JB-Passmedicine Flashcards
ABG metabolic picture in Cushings
Hypokalemic metabolic alkalosis (loss of h+ and Na)
Common organism in OE
Pseudomonas aeruginosa
What is tolterodine
Anti-muscarinic used for overactive bladder, increased frequency and urgency
Maximum recommended rate of potassium infusion via a peripheral line
10 mol/horu
Key carbimazole side effect
Agranulocytosis
Two key Gentamicin side effects
Ototoxicity
Nephrotoxic
When should HIV patients be given prophylactic co-trimoxazole
CD4 below 200
Type of CT in ?stroke
Non contrast
Biochemical changes seen in Legionella
Hyponatraemia
Lymphopenia
Deranged LFTs
How can early keloid scars be treated
Intra-lesional steroids
UTI management in men
7 days nitro or trimethoprim (3 for non pregnant women)
All men need a culture sending
ABG in cushings syndrome
Hypokalaemic metabolic alkalosis
What do anticardiolipin AB suggest
Anti-phospholipid syndrome
Many rheum conditions including SLE, drug induced SLE and Bechets
When do you measure FSH and when mis-luteal progesterone
FSH: menopause
Progesterone: fertility
Test for post h pylori eradication
Urea breath test
Does constipation or diarrhoea cause decompensation in liver failure patients
Constipation
(give laxatives to treat it)
How to differentiate Wilson’s and haemochromatosis
Wilson’s: sub acute neurological and liver disease
HCTs: chronic arthalgia, bronze, ED, DM
Liver disease common in both
What is penicillamine used for
Wilsons
Coper chelation agent
What is used to prevent vasospasm in SAH
Nimodipine
Preceding influenza predisposes to which type of pneumonia
Staph A
Loss of motor or sensory function -> dx
Conversion disorder
Inguinal hernia in infants management
Urgent surgery as high risk
ER+ve breast ca management in pre vs post menopausal
Pre: tamoxifen
Post: anastroazole
Why can methotrexate not be prescribed with co-trimoxazole
Contains trimethoprim
Both deplete folate
Paeds BLS where do you feel for pulse
Infants use brachial or femoral pulse
Children use femoral pulse
At what CR size is a foetus with no cardiac activity confirmed as a miscarriage
over 7mm
Management of thyroid storm
beta blockers, propylthiouracil and hydrocortisone
Investigation in pregnant women with a DVT with ? PE
None
Start LMWH
Most likely selective serotonin reuptake inhibitor (SSRI) to lead to QT prolongation and Torsades de pointes
Citalopram
Treatment for anterior uveitis
Steroid + cycloplegic (mydriatic) drops
(??Dilate as relaxes muscles)
What distinguishes vestibular neuronitis from labyrinthitis
Loss of hearing in labyrinthitis
2 electrolyte abnormalities of PPIs
Low Na, Mg
Osteoporosis
Drug used in prolactinoma
Cabergoline
first-line treatment for superficial thrombophlebitis
NSAIDs
Compression stocking
What is cataplexy associated with
Narcoplexy
What is cataplexy
Sudden loss in muscular tone
What can PCV progress to
AML
HB cut off for oral iron in pregnancy 1st tri
110
what does factor v liden result in
Protein c resistance -> pro clotting
Most common thrombotic disorder in UK
Factor V liden (protein C resistence)
What do protein C and S do
?Natural anti coagulant
Hence if deficient, increased risk of clots
Which lung ca causes SIADH
Small cell
Which ABX is contraindicated in GP6D deficiency
Quinones (Ciprofloxacin and levofloxacin)
(Haemolytic anaemia and Heinz bodies)
2 steps in management of PCV
Aspirin and venesection
3 biochemical abnormality of thiazides
Hypercalcemia (low ca urine)
Hyponatremia
Hypokalaemia
Strangulated vs incarcerated hernias
Strangulated = blocked and dying
Incarcerated = irreducible
Scan of choice in MS
MRI with contrast
Treatment if man has severe voiding symptoms and enlarged prostate
Double (tamsulosin and finasteride)
Main SE of oral Mg
Diarrhoea
What does Phrens sign (ease pain when lifted) suggest
Eppidimitis not torsion
Treatment of pyelonephritis
Cipro or cefalexin
Pneumonia in ETOH with caveatting lesions
Klebsiela
What contrast is used in stroke CTs
None
When is halliperidol used in PD
Never
Benzos/ new gen antipsychotics in acute confusion
Management of TCA OD
IV sodium bicarb
Lithium level testing
12 hours after dose
Every 7 days till stable
3 monthly
What resp rate is a red flag at all ages in feverish illness
> 60
Diplopia looking down
CN4 (trochlea) issue
Of all the clotting factors warfarin blocks, what has shortest half life
Protein C and S (anti coagulants)
2 has longest
Need LMWH first 2 days
What clotting test does warfarin prolong
PT (part of INR)
Most common cause of viral meningitis
Enterococcus virus (coxsackie)
Herpes is second most common
What two things should be monitored in kids with HSP
BP and Urinalysis to check for renal involvement
Difference between lichen planus and lichen sclerosis
Lichen planus: PURPLE skin colour lesions
Lichen sclerosis: itchy white areas on vulva of older women
Who is Sulfasalazine contraindicated in
Aspirin allergy
Other sulph- drugs
G6PD
What needs to be tested for in patients who have a blood products allergic reaction
IgA deficiency
Criteria to diagnose endocarditis
Duke
2nd line treatment in resistant hyperlipidemia
ezetimibe (stops GI inscription)
PKS9 inhibitors (-mab)
Only PAD vasodilator recommended by NICE
naftidrofuryl oxalate
(should only be used in those with poor quality of life)
Wilson’s disease effect on serum caeruloplasmin
Decreased
Transport protein
Critical limb ischaemia management by location
Above IL -> PTA/ stent
CFA -> endartectomy
Below IL ->
Short -> stent
Long -> bypass
Management of mild/ moderate claudication (3)
statin
clopidogrel
exercise training
What CURB-65 needs admission
2 or above
Ranges for CURB-65
Confused
Urea >7
RR>30
SBP<90
65 or older
What is type 2 Necrotising fasciitis caused by
Streptococcus pyogenes
Type 1 is caused by mixed anaerobes and aerobes, is the most common and mainly found in diabetics post surgery
What is blood stained breast discharge most likely to be associated with
Papiloma
Management of MG
Pyridostigmine
long-acting acetylcholinesterase inhibitors
What type of drug is doepezil
Anticholinesterase inhibitor
How does a pontine haemorrhage commonly presents with
reduced GCS, paralysis and bilateral pin point pupils
3 common causes of infective endocarditis
MOST COMMON: Staphylococcus aureus (in intravenous drugs uses or prosthetic valves)
Streptococcus viridans
Staphylococcus epidermidis (in prosthetic valves)
Key SE of Hydroxychloroquine
bull’s eye retinopathy - may result in severe and permanent visual loss
Two ABX unusable in CKD
tetracycline, nitrofurantoin
Key difference in psoriasis management by site
If face, flexor or genital:
mild or moderate corticosteroid applied once or twice daily for a maximum of 2 weeks
Psoriasis management (1,2,3)
Steroid + Vit D (separate creams for 4 weeks)
Vit D BD (4 weeks)
Potent steroid or coal tar (4 weeks)
Where must a lesion be for autonomic dysreflexia to occur
Above T6
Where must a lesion be for autonomic dysreflexia to occur
Firs Above T6
First line in achalasia
pneumatic (balloon) dilation
Angina drug which can cause ulceration of GI tract
Nicorandil
What is Churg-Strauss syndrome
Sub type of granulomatosis with polyangiitis (esonophilic)
Associated with asthma, sinusitis and nasal polyps
pANCA positive and esonopbillia
Which is port wine and salmon patches resolves
Salmon
Dont drink port till older
When should anal fissures be referred to colorectal surgeons
If fissures do not occur on the posterior midline
What is Parklands formula
4ml x % burns x weight (kg)
50% in first 8 hours
50% in next 16 hours
How to dx asthma
Spirometry with reversal
(all adults and under 17s only with uncertainty) FeNo2
When should anti coagulation be started in stroke patients with AF
2 weeks
EVG changes in SAH
Tdp
Acute haemolytic transfusion reactions are usually the result of RBC destruction by what
IgM-type antibodies
‘anchovy sauce’ liver access
Entamoeba histolytica
Most common type of non-hodgkin lymphoma
Diffuse large B cell lymphoma
What electrolyte abnormality predisposes to digoxin toxicity
Hypokalaemia
ITP haematology
Only platelets low
Mutation in familial hypercholesterolaemia
low-density lipoprotein
How to measure disease in Haemachromatosis
Ferritin and transferrin saturation
What is lateral medullary syndrome
Caused by PICA
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
How many weeks pregnant until you can be admitted to EPAU
6 weeks (manage at home and do PT after 7 days)
Treatment for Hepatitis A
None
Management of exomthalmos
Exomphalos (covered in peritoneum outside abdomen) should have a gradual repair
Antibiotic contraindicated in G6PD deficiency
Ciprofloxacin
How often can IM adrenaline be given in anaphylaxis
5 min
Dose of IM adrenaline
1 in 1000
500mcg 11+
300mcg (6-11)
150 (0.5-5)
Regular screening in patients with cirrhosis
MELD score 6/12
AFP and USS 6/12
Endoscopy 3 yearly
Why should blood transplants be limited in CKD
Risk of allosensitisation -> renal transplant reject
Bleeding pattern with POP
20% of women will be amenorrhoeic
40% will bleed regularly
40% will have erratic bleeding.
5 ECG changes in low K
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
Post H Pylori erradication therapy test
Urea breath test
What is hydrogen breath test for
SBBO
How many weeks until cannot have medical abortion
9-13
How many weeks until cannot have medical abortion
9-13
Which medication is associated with the highest chance of inhibition disorders out of the antiparkinsonian medications
Dopamine receptor agonist
What is the antibiotic of choice for GBS prophylaxis
Benzylpenicillin
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA what is the next step in their management
CT head
(even if resolved)
Cushing’s syndrome ABG
hypokalaemic metabolic alkalosis
Why must blood products be irradiated in Hodgkins lymphoma
Risk of G v H disease
Immunocompromised, bone marrow transplants, neonates
First line If CBT or EMDR therapy are ineffective in PTSD,
Venlafaxine (then SSRI)
Otitis externa in diabetics
treat with ciprofloxacin to cover Pseudomonas
Microscopy of trichomonas shows ->
microscopy of a wet mount shows motile trophozoites
Prevention of Menieres disease
Betahistine
How long can lochia go on for before USS
6 weeks
What is Peutz-Jeghers syndrome associated with
Hamartomas (bowel polyps)
Pigmented lesions
ABX class that causes TdP
Macrolide
Drug that stimulates release of ADH
vasopressin
When should warfarin be stopped before surgery
5 days
APTT in antiphopholipid syndrome
prolonged
In 3rd nerve palsy, is the consensual response in tact
Yes as CN2 senses
Criteria for thrombectomy
Must be proximal anterior
<6 hours
OR
6-24 hours AND salvageable tissue on CT
Oligocloanal bands
MS LP
management of MS relapses
500mg methyl pred
Is MND upper or lower
Both
Only drug licenced for MND
Riluzole
What Parkinsons medications are impulse disorders most common in
Dopamine agonist
What is adenoma sebaceum associated with
Tuberous sclerosis
Lots of small angiomas
First line in absence seizures
ethosuximide
Where is speech centre in brain
Opposite side to which side handed
Hearing loss/ vertigo + absent corneal reflex -> dx
Acoustic neuroma (schwannoma)
How many hours after UPSI can levongeosterole be used
72
(UA 120 hrs)
Most common pathogen to cause bronchiectasis
Haemophilus influenzae
Recommend escalating adenosine doses of
6mg → 12mg → 18 mg
Sight prescription which increases risk of open angle glaucoma
Myopia
How long after inhaler use can it be re used
30 seconds
Bone cancer associated with FAP
Osteoma
Most common malignant bone tumour
Osteosarcoma
First line anti thyroid drug
Carbimazole
(Propylthiouracil has risk of liver failure)
two central lung cancers
Squamous
Small cell
When is clopidogrel used in STEMI
Bleeding risk
Already on an anticoagulant
What dementia can haloperidol not be used
PD
DLB
Patients using methotrexate require effective contraception during and for at least ? months after treatment in men or women
6
Valvular disease associated with polycystic kidney disease
Mitral valve prolapse
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with
findoxamicin oral
FAP + bone cancer ->
Gardeners syndrome
Whooping cough management
azithromycin or clarithromycin
Breast fibroadenoma: surgical excision is usual if….
3cm plus
In what common condition can you not use cyclazine
Heart failure (severe)
What is Peutz-Jeghers syndrome
AD
Hamartomatous polyps in GI tract
Can cause obstruction
Hyperpigemented lesions on lips, palms, soles
Raised HbA2
Beta thalassemia
Appearance of papules in guttate pspriasis
Teardrop
Management is emollients and conservative (normal psoriasis mx if no improvement)
Why increased risk of VTE in nephrotic syndrome
Piss out antithrombin 3
Inheritance of HCT
AR
When should cyclizine be prescribed in palliative care?
Intercranial courses
Pseudogout crystals
Rhomboid positive
Gout crystals
Needle negative
4 drugs that cause tinnitus
Aspirin
Nsaids
Loop diuretics
Quinne
Gent
Electrolyte abnormality which shows key risk of refeeding
Hypophosphataemia
(hypokalaemia, magnesia)
Anorexia features on bloods
All low except G and C’s
How to treat bile acid malabsorption
cholestyramine
Where do stones get stuck in submandibular gland
Wharton’s duct
Mx of severe urticaria
Oral pred
Where are seizures with automatisms (lip smacking, grabbing, plucking)
Temporal
Most strange actions are temporal
Common drug risk factor for osteonecrosis
Steroids
(chemo and ETOH)
Medication to prevent attacks of Menieres
Betahistine
Haemophillia bloods
prolonged APTT
bleeding time, thrombin time, prothrombin time normal
HbA2 is raised in what condition
Beta-thalassemia
What drug can be used to stimulated VwF
Desmopressin
