Key concepts Flashcards

Question

Benzylpenicillin Dose in suspected Meningitis

Answer 1

\< 1 year - 300 mg im/iv 1 - 10 years - 600 mg im/iv \>10 years - 1200 mg im/iv

Answer 2

Febrile convulsions ## Footnote Treatment - Midazolam buccal/ rectal diazepam

Answer 3

Impaired Fasting Glucose: FBS 6.1 - 7 mmol/ l Impaired Glucose Tolerance: FBS \< 7.0 mmol/l and OGTT 2-hour \> 7.8 and above Pre-diabetes: HbA1 C 42 - 47 mmol/ l Diabetes: 48 mmol/ l **Blood Sugar Control targets** On metformin alone 48 mmol/ l On insulin or combined drug producung hypoglycaemia 53 mmol/l

Answer 4

**2 WW - Referral Criteria** - Suspected Colorectal Ca: Aged \>=40 PLUS Unexplained weight loss + abdo pain; Aged \<50 AND Rectal bleeding, abdo pain, change in bowel habit, weight loss, IDA; Aged \>=50 PLUS Unexplained rectal bleeding; Aged \>=60 PLUS Iron deficiency anaemia/ Changed in bowel habit, Any age AND FOBT +ve or Rectal/abdominal mass - Suspected Anal Ca: Unexplained anal mass or Unexplained anal ulceration Suspected Ovarian Ca: Ascites, Pelvic or abdo mass, USS suggestive ovarian cancer and raised Ca 125 Suspected Endometrial Ca: Aged \>=55 with PMB or increased ET Suspected Cervical Ca: On examination, appearance of cervix consistent with cervical cancer Suspected Vulval Ca: Unexplained vulval lump, ulceration or bleeding Suspected Vaginal Ca: Unexplained palpable mass in entrance to vagina Suspected Prostate Ca: Feels malignant on DRE; PSA over age-specific range Suspected Bladder Ca: \>=45 AND Unexplained visible haematuria without UTI or after successful treatment of UTI or \>=60 AND Unexplained non-visible haematuria AND dysuria with raised serum WCC Suspected Renal Ca: Aged \>=45 + unexplained visible haematuria without UTI or after successful treatment of UTI Suspected Testicular Ca: Non-painful enlargement/change in shape or texture of testis Suspected Penile Ca: Penile mass/ulcer with STI excluded or STI treated Suspected Melanoma: Major features scoring 2 points each with change in size, irregular shape, irregular colour. Minor features of the lesions (scoring 1 point each): largest diameter 7 mm or more, inflammation, oozing, change in sensation.

Answer 5

## Footnote Tinel test (ankle) tapping in front and behind medial malleolus to check for compression/ damagetp ant tibial and post tibial nerve respectively.

Answer 6

**Section 17a** Supervised Community Treatment Order (CTO); used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community. **Section 135** a court order to allow police to break into property to remove a person to Safety **Section 136** someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety; can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged

Answer 7

**Dissociative disorder** 'separating off' memories from normal consciousness, dissociative identity disorder (DID) is the new term for multiple personality disorder; intentional production of physical or psychological symptom. Has psychiatric symptoms of amnesia, fugue, stupor **Factitious disorder** - patient feigns illness, Munchausen's syndrome - describes the intentional production of symptoms, for example self poisoning **Malingering** patient seek material gain by pretending to be ill

Answer 8

Antipsychotics (predominantly Clozapine) Antiepileptics Antithyroid Drugs (Carbimazole) Antibiotics (Penicillin, Chloramphenicol and Co-Trimoxazole) Cytotoxic Drugs Gold NSAIDs (Naproxen, Indomethacin) Allopurinol Mirtazapine

Answer 9

* *Othello syndrome** - belief that partner is committing infidelity despite no evidence. * *De Clerambault syndrome (erotomania)**, - believes that a person of a higher social/ professional standing is in love with them. * *Ekbom syndrome** is also known as delusional parasitosis and is the belief that they are infected with parasites or have 'bugs' under their skin. * *Capgras delusion** - belief that friends/ family members have been replaced by an identical looking imposter.

Answer 10

Diuretics (especially thiazides), SSRIs Antipsychotics - haloperidol NSAID Carbamazepine.

Answer 11

Autosomal Dominant Conditions - 2 ## Footnote Marfan's syndrome myotonia congenita multiple epiphyseal dysplasia marble bone disease neurofibromatosis osteogenesis imperfecta type I - mild disease osteogenesis imperfecta type IV - moderately severe disease Noonan's syndrome osteogenesis imperfecta retinoblastoma Peutz-Jegher's syndrome protein C deficiency Sipple's syndrome Sturge-Weber syndrome tuberous sclerosis Treacher-Collins syndrome variegate porphyria von Hippel-Lindau syndrome von Willebrand's disease (congenital deficiency of von Willebrand's factor ) Wermer's syndrome Marfan's syndrome myotonia congenita multiple epiphyseal dysplasia marble bone disease neurofibromatosis osteogenesis imperfecta type I - mild disease osteogenesis imperfecta type IV - moderately severe disease Noonan's syndrome osteogenesis imperfecta retinoblastoma Peutz-Jegher's syndrome protein C deficiency Sipple's syndrome Sturge-Weber syndrome tuberous sclerosis Treacher-Collins syndrome variegate porphyria von Hippel-Lindau syndrome von Willebrand's disease (congenital deficiency of von Willebrand's factor ) Wermer's syndrome

Answer 12

Autosomal Recessive - 2 ## Footnote microcephaly (autosomal recessive) ochronosis osteogenesis imperfecta type II - perinatal lethal Kugelberg-Welander disease Hurler syndrome polyglandular autoimmune syndrome I limb girdle dystrophy methaemoglobinaemia Pendred's syndrome Laurence-Moon-Biedl syndrome marble bone disease pseudoxanthoma elasticum Prader-Willi syndrome phenylketonuria Refsum's disease Smith-Lemli-Opitz syndrome spinal muscular atrophy Rotor's syndrome severe combined immunodeficiency disease sickle cell anaemia Tay-Sachs disease thalassaemia vitamin D dependent rickets type I Werdnig-Hoffman disease Wilson's disease xeroderma pigmentosum Zellweger syndrome

Answer 13

Causes of Neonatal Jaundice **Prolonged jaundice** * biliary atresia * hypothyroidism * galactosaemia * urinary tract infection * breast milk jaundice * congenital infections e.g. CMV, toxoplasmosis

Answer 14

* 3 mths: Little/ no head lag on being pulled to sit, lying on abdomen with good head control, Held sitting, lumbar curve * 6 mths: Lying on abdomen, arms extended, lying on back, lifts and grasps feet, pulls self to sitting, held sitting, back straight, rolls front to back * 7-8 mths: Sits without support (Refer at 12 months) * 9 mths: Pulls to standing, crawls * 12 mths: Cruises, walks with one hand held * 13-15 mths: Walks unsupported (refer at 18 months) * 18 mths: Squats to pick up a toy * 2 yrs: Runs, walks upstairs and downstairs holding on to rail * 3 yrs: Rides a tricycle using pedals, walks up stairs without holding on to rail * 4 yrs: Hops on one leg

Answer 15

* 3 mths: Quietens to parents voice, turns towards sound, squeals * 6 mths: Double syllables 'adah', 'erleh' * 9 mths: 'mama' and 'dada', nderstands 'no' * 12 mths: Knows and responds to own name * 12-15 mths: Knows about 2-6 words (Refer at 18 months), understands simple commands - 'give it to mummy' * 2 yrs: Combine two words, points to parts of the body * 2½ yrs: Vocabulary of 200 words * 3 yrs: Talks in short sentences (e.g. 3-5 words), asks 'what' and 'who' questions, identifies colours, counts to 10 (little appreciation of numbers though) * 4 yrs: Asks 'why', 'when' and 'how' questions

Answer 16

* Anterior cerebral artery: Opposite side hemiparesis, sensory loss, LL \> UL * Middle cerebral artery: Opposite side hemiparesis, sensory loss, UL \> LL, Opposite side homonymous hemianopia, Aphasia * Posterior cerebral artery: Opposite side homonymous hemianopia with macular sparing, visual agnosia * Weber's syndrome (branches of the posterior cerebral artery that supply the midbrain): Same side CN III palsy, weakness of upper and lower extremity * Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome): Ipsilateral facial pain and temperature loss, Contralateral: limb/torso pain and temperature loss, Ataxia, nystagmus * Anterior inferior cerebellar artery (lateral pontine syndrome): Symptoms are similar to Wallenberg's (see above), but: Ipsilateral: facial paralysis and deafness * Retinal/ophthalmic artery: Amaurosis fugax * Basilar artery: 'Locked-in' syndrome

Answer 17

**Poisoning Management** ## Footnote Ethylene glycol: ethanol -used for many years, works by competing with ethylene glycol for the enzyme alcohol dehydrogenase - this limits the formation of toxic metabolites (e.g. Glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning, **fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol**, haemodialysis also has a role in refractory cases Methanol poisoning: Fomepizole or ethanol, haemodialysis Organophosphate insecticides: atropine the role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit Digoxin: Digoxin-specific antibody fragments IronDesferrioxamine, a chelating agent Lead: Dimercaprol, calcium edetate Carbon monoxide: 100% oxygen, hyperbaric oxygen Cyanide: Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

Answer 18

**Extrinsic** * Mediastinal masses * Cervical spondylosis **Oesophageal wall** * Achalasia * Diffuse oesophageal spasm * Hypertensive lower oesophageal sphincter **Intrinsic** * Tumours * Strictures * Oesophageal web * Schatzki rings **Neurological** * CVA * Parkinson's disease * Multiple Sclerosis * Brainstem pathology * Myasthenia Gravis

Answer 19

* Any bleeding/ trauma/ operation/ dental extraction * Coma * Pericarditidis * Pulmonary cavitation * Pancreatitis * Peptic Ulcer * Oesophageal varices * Endocarditis * Severe HTN * Aortic aneurysm/ Aortic dissection * Coagulation defect * Bacterial endocarditis * Bleeding disorders

Answer 20

* Mild IQ 50-69 * Moderate IQ 35 - 49 * Severe IQ 20 - 34 * Profound. IQ \<20

Answer 21

* Normal BMI 18.5 - 24.9 * Overweight BMI 25 - 29.9 * Obesity Grade 1 BMI 30 - 34.9 * Obesity Grade 2 BMI 35 - 39.9 * Obesity Grade 3. BMI \> 40

Answer 22

* Physiological - pregnancy, puerperium, excessive exercise * Endocrine - Hypothyroidism, Cushing's syndrome * Metabolic - Chronic Renal Failure * Tumours - Pituitary adenomas * Traumatic - Head Injury, brain surgery * Drugs - Risperidone, Metoclopromide, Domperidone, Tricyclic Antidepressant

Answer 23

**Autoimmune Disease Association with MHC Antigens** ## Footnote Hashimoto's disease. DR11 RR 3 Hereditary hemochromatosis A3/B14 RR 90 Insulin-dependent diabetes mellitus B35, Cw04 RR 1–3 Idiopathic membranous glomerulonephritis DR3 RR 12 Multiple sclerosis. DR2, DQ6 RR 5–12 Myasthenia gravis DR3 RR 10 Narcolepsy DR2, DQβ1\*0602. RR 130 Psoriasis vulgaris. Cw613 Pemphigus vulgaris. DRβ1\*0402-DQβ1\*0302 RR 14–21 DRβ1\*1401-DQβ1\*0503 Rheumatoid arthritis. DR4 RR 4–10 Systemic lupus erythematosus DR3 RR 3–6 Sarcoidosis DRβ1\*1101 RR 1.5–3.6

Answer 24

**Organ-specific autoantibodies** *Clotting (coagulation) system* * Cardiolipin Antibodies * Beta-2 Glycoprotein 1 Antibodies - Antiphospholipid Syndrome * Glycoprotein IIb/IIIa: Immune thrombocytopenic purpura * Antiphospholipid Antibodies (APA) * Lupus anticoagulants (LA) *Endocrine/metabolic system* * Islet Autoantibodies in Diabetes * Anti-glutamate debarboxylase - T1DM *Gastrointestinal tract* * Anti-Tissue Transglutaminase (anti-tTG), Anti-Gliadin Antibodies (AGA) & Anti-endomysial - Coeliac disease (there is deficiency og IgA in 3% of patients) * Intrinsic Factor Antibodies * Parietal Cell Antibodies *Thyroid* * Anti-Thyroid Peroxidase, TSH receptor antibodies - Graves Disease * Anti-microsomal & Anti-thyroglobulin - Hashimoto's disease *Liver* * Smooth Muscle Antibodies (SMA) and F-actin Antibody - Autoimmune Hepatitis * Antimitochondrial Antibodies (AMA) and AMA M2 - Primary Biliary Cirrhosis * Liver Kidney Microsome Type 1 Antibodies (anti-LKM-1) * Kidney* * Anti-Glomerular Basement Membrane (GBM) - Goodpasture's Syndrome * Muscles* * Acetylcholine Receptor (AChR) Antibodies - Myasthenia gravis * Skin* * Anti-Desmoglein - Pemphigus Vulgaris

Answer 25

**Anti-platelets** * Aspirin - inhibits COX1 and so inhibit thromboxane release * Clopidogrel, ticagrelor, prasugrel, ticlopidine - Inhibit P2Y12 receptors for ADP binding * Abciximab, eptifibatide, tirofimab -GPIIb/IIIa inhibitors (prevent fibrinogen cross-linking - can be given iv * Dipyridamole, cilostazole -Phosphodiesterase inhibitors - raise cAMP and promote vasodilation **Anti-coagulants** * Heparin - inactivates both Xa and thrombin formation by binding to antithrombin IIIa * Enoxaparin, dalteparin (LMWH) - accelerate inactivation of Xa by binding to antithrombin III a * Fondaparinux - directly accelerates inactivation of Xa * Apixaban, rivaroxaban - bind to active site of Xa and prevent conversion of prothrombin to thrombin- oral * Argatroban, dapigatran - univalent binding (Xa receptor), direct thrombin inhibitor * Bivalirudin, desirudin - bivalent binding (Xa and prothrombin exosite receptor), direct thrombin inhibitor * Warfarin - reduces activation of II, VII, IX & X through inhibition of Vit K epoxide reductase, INR, narrow therapeutic index, antidote vit K **Thrombolytics** Alteplase, Reteplase, Tenecteplase Urokinase, Streptokinase Antidotes: Protamine sulphate, Vit K, aminocaproic acid, tranexamic acid

Answer 26

(contd) ## Footnote ACE inhibitors: hypotension, renal dysfunction, dry cough Angiotensin II Receptor Blockers Clopidogrel: GI symptoms, bleeding Sulfasalazine (DMARD) - oligospermia, Stevens-Johnson syndrome, pneumonitis / lung fibrosis, myelosuppression, Heinz body anaemia, megaloblastic anaemia, may colour tears → stained contact lense Methotrexate: Myelosuppression, Liver cirrhosis, Pneumonitis Leflunomide: Liver impairment, Interstitial lung disease, Hypertension Hydroxychloroquine: Retinopathy, Corneal deposits Prednisolone: Cushingoid features, Osteoporosis, Impaired glucose tolerance, Hypertension, Cataracts Cyclosporin: gingival hyperplasia Azathioprine - bone marrow depression, nausea/vomiting, pancreatitis, increased risk of non-melanoma skin cancer Gold: Proteinuria Penicillamine: Proteinuria, Exacerbation of myasthenia gravis Etanercept: Demyelination, Reactivation of tuberculosis Infliximab: Reactivation of tuberculosis Adalimumab: Reactivation of tuberculosis Rituximab: Infusion reactions are common NSAIDs (e.g. naproxen, ibuprofen): Bronchospasm in asthmatics, Dyspepsia/peptic ulceration Cimedidine Ranitidine Ondansteron **Alpha-1 antagonists e.g. tamsulosin, alfuzosin** - dizziness, postural hypotension, dry mouth, depression **5- alpha reductase inhibitor - Finasteride:** erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia Isoretinoin: dry skin, hair loss, hyperlipidaemia,

Answer 27

Respiratory - Lung cancer, abscess, bronchiectasis, empyema, Interstitial lung disease,fibrosing alveolitis, cystic fibrosis Cardiac - atrial myxoma, congenital heart disease, infective endocarditis GI - Inflammatory bowel disease, Coeliac disease, Primary Biliary Cirrhosis, GI myxoma Miscellaneous - pregnancy, familial, thyroid acropachy, congenital

Answer 28

Class 1 - No limitation of physical activity, comfortable with physical activity Class 2 - Slight limitation of physical activity, comfortable at rest, symptom with ordinary activity Class 3 - Marked limitation of physical activity, comfortable at rest, symptom with less than ordinary activity Class 4 - Inability to do any physical activity without symptoms

Answer 29

**P450 Inducers: P450 Inhibitors** ## Footnote Carbamazepine Valproate Rifampicin Ketoconazole Alcohol Isoniazid Phenytoin Sulphonamide Griseofulvin Chloramphenicol Phenobarbital Amiodarone Sulphonylureas Erythromycin Quinidine Grapefruit Juice CRAP GPS induces rage VK IS CA EQG

Answer 30

Epworth: Assess obstructive sleep apnoea MMSE (Mini mental state examination), assess cognitive impairment AMTS: Abbreviated Mental Test Score to rapidly assess elderly patients for the possibility of dementia. HAD: Hospital anxiety & Depression scale, assess severity of anxiety depressionPatient Health Questionnaire, assess severity of depression GAD - 7: Screening generalised anxiety disorder PHQ-9: Patient Health Questionnaire to assess severity of depression Edinburgh Postnatal Depression Scale: Screen for PND SCOFF: To detect Eating disorder and aid treatment AUDIT: Alcohol misuse screening CAGE: Alcohol misuse screening FAST: Alcohol misuse screening

Answer 31

Oral morphine to Subcutaneous morphine - Divide by 2 Oral morphine to Subcutaneous diamorphine - Divide by 3 Oral oxycodone to Subcutaneous diamorphine - Divide by 1.5 Oral codeine to Oral morphine - Divide dose by by 10 Oral tramadol to Oral morphine - Divide by 10 Oral morphine to Oral oxycodone - Divide by 1.5-2 Transdermal fentanyl 12 mcg patch = 30 mg oral morphine/ d Transdermal buprenorphine 10 mag patch = 24 mg oral morphine/d

Answer 32

Gastric Ca - Acanthosis Nigricans Lung Ca Small Cell - Hyponatraemia(SIADH); SVC syndrome, Eaton Lambert Syn, Cushing syn (inc ACTH), carcinoid (flushing&diarrhoea) Squamous cell - Hypercalcaemia (PTH rp), Horner's syn (ptosis, miosis & anhydrosis), Pancoast's tumour - T1&2 nerve, shoulder pain & ulnar nv pain) Large Cell - SVC syn, gynaecomastia Adenoca - Pulmonary osteoarthropathy, Breast Ca - Ovarian Ca - Lympatic system Ca - Hodgkin’s disease (PCD) Testicular cancer (brainstem and limbic encephalitis), Neuroblastoma (opsoclonus–myoclonus).

Answer 33

Anterior cerebral artery: Contralateral hemiparesis and sensory loss, lower extremity \> upper Middle cerebral artery: Contralateral hemiparesis and sensory loss, upper extremity \> lower Contralateral homonymous hemianopia, Aphasia Posterior cerebral artery: Contralateral homonymous hemianopia with macular sparing,Visual agnosia Weber's syndrome (branches of the posterior cerebral artery that supply the midbrain): Ipsilateral CN III palsy Contralateral weakness of upper and lower extremity Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome): Ipsilateral: facial pain and temperature loss, Contralateral: limb/torso pain and temperature loss, Ataxia, nystagmus Anterior inferior cerebellar artery (lateral pontine syndrome): Symptoms are similar to Wallenberg's (see above), but: Ipsilateral: facial paralysis and deafness Retinal/ophthalmic artery: Amaurosis fugax Basilar artery: 'Locked-in' syndrome

Answer 34

Capgras - belief that friends/ family members have been replaced by an identical looking imposter Othello - belief that partner is committing infidelity Cotard - belief that insides are rotting as one is deceased De Clerambault (erotomania), belief that a person of a higher social/ professional standing is in love with them Ekbom - belief that they are infected with parasites or have 'bugs' under their skin - delusional parasitosis

Answer 35

Green – low risk Amber – intermediate risk Red – high risk Colour (of skin, lips or tongue) • Normal colour Activity • Responds normally to social cues Content/smiles Stays awake or awakens quickly Strong normal cry/not crying • Pallor reported by parent/carer social cues No smile Wakes only with prolonged stimulation Decreased activity * Pale/mottled/ashen/ blue * Not responding normally to * No response to social cues Appears ill to a healthcare professional Does not wake or if roused does not stay awake Weak, high-pitched or continuous cry Respiratory • Nasal flaring • Tachypnoea: - RR \>50 breaths/ minute, age 6–12 months - RR \>40 breaths/ minute, age \>12 months Oxygen saturation ≤95% in air Crackles in the chest Grunting Tachypnoea: RR \>60 breaths/minute Moderate or severe chest indrawing Circulation and hydration Normal skin and eyes Moist mucous membranes Tachycardia: - \>160beats/minute, age \<12 months - \>150beats/minute, age 12–24 months - \>140beats/minute, age 2–5 years CRT ≥3 seconds Dry mucous membranes Poor feeding in infants Reduced urine output • Reduced skin turgor Other • None of the amber or red symptoms or signs Age 3–6 months, temperature ≥39°C Fever for ≥5 days Rigors Swelling of a limb or joint Non-weight bearing limb/not using an extremity Age \<3 months, temperature ≥38°C\* Non-blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures CRT, capillary refill time; RR, respiratory rate \* Some vaccinations have been found to induce fever in children aged under 3 months This traffic light table should be used in conjunction with the recommendations in the NICE guideline on fever in under 5s.

Answer 36

**Pupillary conditions** ## Footnote Marcus Gunn - both pupils dilate to swinging light Argyll Robertson Holmes Adie Horner's Acute angle closure glaucoma Primary open angle glaucoma

Answer 37

**Management** ## Footnote A loop diuretic may - for symptom relief while awaiting specialist assessment. To relieve symptoms of fluid overload, a diuretic should be prescribed. To reduce morbidity and mortality - angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker should be prescribed. One drug should be introduced at a time, adding the second drug once the person is stable on the first drug. If symptomatic despite optimal treatment with an ACE-inhibitor and beta-blocker - arrange specialist referral heart failure with preserved ejection fraction - a low to medium dose diuretic should be prescribed and specialist referral antiplatelet drug and statin should be considered. Comorbidities and precipitating factors should be managed. Screening for depression or anxiety should be undertaken. Supervised exercise-based rehabilitation programme should be offered. Appropriate vaccinations . Self-care advice Nutritional status - assess. Follow-up and advanced care planning should be offered, if appropriate. Women of child-bearing age should be given advice about contraception and pregnancy.

Answer 38

**Categories of Antidepressants** * SSRI (Selective Serotononin Reuptake Inhibitors) - fluoxetine (1st choice - in young \<30, Citalopram in elderly), Sertraline (in presence of Heart Conditions, in post natal depression) * SNRI (Serotonin and Norepinephrine Uptake) Inhibitors: Duloxetine, Venlafaxine * TCI (Tricyclic Inhibitor Antidepressants): Amitrptiline, Desipramine, imipramine * MAOI (Monoamine Oxidase Inhibitor): Selegeline, phenelzine, Isocarboxazid * NDRI (Norepinephrine and Dopamine Reupdake Inhibitors): Bupropion * Tetracyclics - Mirtazapine; stops neurotransmitters from binding to receptors * (SARI) Serotonin Antagonist and reuptake inhibitors; Nefaxodone, trazodone

Answer 39

NSTEMI - Subendocardial infarct - ST depression STEMI - Transmural infarct - ST elevation Anteroseptal - Left anterior descending - V1-V4 Inferior - Right coronary - II, II, aVF Anterolateral - Left ant descending/ left circumflex - V4-V6, I, aVL Lateral - Left Circumflex - 1, aVL, +/- V5-6 Posterior - left circumflex, right coronary - Tall R waves in V1-2 T/t - initial M-O-N-A: Morphine, Oxygen if sats \< 94%, Nitrates, Aspirin then, PCI within 90%, if not possible then Thrombolysis (TPA, streptokinase, tenecteplase, ateleptase) Long term: A-B-A-S (ACE inhibitor, Beta blocker, Aspirin+Clopidogrel, Statin) No driving for 4 weeks after MI, No driving for 1 week after successful PCI

Answer 40

Cardioprotective diet: Anti-Diabetic diet: high fibre, high glycaemic index Crohn's ds: Gluten and diary free diet IBS: low sugar, low fibre (only soluble sugar), low fat, FODMAP (fermentable oligo, di-, mono-

Answer 41

Drugs causing **psychosis**: steroids, Causing **long QT**: Citalopram, low K, haloperidol and chlorpromazine Drugs causing **bradycardia:** beta blockers, clonidine, lithium, opiates, phenytoin, neostigminr, TCA, phenylpropanolamine, lidocaine, mexiletene, beta blockers, amiodarone, sotalol, ticagrelor Drugs causing **bronchospasm**: NSAID, aspirin Drugs causing **erythema nodosum**: streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill) Worsening **Psoriasis**: Alcohol, lithium, beta blockers, NSAIDs, antimalarials (chloroquine and hydroxychloroquine), ACE inhibitors, infliximab, withdrawal of systemic steroid Causing **hair loss:** Isoretinoin**,** ACEI**,** lithium, heparin, allopurinol, antidepressants, chemotherapy drugs Causing **SLE**: Hydralazine, Minocycline, Methadone, Procainamide, Chlorpromazine, Quinidine Causing **gout:** diuretics: thiazides, furosemide, ciclosporin, alcohol, cytotoxic agents, pyrazinamide, aspirin Causing Interstitial pulmonatry fibrosis: methotrexate, sulfasalzine

Answer 42

* Anteroseptal - V1-V4: Left anterior descending * Inferior - II, III, aVF: Right coronary * Anterolateral - V4-6, I, aVL: Left anterior descending or left circumflex * Lateral - I, aVL +/- V5-6: Left circumflex * Posterior - Tall R waves V1-2: Usually left circumflex, also right coronary * Septal = V1-2 * Anterior = V2-5 * Extensive anterior / anterolateral = V1-6, I + aVL

Answer 43

Ethinylestradiol 20 microgramsDesogestrel 150 microgramsGedarel® 20/150 Ethinylestradiol 20 microgramsDesogestrel 150 microgramsMercilon® Ethinylestradiol 20 microgramsGestodene 75 microgramsFemodette® Ethinylestradiol 20 microgramsGestodene 75 microgramsMillinette® 20/75 Ethinylestradiol 20 microgramsGestodene 75 microgramsSunya® 20/75 Ethinylestradiol 20 microgramsNorethisterone acetate 1 mgLoestrin® 20 Ethinylestradiol 30 microgramsDesogestrel 150 microgramsGedarel® 30/150 Ethinylestradiol 30 microgramsDesogestrel 150 microgramsMarvelon® Ethinylestradiol 30 microgramsDrospirenone 3 mgYasmin® Ethinylestradiol 30 microgramsGestodene 75 microgramsFemodene® Ethinylestradiol 30 microgramsGestodene 75 microgramsKatya® 30/75 Ethinylestradiol 30 microgramsGestodene 75 microgramsMillinette® 30/75 Ethinylestradiol 30 microgramsLevonorgestrel 150 microgramsLevest® Ethinylestradiol 30 microgramsLevonorgestrel 150 microgramsMicrogynon® 30 Ethinylestradiol 30 microgramsLevonorgestrel 150 microgramsOvranette® Ethinylestradiol 30 microgramsLevonorgestrel 150 microgramsRigevidon® Ethinylestradiol 30 microgramsNorethisterone acetate 1.5 mgLoestrin® 30 Ethinylestradiol 35 microgramsNorgestimate 250 microgramsCilest® Ethinylestradiol 35 microgramsNorethisterone 500 microgramsBrevinor® Ethinylestradiol 35 microgramsNorethisterone 1 mgNorimin® Mestranol 50 microgramsNorethisterone 1 mgNorinyl-1® Ethinylestradiol 30 microgramsGestodene 75 microgramsFemodene® ED Ethinylestradiol 30 microgramsLevonorgestrel 150 microgramsMicrogynon® 30 ED Estradiol (as hemihydrate) 1.5 mgNomegestrol acetate 2.5 mgZoely®

Answer 44

* Sinus tachycardia (44%) – the most common abnormality * Complete or incomplete RBBB (18%) – associated with increased mortality * Right ventricular strain pattern (34%)– T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). * Right axis deviation – seen in 16% of patients. Extreme right axis deviation may occur, with axis between zero and -90 degrees, giving the appearance of left axis deviation **(“pseudo left axis”**). * Dominant R wave in V1 – a manifestation of acute right ventricular dilatation. * Right atrial enlargement (P pulmonale) 9% – peaked P wave in lead II \> 2.5 mm in height. * SI QIII TIII pattern (20%) – deep S wave in lead I, Q wave in III, inverted T wave in III. This “classic” finding is neither sensitive nor specific for pulmonary embolism * Clockwise rotation – shift of the R/S transition point towards V6 with a persistent S wave in V6 (“pulmonary disease pattern”), implying rotation of the heart due to right ventricular dilatation. * Atrial tachyarrhythmias (8%) – AF, flutter, atrial tachycardia. * Non-specific ST segment and T wave changes, including ST elevation and depression (50%) * Simultaneous **T wave inversions in the inferior (II, III, aVF)** and right precordial leads (V1-4) is the **most specific** finding in favour of PE

Answer 45

ALL: children ~ 10, myeloperoxidase neg, LN enlargement, fatigue and flu like,, immature lymphocytes, cytarabine for t/t CML: Middle age ~40, myeloid chain ,defect mature neutrophils, philadelphia chromosome, Imatinib for t/t AML: Middle age ~50, pancytopaenia, immature neutrophils, myeloperoxidase +, Auer bodies, ATRA and Vit A CLL: Elderly ~80, mature lymphocytosis, LNs enlarged, weight loss, night sweats No Rx