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5th Year!! > Internal Med > Flashcards

Internal Med Flashcards

1
Q

Mx of provoked PE

A

E.g. long flight

Loading dose then 3 months DOAC

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2
Q

What drugs given to treat oesophageal varices and then prevent it

A

Treat= terlipressin

Prevent= Propranolol

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3
Q

Which drug to offload fluid in ascites

A

Spirinolactone

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4
Q

Which kind of seizure is normally associated with lip/ mouth involvement

A

TempORAL lobe partial seizure

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5
Q

Most common cause of endogenous Cushing

A

Pituitary adenoma (cushings’s disease)

Drugs is most common cause (steroids)

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6
Q

If no asthma signs and ipratropium not working what to do

A

Stop the SAMA (ipratropium)

Start LAMA and LABA so tiotropium and formoterol

LAMA and SAMA work on the same receptors

Also add salbutamol ?

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7
Q

Crypt abscesses which GI problem

A

Ulcerative colitis

Goblet cells and granulomas, villus atrophy are coeliac

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8
Q

Which antihistamines are sedating and non-sedating

A

Clhlorphenamine is sedating

Cetirizine, fexofenadine and loratadine are non sedating

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9
Q

Which test determines whether kidney injury is acute or chronic

A

If hypocalcaemic it is chronic

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10
Q

How to manage bilateral adrenocortical hyperplasia vs adrenal adenoma

A

Hyperplasia treat with spirinolactone (aldosterone antagonist)

Adenoma treat with surgery

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11
Q

How to treat trigeminal neuralgia

A

Carbemazepine is first line

Neuro referall if that doesn’t work

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12
Q

How to differentiate lambert Eaton and myasthenia gravies

A

Lambert Eaton usually gets a bit better with muscle use, MG worsened

MG affects the face and arms earlier, then legs

LES affects legs

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13
Q

What size of AAA requires what monitoring

A

3-4.5cm = every 12 months USS
4.5-5.5 = every 3 months USS
>5.5cm= 2ww to vascular surgery

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14
Q

Breastfeeding with HIV

A

No

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15
Q

What condition is carbimazole used to treat

A

Propanolol initially to help with Sx

Then if graves

Then carbimazole

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16
Q

How to treat mild/ moderate UC flares vs severe

A

Mild/moderate treat at home with topical (rectal) aminosalicylate -> add oral if that doesn’t work

Severe colitis treat with IV steroids -> add IV cyclosporine if that doesn’t work

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17
Q

Which cardiac abnormality occurs with high calcium

A

Short QT

Same with high k+

And the opposite is true for low of both

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18
Q

Triad of budd-chiari syndrome,e

A

Sudden onset abdominal pain

Ascites

Tender hepatomegaly

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19
Q

How to manage idiopathic intracranial hypertension

A

Weight loss

Carbonic anhydrase inhibitors e.g. acetazolamide

Can also use topiramate which helps with WL also

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20
Q

Which seizure Types do you not give sodium valproate

A

Focal seizure (partial) give lamotrigine or levetriacetam

Absence seizures (petit mal) give ethosuximide

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21
Q

How do discern between anaemia of chronic disease and IDA from iron studies

A

Total iron binding capacity (body’s ability to take in iron)

High in IDA as there’s no iron

Low/ normal in AOCD as the body is storing iron outside of the blood so no free space

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22
Q

How to diagnose chronic pancreatitis

A

CT pancreas

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23
Q

Which type of prostate drug is likely to cause gynaecomastia

A

GnRH agonists e.g. goserelin

Not doxazosin as much but i think it still can

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24
Q

Which diabetes drug causes weight gain

A

Sulphonylureas e.g. gliclazide

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25
Q

Why could u do an ECG before starting SSRIs or TCIs

A

Risk of prolonged QT syndrome

So can do a baseline ECG

Seen more in higher dose

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26
Q

Severe acute alcoholic hepatitis Mx

A

Glucocorticoids e.g. pred in acute episode

Pentoxyphylline is also sometimes used

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27
Q

Which BP drug causes ED

A

Indapamide or other thiazide-like diuretics

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28
Q

Which clotting screen does warfarin affect

A

PT (prolongs it )

No effect on APTT

Because warfarin reduces F7 levels which is in the extrinsic pathway afffecting PT but nt the intrinsic pathway which affects APTT

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29
Q

How to differentiate between gastric and duodenal ulcer

A

Gastric worse on eating

Duodenal better on eating

As when eating the sphincter is closed between the stomach and duodenum so no acid in duodenum and all in stomach

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30
Q

Lyme disease Mx

A

If caught early then 14-21daycourse of oralodxycycline

IV cef when there is CNS involvement

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31
Q

What should all people with peripheral artery disease be taking

A

Statin 80mg

Clopidogrel

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32
Q

what us Chvostek’s sign

A

Twitching of facial muscles on percussion

Classic indication of hypocalcaemia

E.g. after thyroid surgery, damage to PT gland

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33
Q

What rate should maintainance fluids be prescribed at

A

30 ml / kg / DAY

So someone who weighs 75kg needs 2250mls over 24 hours

So they need 93.75 ml/hr aka 100 ml/hr

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34
Q

What is a normal anion gap

A

8-14

On pass med it says 10-18

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35
Q

How do you investigate a suspected perforated duodenal ulcer

A

Erect CXR

As you can see pneumoperitoneum

Which is suggestive of the above

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36
Q

Which analgesic is first line in renal colic pain

A

IM diclofenac 75mg

In less severe pain you can do rectal or oral route

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37
Q

How to manage alcohol withdrawal in those with and without liver cirrhosis

A

Without cirrhosis= chlordiazepoxide (long-acting benzodiazepine)

With cirrhosis= lorazepam (metabolism less affected by liver dysfunction)

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38
Q

How to discern between IgA nephropathy and post-streptococcal glomerulonephritis

A

IgA nep is shorter word so comes on after 1-3 days of infection

Post-strep glom is longer so comes on 1-2 weeks after infection

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39
Q

Which t2dm meds can cause pancreatitis

A

DPP-4 inhibitors e.g. gliptins e.g. sitaliptin

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40
Q

UC is linked with which liver problem and how do we diagnose it

A

Linked with primary sclerosing cholangitis

Diagnose with ERCP or MRCP (ERCP is endoscopic and MRCP is MRI scan)

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41
Q

Which blood pressure med messes with thyroid levels

A

Amiodarone

Can cause hypo and hyperthyroid

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42
Q

4 drugs that cause idiopathic intracranial hypertension

A

Tetracyclines e.g. doxycycline

Isotretinoin

Contraceptives

Steroids

Also levothyroxine, lithium, cimetidine (for ulcers)

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43
Q

Hello how do you manage thyrotoxic storm

A

Beta blockers

Propylthiouracil

Hydrocortisone

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44
Q

How do you investigate hyperadrenalism vs adrenal insuficiency

A

Hyper e.g. Cushing = dexamethasone supression test

Hypo e.g. addisons = ACTH stimulation test (short Synacthen test)

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45
Q

Ischaemic stroke management outline

A

1) exclude haemorrhage with CT head
2) Aspirin 300mg OD for 2 weeks
3) if presents <4.5 hours then thrombolysis with alteplase (or <9 hours sometimes)
4) if proximal ant circ (or sometimes prox post circ) and presents <6 hours then thrombectomy, consider thrombectomy <24 hours if salvageable tissue

Secondary prevention with clopidogrel monotherapy

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46
Q

How to manage active and latent TB

A

Active= RIPE
Rifampicin 6/12
Isoniazid 6/12
Pyrazinamide 2/12
Ethambutol 2/12

Co prescribe vitamin B6 (Pyridoxine) as isoniazid causes peripheral neuropathy

RifamPEEcin
IsoNERVEzid
PyraLIVERmid
EYEthambutamol

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47
Q

Fatigue, positive anti mitochondrial antibodies and raised IgM diagnosis and management

A

Primary biliary cholangitis

Also has cholestatic LFTs

Mx with urseodeoxycholic acid

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48
Q

Return from travel with non-bloody, yellow green diarrhoea, persistent fever and abdominal pain AND rose coloured spots around the umbilicus

A

Typhoid fever

Which is caused by salmonella typhi

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49
Q

What makes an UC flare severe and how does that affect management

A

Mild= <4 stools/day, small amount of blood
Moderate= 4-6 stools/day, varying amount of blood, no systemic upset
Severe= >6 bloody stools a day, systemic upset

For mild/moderate give rectal/ oral aminosalicylate +/- oral corticosteroid

For severe give IV steroids

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50
Q

Which virus causes suppression of the bone marrow

A

Parvovirus

Can trigger an aplastic crisis in those with blood cell deformity e.g. spherocytosis

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51
Q

How does haemolytic uraemic syndrome present

A

AKI

Thrombyocytopenia (low platelets)

Microangiopathic haemolytic anaemia (normocytic)

Can also have bloody stool x

52
Q

What is nephrogenic diabetes insipidus and thus how do you investigate it

A

When the kidneys are no longer sensitive to ADH meaning they have no ability to concentrate urine (polydipsia etc)

Do water deprivation test:
Urine osmalality after fluid deprivation is still low
Urine osmalality after desmopressin (synthetic ADH) is still low!

53
Q

Which T2DM drug causes fasciitis of the genitalia

A

SGLT-2 inhibitors e.g. dapagliflozin

As the glucose flows in the urine i.e excreted in the urine causing genital problems

54
Q

Patient with HIV presenting with diarrhoea most likely organism

A

Cryptosporidium parvum

55
Q

How to manage allergic bronchopulmonary aspergillosis

A

Prednisolone oral

Often occurs in those with existing lung pathology e.g. CF/ asthma

do RAST test to diagnose it

56
Q

When is prasugrel indicated

A

In a STEMI before PCI given as dual antiplatelet therapy with aspirin

Not given if they are taking an oral anticoagulant (clopidogrel instead)

Not given in NSTEMI- ticagrelor given instead

57
Q

Which type of sensation crosses to the contralateral side at which level

A

Fine touch (normal sensation) crosses at the brainstem

Pain and temperature crosses at the level that it enters the spine

Motor crosses at the brainstem also

58
Q

What acid-base imbalance is caused by addisonian crisis

A

Hyperkalaemic metabolic acidosis

Addisons-> less aldosterone production-> more K+ in the blood. K+ is equivalent to H+ so it is acidic and so causes an acidosis

59
Q

How to diagnose Graves’ disease

A

Thyroid autoantibodies

TRAB/ TBII - positive in 95% of graves
Also TPO - positive in 80z of graves

Can do a thyroid uptake scan if these are negative but you’re still suspicious of graves

60
Q

4 specific signs for graves

A

Pretibial myxoedema
Thyroid acropachy - soft tissue swelling and periosteal bone changes
Eye problems
Thyroid bruit

Aren’t common but very specific

61
Q

Myxoedema coma mx

A

Iv levothyroxine

Iv hydrocortisone until AI cause ruled out

ICU

62
Q

What is the risk when managing SIADH

A

Osmotic demyelination syndrome

Due to rapid change in osmalality

Presents with non specific neuro sx diagnose with mri

63
Q

Which cardiac problem causes notching of the inferior border of the ribs

A

Aortic coarctation

Aortic obstruction gives rise to the development of dilated intercostal collateral vessels which erodes the inferior margin of the ribs

64
Q

Angina drug management options

A

EITHER

Rate-limiting CCB monotherapy e.g. verapamil or diltiazem

OR

Longer-acting dihydropyridine CCB e.g. amlodipine/ modified-release nifedipine WITH a beta blocker

65
Q

What is the threshold aortic valve gradient that makes people eligible for surgery in aortic stenosis

A

> 40mmHg

If less than than then regular outpt review

Also eligible for surgery if symptomatic with significant left ventricular dysfunction

66
Q

Most likely causative organism for endocarditis normally and <2 months post-valve surgery

A

Staph. Aureus

Staph. Epidermidis if <2months post valve-surgery

67
Q

What is fonaparinux’s role in NSTEMI management

A

They are an anticoagulant - it is a LMWH

Used long-term for those who have had an NSTEMI to prevent future clots and has less bleeding risk than other LMWHs

Used in those who aren’t going straight for PCI

68
Q

How does NSTEMI drug management change if they are undergoing PCI or not

A

For antiplatelet therapy: still give initial aspirin loading dose AND another antiplatelet (either ticagrelor or prasugrel)

Still anticoagulate but in PCI you might give fondaparinux and unfracitonated heparin

Rest of management is the same?

69
Q

How does NSTEMI management change if they are high bleeding risk

A

Still give aspirin plus another antiplatelet therapy BUT in high bleeding risk give clopidogrel instead of ticagrelor or prasugrel

Nothing else changes apart from that you might stop DAPT earlier e.g. 3-6 months instead of 12

70
Q

How does the management of aortic dissection differ based on the type

A

If it is Stanford type A (ascending aorta) then do surgery while controlling BP to 100-120

Type B (descending aorta, distal to left subclavian origin, 1/3 of cases) = conservative Mx with IV labetalol and bed rest

You do a CT angiography to diagnose and classify- look for a false lumen

71
Q

How to clinically differentiate between ascending and descending aortic dissection

A

New onset diastolic murmur (aortic dissection) in ascending dissection

72
Q

Which cardiac drug can cause erectile dysfunction

A

Beta blockers

73
Q

Two surgical options for severe symptomatic aortic stenosis

A

Surgical aortic valve replacement- done in those of low/medium operative risk

trans catheter AVR for high risk

74
Q

Tall broad R waves and some ST depression

A

Posterior MI

Posterior MIs cause reciprocal changes in V1-3
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2

75
Q

Is pulseless electrical activity a shockable rhythm

A

No

Give adrenaline and then do chest compressions

76
Q

What is the potassium threshold when deciding to add spironolactone or beta blocker in HTN Mx

A

If potassium is <4.5, add spiro

If >4.5 add BB

77
Q

Which cardiac drugs can cause ototoxicity

A

Loop diuretics

E.g. bumetanide or furosemide

78
Q

Which type of MI can be followed by third degree heart block

A

Right coronary artery

As this supplies the AV node

Trouble in the AV node causes third-degree heart block

79
Q

First line management of acute pericarditis

A

NSAIDs and colchicine

80
Q

Is pulseless ventricular tachycardia a shockable rhythm

A

Yes!

As is VF

Pulseless electrical activity and asytole are not shockable

81
Q

Alcoholic hepatitis what is the AST:ALT ratio

A

2:1

82
Q

What rate can you give potassium in mmol/hour

A

10mmol/hour

83
Q

What are the physiological requirements in a day for water, Na, Cl and K+

A

Water= 25-30 ml/kg/day
Na= 1mmol/kg/day
Cl=1mmol/kg/day
K=1mmol/kg/day

84
Q

How do you monitor someone on warfarin

A

Measure their INR regularly (frequency depends on how stable their INR is)

Target 2.5 but typically between 2-3 is accepted

85
Q

How does aortic regurgitation present

A

SOB
Cardiac murmur (diastolic heard loudest on expiration)
Collapsing pulse
Quincke’s sign (nail bed pulsation)

86
Q

How do loop diuretics and thiazide diuretics differ in their effect on electrolytes

A

Similar! Loop diuretics have a stronger ability to excrete Na, K, Cl and Mg

But loop diuretics also excrete calcium whereas thiazide diuretics retain calcium !

87
Q

Which cardiac problem predisposes you to mesenteric ischaemia

A

AF

Clot formation in left atrium goes to superior mesenteric artery causing ischaemia of the meentery

Causes severe abdominal pain

88
Q

When do you offer PCI in NSTEMI

A

NEVER!

Only joking

If GRACE score is above 3.% then offer it!

Immediately if clinically unstable, otherwise within 72 hours

Also give prasugrel/ ticagrelor and unfractionated heparin

89
Q

How to diagnose PSC

A

ERCP/ MRCP

90
Q

Which liver disease is indicated if someone has positive anti-mitochondrial antibodies

A

Primary biliary chonlangitis

Occurs in middle aged females

Autoimmune conditions resulting in the destruction of bile ducts in the liver

High IgM also

Managed with antipruritics and ursodeoxycholic acid

91
Q

How to manage autoimmune haemolytic anaemi

A

Steroids and ritixumab

Present with anaemia

High bilirubin
High reticulocytes
Blood film would show spherocytes and direct antiglobulin test is positive

92
Q

Mainstay of treatment for haemochromatosis

A

Regular venesection (removing blood)

Transferring saturation should be kept below 50%

93
Q

What type of malignancy is a complication of coeliac

A

T-cell lymphoma of the small intestine

94
Q

What ABG result in Cushing’s

A

Hypokalaemic metabolic acidosis

Same mechanism that causes the low K+ leads to the excretion of hydrogen ions in the renal tubules and bicarbonate retained-> met alk

95
Q

Which cardiac drug should be stopped with erythromycin/ clarithromycin

A

Statins !

Can increase the risk of hepatotoxcitiy and rhabdomyolysis

96
Q

What is the mechanism for why nephrotic syndrome makes you in a hypercoagulable state

A

Loss of antithrombin III and plasminogen

Antithrombin III inhibitors coagulation by inhibiting the action of thrombin

plasminogen is involved in fibrinolysis

These are both lost via the kidneys in nephrotic syndrome

97
Q

How to diagnose idiopathic pulmonary fibrosis

A

High-resolution CT chest

98
Q

Which organism causing pneumonia causes cavitating lesions

A

Staph aureus

99
Q

Which type of pneumonia is more common in people with CF

A

Pseudomonas aeruginosa

100
Q

How to differentiate between spider naevi and telangiectasia

A

Spider naevi when pressed on fill from the centre

Telangiectasia from the edge

101
Q

How to distinguish between the causes of RUQ pain

A

RUQ pain only –> biliary colic
RUQ pain + fever –> acute cholecystitis

RUQ pain + fever + jaundice –> ascending cholangitis (Charcot’s triad)

Charcot’s triad + confusion + hypotension = Reynold’s pentad (more severe ascending cholangitis)

102
Q

Which anti-emetic causes galactorrhoea

A

Metoclopramide

103
Q

Which vaccine is given yearly to those with heart failure

A

Influenza vaccine

104
Q

Which type of pneumonia occurs in alcoholics

A

Klebsiella

105
Q

What drug is given to treat idiopathic intracranial hypertension and what is its mechanism of action

A

Acetazolamide

Carbonic anhydrase inhibitor - reduces CSF production

106
Q

First line Tx of essential temor

A

Propanolol

107
Q

How do you manage anti-phospholipid syndrome in pregnancy

A

Aspirin and LMWH

Due to increased chance of VTE

108
Q

Which type of leukaemia affects kids most commonly

A

ALL

Associated with Down’s syndrome

109
Q

Which leukaemia is associated with Philadelphia chromosome

A

CML

Translocation t(9:22)

Seen in 95% of CML pts

Also seen in 25% of adult ALL

110
Q

Which finding on blood film is associated with myelofibrosis

A

Tear-drop poikilocytes

Often high urate and LDH

111
Q

How to differentiate between aplastic and sequestration crises of sickle cell anaemia

A

Aplastic is caused by parvovirus infection. Sudden fall in Hb and low reticulocytes due to bone marrow suppression

Sequestration is pooling of blood due to sickling within organs. Associated with increased reticulocyte count

112
Q

What drug do you give to prevent sickle cell crises

A

Hydroxyurea

This increases the foetal haemoglobin levels so reduces the amount of sickling (?)

So prevents crises

113
Q

What is the mechanism of Factor V Leiden mutation

A

Resistance to action of protein C

Protein C controls the coagulation systems and so a lack thereof leads to more coagulation

114
Q

Tremor cause if worse on arm extension

A

Benign essential tremor

PD tremor is worse when they are resting, able to control it with movement

Treat BET with propanolol

115
Q

Which test to diagnose acromegaly

A

Serum IGF-1 levels

Correlates well with GH levels - highly sensitive

116
Q

Which test to diagnose acromegaly

A

Serum IGF-1 levels

Correlates well with GH levels - highly sensitive

117
Q

What kind of vision change does pituitary adenoma cause

A

Bitemporal hemionopia

118
Q

Is goitre tender or non tender is hashimotos and subacute thyroiditis

A

Tender in subacute (De Quervain’s) thyroiditis

Non tender in hashimotos Thyroid goes from hyper to hypo then back to euthyroid

119
Q

Management of hyperprolactinaemia

A

Dopamine agonists e.g. cabergoline or bromocriptine

120
Q

How to diagnose Guillain-Barre

A

LP

Presents with acute onset symmetrical weakness in lower limbs first. Usually preceded by gastroenteritis

121
Q

Vaccinations for heart failure patients

A

Annual flu

One off pneumococcal

122
Q

6 causes of transdative exudate protein under 30

A

Heart failure!
Liver disease
Nephrotic sx
Malabsorption
Hypothyroid
Meig’s syndrome

123
Q

Achalasia management

A

Pneumatic (balloon) dilation is increasingly the preferred first line option

Surgical intervention with Heller cardiomyotomy is considered if persistent Sx

Drug therapy with nitrates and CCBs also have a role

124
Q

Wilsons disease Mx

A

Penicillamine

It is a copper chelating agent

Wilson’s has increased copper accumulation in liver and brain

125
Q

What fasting glucose is pre diabetes

A

6.1-6.9

126
Q

Imaging in suspected renal colic

A

non contrast CT-KUB

5th Year!! (10 decks)

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