Last min Flashcards
Seborrhoeic dermatitis - first-line treatment is
topical ketoconazole
A 38-year-old woman with a 4.5cm fibroid has been listed for a myomectomy following a 5 month history of heavy menstrual bleeding.
What drug should be prescribed to be taken whilst awaiting surgery?
For patients with uterine fibroids, GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
Acute heart failure not responding to treatment -
consider CPAP
which bacterial infection common after influenza
staphylococcus aureus
Whooping cough management
- azithromycin or clarithromycin if the onset of cough is within the previous 21 days
Nancy, 72, is diagnosed with chronic obstructive pulmonary disease (COPD). Despite using a short-acting beta agonist along with a short-acting muscarinic antagonist, she is still breathless at rest. Her current FEV1 is found to be 45%.
On reviewing the full blood count she had at the time of diagnosis you note a raised eosinophil count.
Which of the following would be the most appropriate next step in her management?
A. Long acting beta agonist B. Inhaled corticosteroid C. Inhaled corticosteroid and long-acting muscarinic antagonist D. Inhaled corticosteroid and long-acting beta agonist E. Long-acting beta agonist and Long acting muscarinic antagonist
D. Inhaled corticosteroid and long-acting beta agonist
A 12 day old infant is brought to the emergency department by his anxious mother who notices that he has developed a right sided groin swelling. On examination the testes are correctly located but it is evident that the child has a right sided inguinal hernia. It is soft and easily reduced.
What is the most appropriate management?
A. Surgery over the next few days B. Reassure and discharge C. Surgery at 1 year of age D. Surgery once the child is 6 months old E. Application of a hernia truss
A. Surgery over the next few days
Inguinal hernia in infants = Urgent surgery
The high incidence of strangulation necessitates an urgent herniotomy be performed. In infants with a reducible hernia this can be performed on a daycase list during the same week. Deferring surgery on the basis of age is not justified.
A 56-year-old gentleman is brought in by paramedics. The patient fainted this morning and has not regained consciousness. No injuries reported from his faint. On examination his heart rate is 37 beats/minute, respiratory rate is 16 breaths/minute, blood pressure is 105/70 mmHg. The ambulance crew gave the patient six doses of IV atropine while on route to the hospital. You order an ECG:
The ECG shows prolonged PR interval.
What would be the initial management?
A. Synchronised cardioversion B. Implant pacemaker C. IV amiodarone D. External pacing E. IV adenosine
External pacing is used for symptomatic bradycardia if atropine fails
A 42-year-old woman falls off her horse and sustains a head injury. A CT scan on admission to the Emergency Department demonstrates a skull fracture and an associated extra-dural haematoma overlying the left parietal lobe. She has a Glasgow coma score of 12; E3 V4 M5, on arrival with no apparent neurological deficits. At the time both pupils are 4mm in diameter with intact pupillary light responses. She deteriorates within an hour to a Glasgow coma score of 8; E2 V2 M4. Her left pupil is now fixed at 7mm and her right pupil is 3mm and reacts to light. Additionally, her left eye is deviated inferiorly and away from the midline.
What is the most likely pathology responsible for her clinical findings?
A. Trans-tentorial herniation B. Cerebellar tonsillar herniation C. Posterior communicating artery aneurysm D. Frontal eye field injury E. Optic nerve compression
Trans-tentorial herniation
Raised ICP can cause a third nerve palsy due to herniation
IgA nephropathy vs Post-streptococcal
IgA- presents within days
Post-strep- presents 1-2 weeks after
The three criteria for aneurysm surgery are:
- An asymptomatic aneurysm larger than 5.5 cm in diameter.
- An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
- A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.
A patient who presents to their GP within 7 days of a clinically suspected TIA should have
300mg aspirin immediately (and be referred for specialist review within 24h)
You have been called to see a 36-year-old lady, Saira, on the acute medical admissions ward. The nurse started her blood transfusion two minutes ago, and now Saira is complaining of chills, abdominal and chest pain and dizziness. On examination, you cannot visualise a rash or any angioedema, however, her blood pressure has fallen from 115/75 mmHg to 80/60 mmHg and her temperature has risen to 38ºC. She is beginning to become agitated.
Which one of the following management options would be most suitable to treat this patient?
A. Temporary transfusion termination and an antipyretic B. Permanent transfusion termination and high dose immune globulin therapy. C. Permanent transfusion termination, generous fluid resuscitation with saline solution and inform the lab D. Temporary transfusion termination and an antihistamine E. Permanent transfusion termination, intramuscular adrenaline, corticosteroids and supportive care
Acute haemolytic transfusion reaction should be treated with generous fluid resuscitation and termination of the transfusion.
caput succedaneum vs cephalohaematoma
Caput succedaneum is a subcutaneous, extraperiosteal, collection of fluid that collects as the result of pressure on the baby’s head during delivery.
A cephalhaematoma is a haemorrhage between the skull and periosteum. Because the swelling is subperiosteal, it’s limited by the boundaries of the baby’s cranial bones.
when to 2 week wait a women with breast lump
women>30
A 78-year-old male is recovering on the ward following a partial thyroidectomy to remove a thyroid nodule 48 hours previously.
He complains of muscle cramps and a ‘tingling sensation’ around his mouth. An ECG is performed on the ward.
Given the likely cause of his symptoms, which of the following abnormalities may be observed on his ECG?
A. Prolonged PR interval B. Shortened ST segment C. Prolonged QT interval D. Tall, peaked T wave E. ST elevation
Prolonged QT interval
Complications of thyroid surgery - damage to parathyroid glands can result in hypocalcaemia
management of reactive arthritis
ibuprofen
Acute reactive arthritis can be treated with NSAIDs, as long as there are no contraindications
A 30-year-old woman who is 41 weeks pregnant is being induced in the labour ward. She has an artificial rupture of membranes, but the midwife notices that the umbilical cord is visibly protruding from the vagina. She is brought for an emergency caesarean section.
What is the correct position for her to be in while being prepared for surgery?
A. Flat on her back B. McRobert's position C. On her back with head lowered and lower half of bed raised D. On her knees and elbows E. Standing
The correct position for women who have a cord prolapse is on all fours, on knees and elbows
This is an example of cord prolapse, the majority of which occur after artificial rupture of membranes. The correct position for a woman to be in while being prepared for caesarean is on all fours (on knees and elbows), while someone pushes the presenting part of the fetus up. McRobert’s is a manoeuvre used during shoulder dystocia.
A 72-year-old gentleman is admitted to the emergency department with abdominal pain, nausea, fatigue, and confusion. He has a past medical history of stage IV lung cancer, diagnosed two months ago. Blood samples are taken and sent to the lab.
Given the most likely electrolyte abnormality, what would you most likely observe on this patient’s ECG?
A. Prominent U waves B. Tenting of the T-waves C. Wide QRS complexes D. Shortening of the QT interval E. Osborne (J) waves
The main ECG abnormality seen with hypercalcaemia is shortening of the QT interva
This man is presenting with symptoms characteristic of hypercalcaemia, secondary to malignancy. The main ECG abnormality seen with hypercalcaemia is shortening of the QT interval. Osborne (J) waves may also be seen in more severe cases. If the hypercalcaemia is not corrected, ventricular arrhythmias like Ventricular Fibrillation can develop.
What is the single most appropriate initial investigation(s) to assess for the presence of free fluid in the abdomen and chest?
A. CT abdomen and CT chest B. MRI abdomen and MRI chest C. MRI abdomen and CT chest D. Diagnostic peritoneal lavage E. FAST scan
FAST scans can be used to assess the presence of fluid in the abdomen and thorax
While CT imaging is useful in the assessment of free fluid in the abdomen and chest of trauma patients, the most appropriate initial investigation to conduct is a focused assessment with sonography for trauma (FAST) scan. In the hands of a skilled practitioner, this can detect free fluid surrounding the kidneys, the spleen, the liver, bladder and pericardium. It is also possible to visualise all four chambers of the heart and to assess the hepatic vasculature. An extended focused assessment with sonography for trauma (eFAST) can be conducted, which also assesses for pneumothorax. The sensitivity of a FAST detecting a pneumothorax is 40%, however is considered more sensitive than a supine chest radiograph at detecting pneumothoraces.
management of myxoedemic coma
thyroxine and hydrocortisone
Thyrotoxic storm management is treated
with beta blockers, propylthiouracil and hydrocortisone
Intrahepatic cholestasis of pregnancy
increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation
Ursodeoxycholic acid reduces itch and improves LFTs but does not reduce the risk of stillbirth
Mr Wyle, a 69-year-old man has been brought to the emergency department by his wife. She is very concerned about his breathing. She says he has a background of COPD and he has been becoming progressively more breathless over the last 3 days with a productive cough and today she noticed that he was working hard to breath at rest. She says he has become even more breathless on the journey in to hospital.
You note that his oxygen saturations are 60% on room air. He is in the tripod position and using his accessory muscles to breathe. His lips have a blue tinge to them. You note that he has been admitted to hospital several months ago and that he is known to retain CO2.
Which of the following methods of oxygen delivery would be most suitable for Mr Wyle?
A. Nasal cannulae B. Simple face mask C. 28% venturi mask D. 15L via non-rebreathe mask E. 24% venturi mask
15l
Any critically ill patient (including CO2 retainers) should initially be treated with high flow oxygen which is then titrated to achieve target sats. Hypoxia kills
