix is needed before commencing Herceptin (trastuzumab) for HER2 breast cancer
ECHO - as can cause cardiac toxicity
Which organism causes gas gangrene
C.perfringens
What can precipitate lithium toxicity
Dehydration, Renal Failure, Diuretics (thiazides), ACEi, ARBs, NSAIDs, metronidazole
What is the mx lithium toxicity
dIGIBIND
Which medication toxicity has yellow green vision
Digoxin
What is this and the causes
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
Clinically unstable patients with suspected aortic dissection -which Ix
Transoeosphageal echo
Meds that cause urinary retention
TCA, Anticholinergics, opioids, NSAIDs, disopyramide
Saddle pulmonary embolism
