Laz Paper 10 Flashcards
What is the initial management in the GP of someone presenting with meningitis?
IV or IM benzylpenicillin
What is Kernig’s sign?
Kernig’s sign is lying the patient supine with flexed hip and knee and passively extending the knee elicits pain
What is Brudzinski’s sign?
Patient is lying supine and neck is flexed causing patient to flex hips and knees
When would dexamethasone be used in meningitis?
Dexamethasone would be used to reduce cerebral oedema in meningitis
Which crystals are associated with gout?
Monosodium urate rod shaped negatively birefringent crystals are associated with gout
What are the manifestations of gout?
- Swelling of the first metatarsal joint
- Tophi in the tendons
- Tophi in the pinna
What is primary ciliary dyskinesia?
Disorder of the cilia which leads to ciliary paresis of the respiratory tract meaning patients may develop recurrent chest infections
What is the presentation of primary ciliary dyskinesia?
- Recurrent chest infections (occasionally leading to bronchiectasis)
- Situs inversus (cilia guide placement of organs, in 50% of cases organs will be on the wrong side)
- Recurrent otitis media
What is Kartagener’s syndrome?
- Primary ciliary dyskinesia
- Situs inversus
What is Caplan’s syndrome?
- Rheumatoid arthritis
- Pneumoconiosis
What is Young’s syndrome?
- Sinusitis
- Infertility
- Bronchiectasis
What is situs inversus?
When the organ systems develop on the wrong side of the body
What is the Ann Arbor scale used to stage?
Hodgekins and non-hodgekins lymphoma
What is the Gleason score used for?
To stage prostate cancer
What is the Dukes’ score used for?
- Staging of colorectal cancer
- Diagnosing infective endocarditis
What is the Rai and Binet score used for?
Staging of chronic lymphocytic leukaemia
What is the Breslow score used for?
Staging of melanoma
Where are venous ulcers most commonly found?
Superior/ lateral to the medial malleolus
What are the common associated features with venous ulcers?
- Stasis eczema
- Lipodermatosclerosis
- Haemosiderin deposition
What are simple partial seizures?
Simple = patient does not lose consciousness or have impaired memory
Partial = the seizure is localised to one area of the cerebrum
What is a Jacksonian March?
Jacksonian march is where the seizure starts by affecting one muscle group and spreads to other adjacent muscle groups
What are automatisms?
Automatisms are involuntary muscle movements
What are the scores for pressure ulcers?
- Waterlow
- EPUAP (european pressure ulcer advisory panel)
What is the EPUAP for pressure ulcers?
- Grade 1: intact skin with non-blanching erythema, may be painful or itchy
- Grade 2: partial thickness loss of dermis, may be a blister or shallow open wound
- Grade 3: full thickness loss of dermis, subcutaneous tissue visible, slough (tissue necrosis) may be present
- Grade 4: full thickness loss of tissue with bone, tendon and muscle exposed, slough may be present
What is the most common cause of encephalitis?
HSV
What is extrinsic allergic alveolitis?
A hypersensitivity reaction to inhaled dust/ pollution that leads to interstitial lung disease
What is the difference between extrinsic allergic alveolitis and pneumoconiosis?
Both lead to interstitial lung disease, but pneumoconiosis is not a result of hypersensitivity reactions
What is the moa of tamsulosin?
Alpha blocker
What is the moa of finasteride?
5-alpha-reductase inhibitor
What are two examples of anti-cholingergics used to treat urinary incontinence?
Oxybutynin and solifenacin
Why does it take several years to develop vitamin B12 deficiency?
Because there are large stores in the liver
What are the features of anti-phospholipid syndrome?
- Miscarriage (recurrent)
- Livedo reticularis
- Thrombophilia
- Thrombocytopaenia
Which antibodies are associated with rheumatoid arthritis?
Anti-CCP
What are anti-Jo-1 antibodies associated with?
Polymyositis
What are anti-centromere antibodies associated with?
Limited cutaneous systemic sclerosis
What are rose spots?
Red spots on the trunk due to typhoid fever
What are roth spots?
Spots seen on fundoscopy due to infective endocarditis
What is stress incontinence?
Increased intra-abdominal pressure causes incontinence eg. sneezing, straining etc
What is urge incontinence?
The feeling of needing to urinate followed by an uncontrollable urination
What is overflow incontience?
Involuntary release of urine from an already full bladder it occurs in patients with outflow obstruction or an underactive detrusor muscle
What is double incontinence?
Urine and faecal incontinence
How can Acromegaly lead to carpel tunner syndrome?
It causes soft tissue swelling of the wrist
What is the Alvarado score used for?
Appendicitis diagnosis
What is the modified Glasgow score?
A score used to triage the severity of acute pancreatits
P--> PaO2 <7.9mmol/L A--> Age >55 N--> Neutrophils > 15x10^9/L C--> Calcium <2 mmol/L R--> Renal function (urea >16mmol/L) E--> Enzymes (LDH >600, ALT >200) A--> Albumin <32 g/L S--> Sugar >10 mmol
A score of >3 indicates severe acute pancreatitis
What are Lisch nodules?
Yellow spots on the iris that indicate neurofibromatosis type 1
Why do patients with COPD have a bounding pulse?
Due to CO2 retention
What is paraphimosis?
Paraphimosis is when a tight foreskin is retracted over the glans and can’t be replaced
What is balanitis?
Inflammation of the foreskin and glans
What is phimosis?
A tight foreskin obstructing the meatus
What is Quincke’s sign?
Pulsation of the nail beds in aortic regurgitation
What is De Musset’s sign?
Nodding of the head in time with the pulse in aortic regurgitation
What is Traube’s sign?
‘Pistol-shot’ like systolic and diastolic pulse in the femoral artery
What is Corrigan’s sign?
Pulsation of the neck in aortic regurgitation
What is Becker’s sign?
Pulsation of the pupils and retinal arteries in aortic regurgitation
What is the management of H.pylori?
Omeprazole (or other PPI), amoxicillin and clarithyromycin x2 per day
What is the mechanism of neural tube defects?
Inability of the neural tube to close during gestation leading to anencephaly (affecting the brain) or spina bifida (affecting the spine)
What is the sepsis 6 protocol?
Give 3, take 3
- Give IV fluids
- Give broad spectrum antibiotics
- Give high flow O2
- Take blood cultures
- Take serum lactate and Hb
- Take urine output
What are the parameters that define sepsis?
- Temperature >38, <36
- Heart rate <90 bpm
- Resp rate >20
- Cell count >12,000/mm3, <4,000/mm3
- CO2 <4.3kPa
What is the inheritance pattern of Wilson’s disease?
Autosomal recessive
How does Wilson’s present?
Deposits in the basal ganglia:
- Parkinsonian symptoms
- Changes in behaviour
- Seizures
Deposits in the eyes:
- Kaiser-Fleischer rings
Deposits in the liver:
- Jaundice
- Easy bruising
- Variceal bleeding
What would blood results of Wilson’s show?
- Low caeruloplasmin
- Low copper
What is the mechanism of CF?
Reduced functioning of the CFTR chloride ion channel leading to abnormally thick mucosal secretions
What is the diagnostic test for CF?
The sweat test, >60 mmol/L of Cl- in the sweat makes CF likely
What is Virchow’s triad?
- Stasis
- Epithelial cell damage
- Hypercoagulability
What will an x-ray of mesothelioma show?
Lung tumour proximal to the pleura (peripheral)
