ID, Haemonc, GUM, Opthal, psych, geris Flashcards
(144 cards)
1
Q
Anal sex, now painful defecation with flecks of blood and tender inguinal lymph nodes
A
Lymphogranuloma verenum
2
Q
What previous op have they had if iron and b12 deficiency
A
partial gastrectomy
3
Q
Abdominal pain, and neuropsych disorder
rx?
A
Acute intermittent porphyria
IV haem arginate
4
Q
Meningitis following neurosurgical procedure usually?
A
S epidermis
5
Q
Cervicitis with discharge - abx to prescribe
A
Single dose cef
+ 14 days doxy + metronidazole
6
Q
NHL given chemo. Now anaemia with low/normal reticulocytes. Normal platelets / wcc
A
Paravirus infection
[autoimmune haemolytic anaemia would have raised reticulocytes]
7
Q
Gross haematuria and mass on kidney in CT. Next step?
A
Urology + radical nephrectomy
8
Q
Branch retinal vein vs artery on fundocsopy
A
Vein - flame haemorrhages and engorge vessels
Artery - pail and absent vessels
9
Q
Female - 6 weeks Hx lower abdo pain, occasionally feverish.
Prev UTIs, normal dipstick =
A
PID
10
Q
Type A vs B arotic dissection and rx?
A
A - ascending aorta
-> urgent surgery
B - doesn’t involve ascending aorta
-> Labetalol first
11
Q
Evidence of end organ damage in myeloma
A
C - Ca >2.75
R - renal impairment
A - anaemia <100
B - Bone lesions
12
Q
Gent renal damage is from damage to
A
proximal tubule
13
Q
recurrent breeast Ca, why HyperCa
A
Production of PTH-Related protein
14
Q
unwell with diarrhoea, neuro sx, schistocytes, thrombocytopenia and only mild renal impairment =?
rx?
A
TTP
Plasma exchange
15
Q
Fever, anaemia, thrombocytopenia neuro/ renal abnormalities
A
TTP
16
Q
Any hints of infective endocarditis needs
A
serial blood cultures
17
Q
Immunocompromised with fever, cough, red conjunctiva and this spreading morbilliform rash = ? ix?
A
Measles
NPA aspirate as immunocompromised so measles IgM might not be positive
18
Q
Reversal of Apixaban?
rivaroxiban?
Dabigatran?
heparin?
LMWH?
A
Apixaban - Andexanet alpha
rivaroxiban - andexanet alpha
Dabigatran - Idarucizumab
heparin - protamine
LMWH - protamine
19
Q
Had whooping cough for several weaks - best Ix?
A
serology
20
Q
Fresh water exposure, now headaches fevers and jaundice =? rx?
A
Lepto
BenPen / cef
21
Q
Doxy mechanism
A
Inhibits 30s subunit of ribosomes
22
Q
Which abx inhit 50s subunit of ribosomes
A
Macrolides
Clinda
Linezolid
23
Q
Inhibit steroid hormone synthesis drug?
A
Mitotane
24
Q
Any presentation of self harm should get
A
Psychosocial assessment prior to discharge
25
55M lethargy.
Anaemia, WCC 55, thrombocytopenia
Cytogenetitcs t: 15 :17
Dx?
Derranged clotting why?
rx?
APML
Get DIC -> platelets, FFP, cryo
ATRA - (Vit A)
26
Most likely primary Ca
Renal - cannonball mets
27
ewings sarcoma poor prognostic features
Anaemia
Male sex
Raised LDH
28
Pregnant exposire to VZV rx?
VZV antibody testing
-> VZV Ig if neg
29
Weight loss, worsening diabetic control, skin rash =?
describe rash? ix?
Glucagonoma
glucagon levels and CT of pancreas
Rash is necrolytic migratory erythema
30
HZV on tip of nose makes you worried about?
'hutchinsons sign' = likely Opthal HZV
-> opthal opinion + IV aciclovir
31
Symptoms pyelonephritis with temp 39.4 rx?
Urine culutre fist
then IV Abx
32
LFTs in cirrhossis to suggest development of HCC
Sudden increase in ALP
33
neutropenic sepsis Rx?
IV Taz
[gent no longer recommended]
34
Swelling of lower legs
Itching and crusting
varicose eczema
35
HIV - excoriated papules and pustules on chest, back and arms =
Eosinophilic folliculitis
36
Excercise now unable to see out left eye =
left-sided carotid dissection
Ptosis and miosis visible
37
Small cell lung Ca with ipsilateral node involvement rx
Combination chemo + radio
38
Visits jungle get a warty lump on arm which heals up. Now maculopapular rash
Yaws
39
RUQ discomfort
hepatomegaly
CEA 2x normal and Ca-19-9 10x normal
Normal AFP
=?
Ca-19-9 =?
Intrahepatic colangiocarcinoma
pancreas, gallbladder, lung, or colon.
40
Several months of low mood, low energy, difficulty sleeping
Auditory hallucinations saying he is worthless
Depression
41
Who should get a DXA scan
Anyone post menopausal / older men with fragility fracture
Eg Collies, vertebral wedge, or NOF
42
university with severe pain in eye and Hx of back problems
Describe eye
Anterior uveitis - with oval pupil
43
Headaches, anaemia, raised IgM
Waldenstrom
44
Whats it called when nucleated red cells or myelocytes seen on blood film
leuco-erythroblastic anaemia
45
Whats it called when nucleated red cells or myelocytes seen on blood film
leuco-erythroblastic anaemia
46
Whats it called when nucleated red cells or myelocytes seen on blood film
leuco-erythroblastic anaemia
47
Presents like anorexia + irregular patchy alopecia
firm compressible mass in LUQ =?
trichobezoar
[Eating own hair]
48
Anaemia with splenomegaly
Hereditary spherocytosis
loss of central pallor
49
On tamoxifen for breast Ca, periods stopped and debilitating hot flushes rx?
Progesterone
eg megestrol, norhisterone....
50
Renal Ca needs nephrectomy then?
Treatment with a kinase inhibitor
Eg Sunitinib / pazopanib
51
Asian man with anaemia and low MCV but normal ferritin Ix?
Hb electrophoresis
52
HIV 1 week headache with focal signs
Toxo
53
Given Benpen for syphilis and within 1 minute visual hallucinations and agitation
Procaine reaction
54
Post partum, foul smelling dischage. Erythema around episiotomy site and abdo tenderness
Ix?
Endometriitis
High vag swab
55
painless loss of vision ? rx?
Central RAO
Any of
-Acetazolomide + mannual massage
-Thrombolysis
-Anterior chamber paracentesis
56
Key complication of diphtheria
Myocarditis
57
Clue in question for leigonaiires vs mycoplasma
Leigon - HypoNa, travel
Mycoplasma - erythema multiform, haemolytic anaemia
preceding flu like illness
58
Low ristocetin co factor (RoCF) level means
VWD
59
Heaches blurred vision, weight loss purpuric rash, lymphadenopathy
Marrow - infiltration with lymphoplasmacytoid cells
Waldenstrom
60
HIV - red tender leisions on shins
subacute cavitating pneumonia
Histoplasma
61
Molluscum
62
Dermatomyositis with HyperCa
SSC of lung
63
Pancytopenia
Marrow - increased cellularity with ring sideroblast cells
Myleodysplasia
64
What do you need post resection of RCC
VGEF or immunotherapy eg sunitinib
65
Poor prognosis in kids ALL
pHILADEPHIA 9:22
66
Which infection mimics appendicitis
Yersinia entercolitica
67
Haemorrhage on apixaban what can be used if no reversal agent adexenat
Prothrombin complex concentrate
68
For MGUS what is M protein level? Plasma cells on marrow?
M protein <30g/l
plasma <10%
69
Atypical lymphocytes with abnormal villous projections
Hairy cell leukaemia
[hair like projections]
70
few weeks Night sweats weight loss
thickened bowel wall and ++ LDH
burkits lymphoma - get spontaneous tumour lysis as grows rapidly
71
bacteria infecting a joint prothesis but no real symptoms and not bad at all
p acnes
72
Gangrene caused by? rx/
C perfringes
benpen + clinda
73
ovarian ca chemo regime
paclitaxel and carboplatin
74
2 malignancies commonly with hyperviscosity
waldenstron
myeloma
75
CBT for body dysmorphic disorder
exposure and response prevention
76
Warfarin overdose and bleeding but no prothrombin complex available
FFP
77
Which testi Ca has ++ HCG levels
choriocarcinoma
78
2 month hx flu like sx and endocarditis
coxiella
79
Which abx most impicated C dif
cipro
clinda
cefalosporins
80
Peutz jehger inheritance? gene?
Dominant
STK11
81
Hypertensive retinopathy
optic disk oedema, cotton wool spots
haemorrhages, AV nipping
82
Sickle cell crisis anagesia
IV mophine (rather than fentanyl)
83
Previous rx with cyclophosphamide years ago now haematuria
Bladder Ca
84
Shigella 1st line UK
Azithro
85
Immunocompromised. Exposed to VZV. IgG positive on test
rx?
reassure - only need IVIg if neg
86
Long term tamoxifen common comp?
Clots
87
Flu A Drug and class
oseltamvir
neuraminidase inhibitor
88
methaemoglobin rx
methyline blue
Low Sa02 with high PaO2
89
Pancoast tumour with horners - what happens with atropine and pupil
constricted pupil that does not dilate with atropine properly
90
Loss of vision and vague discomfort over 2 days
central RVO
91
Sudden onset eye pain fixed dilated pupil
glaucoma
92
Young person acute agitation needing IM sedation
Loraz
risk of dystonic reactions with haloperidol in young
93
Young gal lower abdo pain for 9 days with post coital bleeding.
Neutrophils on cervical smear
chlamydia
94
T2DM worsening acuity =? rx?
Hard exudates and haemorrhage within 1 optic disc diameter of macula = macular oedema
VGEF inhibitors / focal laser therapy
95
What speeds up mesothelioma progression
Prev radiation exposure
96
FHx of splenectomy
recent flu like illness and now epistaxis and platelets 16 = ?
RX? second line?
ITP
steroids
IVIg
97
When add methylpred to co-trimox in Pneumocystis rx?
PO2 <9.3
spo2 <92%
98
Oxaliplatin chemo key side effet
Peripheral neuropathy
99
Sudden loss of vision
Branch RVO
100
HUS new 1st line rx if required
eculizumab
(binds to C5)
101
Flu with resistance to oseltamivir?
Inhaled zanamivir
102
t 15:17?
t 8:14?
t 9:22?
t 15:17 - acute promyelocytic leukaemia
t 8:14 - burkits lympoma
t 9:22- philadephia
103
PCP prophylaxis if no co-trimox? What if g6pd?
Dapsone second line
Inhaled pentamidine if G6PD
104
Often gets a stuffy nose, No response to Hep / tetanus vaccinations
IgA deficiency
105
HyperCa key Rx
IV fluids
then bisphosphonates
106
What type of blood for haemonc
Irradiated
Doesn't need to be CMV negative
107
Farmer with cut on leg goes into some drainage ditches and now has hepatitis with ++ bili and thrombocytopenia? rx?
Lepto
Benpen
108
Headaches lethargy back pain. Severe renal impairment, ++ raised viscosity and protein with low albumin
Myeloma
[Dont get bone pain in waldenstrom]
109
Most common complication of endpcarditis
emboli stroke
110
Scaring on legs from old sores in childhood
+tremponema agglutination but negative RPR
Yaws
111
Which antipsychotic best for psychosis in Parkinsons
quetiapine
[Quiet them down without reactions]
112
Who gets 5-FU toxicity
Deficiency of DPD enzyme
113
CRVO
114
coxiella dx?
complement fixation
115
long standing RheumA. Now raised bili, low hapto, low platelets
Haemolytic anaemia
direct antiglobin test
116
65 headaches rasied Hb, mass in LUQ
Polycythaemia
117
Does HepC have PEP?
No
118
STE 1, AvL
= High lateral MI
[branch of LAD]
119
virulence factor for nec fasc
M protein
120
Optic disc oedem
cotton wool spots
AV nipping
= hypertensive retinopathy
121
pancytopenia and positive TRAP stain
hairy cell leukaemia
122
TRAP stain
Sudan black B stain
TDT stain
LAP stain
TRAP stain - hairy cell leukaemia
Sudan black B stain - AML
TDT stain - ALL
LAP stain - Polycythaemia and myelofibrosis
[Trap Hairs, AM sudanise
123
Which meds Llower b12 absorption
PPI
124
Gonococcal septic arthritis most likely to be seen on aspirate
Neutrophils
[gonno only found in 25% of aspirates]
125
Gram-positive rod causing diarrhoea morning after BBQ
c perfringes
126
Trifasicular block
Right bundle branch block
Left axis deviation (= left anterior fascicular block)
First degree AV block
127
Trifasicular block
Right bundle branch block
Left axis deviation (= left anterior fascicular block)
First degree AV block
128
2 ways an ecg shows bifasicular block
Right bundle branch block (RBBB) with left anterior fascicular block (LAFB), manifested as left axis deviation (LAD)
RBBB and left posterior fascicular block (LPFB), manifested as right axis deviation (RAD) in the absence of other causes
129
bifascicular block pattern: RBBB combined with LAFB (manifested as LAD)
130
Bifasicular block
RBBB with LAFB
RBBB pattern in precordial leads with RSR’ complex in V1-2
Prominent LAD indicating LAFB
131
Acquired factor VIII deficiency Rx
Factor VII
[not VIII]
132
Prolonged Hx of dry cough worst in cold air
Bordetella pertusus
133
Which antipsychotic particularly related do developing diabetes
Olanzapine
[Big O fatty]
134
14 days post renal Tx
Flu like symptoms and sore throat
CMV
135
Family Breast and melanoma Ca gene
CDKN2A
136
1st thing to rise following MI? most specific?
Myoglobin first to rise
Trop I most specific
137
Dry age-related macular degeneration
138
Bitten by tick
Anaemia and jaundice
Babesia
139
HPV anogenital warts 1st line? if preg?
Topical podophyllotoxin
Cryotherapy if preg
140
Bacilus cerrus endocarditis rx
Vanc
141
VP shunt with signs of raised pressure initial Ix
MRI
Not CT
142
How to treat TTP if no plasma exchange available
Need to increase ADAMTS13
- FFP
- Steroids to strop antibody production
- consider rituxumab
143
Rx cmv if increasing Viral load despite rx with vaniclovir
Foscarnet
144
Diffuse alveolar haemorrhage rx
High dose steroids
+ etanercept
