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AIM exit > Lightning round > Flashcards

Lightning round Flashcards

1
Q

MgSO4 dose

A

iv MgSO4 2g (in 10ml D5)

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2
Q

Ticargrelor dose

A

180mg loading, then 90mg BD

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3
Q

Heparin dose for PPCI

A

50-70 IU/kg, max 5000 IU

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4
Q

Drugs for Dressler syndrome

A

Aspirin 750 mg q6h, then taper weekly over 3 months
colchicine 0.5mg BD for 3 months

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5
Q

Lignocaine dose for VT

A

0.5mg/kg iv push +/- repeat another dose
then infuse 1mg/min
only for VT, not for supraventricular arrhythmias

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6
Q

Lignocaine dose for VF

A

1-1.5mg/kg iv push, can repeat 0.5mg/kg at 5-10min

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7
Q

Nitroprusside dose

A

0.5mcg/kg/min and then titrate to max 10 mcg/kg/min
Not to use in pregnant ladies / use more than 48h

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8
Q

PRES associations

A
  • HT crisis, PET
  • Acute / chronic kidney disease
  • TTP / HUS
  • Vasculitis (includes SLE, PAN)
  • Immunomodulatory drugs, chemotherapy drugs (includes anti-VEGF incl Bevacizumab, Platin chemo, CyA / RTX / MTX / FK)
  • iodine contrast (cerebral angiography)
  • severe sepsis
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9
Q

Features of complicated type B aortic dissection

A
  • evidence of malperfusion - renal artery involvement, limb or visceral ischemia
  • hemoperitoneum, mediastinal hematoma
  • rapid expansion or aneurysmal degeneration of the aortic wall / progression of dissection
  • impending or frank rupture
  • uncontrolled pain, or refractory hypertension (despite ≥3 classes of anti-HT at max doses)
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10
Q

VTE screen

A
  • APS antibodies (LA, B2GP, ACL)
  • protein C/S, anti-thrombin III deficiency, factor V leiden
  • malignancy
  • MPN (ET, PCV)
  • nephrotic syndrome
  • cushing; OCP, HRT
  • immobilization
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11
Q

Empirical Abx for treatment of IE

A
  • Ampicillin 2g q4h + Gentamicin 1mg/kg Q8H

Prosthetic valve
- cloxacillin 2g q4h + Rifampicin (300mg tds) + Gentamicin 1mg/kg Q8H
- MRSA - switch cloxacillin for Vancomycin 15-20mg/kg/dose

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12
Q

Abx prophylaxis for IE

A
  • ampicillin 2 gram x1 dose (oral or iv)
  • alternatively consider vancomycin 15mg/kg x 1 dose, or zithromax 500mg x 1 dose
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13
Q

High risk drugs for SCAR

A

allopurinol (HLA B5801), carbamazepine (HLA B1502), phenytoin, NSAID, septrin

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14
Q

Insulin infusion dose

A

0.1 unit/kg/hr

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15
Q

Metabolic syndrome components

A
  • dysglycemia (FG >5.6)
  • HDL <1 (M) or <1.3 (F)
  • TG >1.7
  • waist circumference >90 (M) or >80 (F)
  • HT >130/85
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16
Q

Friedewald equation for LDL

A

TC - HDL-C - (TG/2.2 in mmol/L)

assumes a 5:1 relationship between TG and VLDL
cannot use if TG >4.5 or <1.1

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17
Q

Alirocumab, Evolocumab and inclisiran dose

A

Alirocumab / Praluent 150mg q2wk
Evolocumab / Repatha 140mg q2wk
Inclisiran 284 mg at 0,3m and then q6m

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18
Q

Agents for LDL

A
  • statin
  • ezetrol
  • PCSK9i
  • bempedoic acid
  • cholestyramine
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19
Q

significant alcohol consumption definition

A

70g/week for women
140g/week for men
(ie <1 and <2 standard drinks/day respectively, 1 standard drink being 10g)

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20
Q

Exercise for weight loss

A
  • At least 150min moderate intensity aerobic exercise per week
  • spread over at least 3 days per week
  • no more than 2 consecutive days of rest
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21
Q

Doses of osteoporotic agents
- Alendronate
- Zoledronic acid
- Prolia
- Teriparatide
- Romosozumab

A
  • ALN - 70mg weekly
  • ZOL - 5mg yearly
  • Dmab - 60mg q6m
  • TPT - 20 mcg daily
  • Rmab - 210mg q1m
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22
Q

Calcium correction for albumin

A

Correction factor - (40-Alb) x 0.02

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23
Q

Thyroid storm parameters

A

Fever, HR, presence of AF, CHF, neurological symptoms, GI symptoms (N/V/D/Jaundice), precipitant

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24
Q

Thyroid storm treatment

A
  • supportive, monitoring
  • PTU 150mg q6h
  • lugol’s 0.3ml tds
  • beta-blocker if not CI eg inderal
  • hydrocortisone
  • may consider lithium and cholestyramine
  • panadol for fever
  • plasmapharesis
  • treat any precipitants
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25
Q

Causes of elevated PRL

A
  • exclude pregnancy
  • stress
  • hypothyroid, ESRF
  • antipsychotics (eg risperidone)
  • PRLoma / stalk effect of non-functioning tumors
  • macroPRL
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26
Q

Features of Acromegaly

A
  • Enlarged hands and feet, nose
  • Frontal bossing, supraorbital bulging, macroglossia, prognathism, increased interdental space
  • Goitre; cardiomegaly; hepatosplenomegaly; colonic polyps
  • carpal tunnel syndrome, OA of joints
  • DM, HT, OSA; osteoporosis
  • local mass effect of tumor - headache; VF; hypopituitarism; co-secreting PRLomas
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27
Q

Diagnosis of PCOS

A

Rotterdam Criteria for PCOS (any 2 of following)
- oligo- or anovulation (<21d or >35d menses); consider mid-luteal progesterone
- hyperandrogenism (clinical - hirsutism with Ferriman-Gallwey >7, acne; but usually NO signs of virilization) (biochemical - total or free testosterone)
- polycystic ovaries on USG examination: presence of 12 or more follicles in either ovary measuring 2-9 mm in diameter and/or increased ovarian volume (>10ml)

Exclude thyroid, hyperPRL, non-classical CAH (mainly 21OH)
Consider androgen secreting tumors if serum testosterone >2x ULN

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28
Q

Contraindiations to HRT

A
  • unexplained vaginal bleeding; CA breast, CA endometrium risk
  • stroke / TIA, ACS, PE / DVT, thrombophilia
  • active liver disease
  • TG >5.6; uncontrolled DM / HT
  • SLE, migraine with aura
  • Caution in CV risk, active gallbladder disease,
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29
Q

PPI infusion dose

A

iv pantoloc 80 mg stat then 8mg/h for 72h

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30
Q

King’s college criteria for liver transplant in paracetamol overdose

A

pH <7.3, INR >6.5, Cr >300, Grade III / IV HE

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31
Q

HE precipitants

A
  • excessive alcohol / protein intake
  • constipation / vomiting
  • infection
  • GIB
  • diuretics / large volume paracentesis
  • vascular occlusion
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32
Q

Child-Pugh score for cirrhosis - criteria

A

Albumin
Bilirubin
Coagulopathy
Distended Abdomen
Encephalopathy

33
Q

SAAG interpretation

A

High SAAG >11 g/L
- low protein (25g/L) - cirrhosis
- high protein - Budd-chiari, CHF

Low SAAG < 11 g/L
- nephrotic syndrome
- pancreatitis, biliary leak
- peritoneal carcinomatosis
- TB peritoneum

34
Q

Alcoholic hepatitis management

A
  • monitor GC and HE
  • thiamine
  • ativan for DT prophylaxis
  • laxatives
  • high dose prednisolone if high DF
35
Q

Causes of pancreatitis

A
  • Alcohol, Hypertriglyceridemia
  • Gallstone
  • Post-ERCP
  • HyperCa
  • IgG4
  • drugs - DPP4, GLP1RA, azathioprine, 5-ASA, sulphonamide
  • infections - mumps, Cox, salmonella
  • idiopathic
36
Q

Chronic diarrhoea ddx

A
  • inflammatory bowel disease
  • infections including CDT
    infections in HIV - Giardiasis, cryptosporidiosis, MAC, CMV
  • chronic pancreatitis
  • hyperthyroidism
  • laxative use, orlistat, other med SE
  • IBS
37
Q

Meds for urinary incontinence

A

OAB
- oxybutynin (antimuscarinic)
- mirabegron (Betmiga) (beta3 agonist)

UAB
- distigmine (Ubretid) (AChE inhibitor)

Males - alpha antagonist (eg terazosin), 5a-reductase inhibitor (eg finasteride)

38
Q

Dementia drugs

A
  • Cholinesterase inhibitor - Aricept / Donepezil (CI asthma; SE bradycardia, nausea), Rivastigmine patch
  • NMDA receptor antagonist - Memantine (SE constipation)
  • Aducanumab
39
Q

ITP treatment

A

Prednisolone 1mg/kg if Plt <30 and minor symptoms

Sig bleed - IVIG 1g/kg/day + iv MP 1g/day x3 days
Consider RTX, Eltrombopag, Splenectomy

May give transamin, anti-D

40
Q

Management if suspect TTP

A

Ix
- low haptoglobin, high retic, LDH, urate, bili
- measure ADAMTS13 level & activity (<10%)

Mx
- Plasma exchange + steroid (iv MP 1g/day x 3 days)
- contraindicated to any Plt transfusion

if not ADAMTS13 but Shiga toxin from ETEC –> likely to be HUS; supportive management only

41
Q

prolonged APTT causes

A
  • APS
  • hemophilia (factor 8 and 9)
  • vWD (esp severe vWD)
  • heparin contamination
  • part of mixed picture (warfarin, DIC)
42
Q

Vitamin K factors, APTT factors, PT factors

A

vitamin K - 2,7,9,10
APTT - 8,9,10,11
PT - 2,5,7,10

43
Q

vWD bleeding

A
  • DDAVP can raise vWF levels in mild vWD (not useful if absent vWF)
  • transfuse vWF concentrate, or recombinant vWF + factor 8
  • or consider FFP + factor 8 + additional Plt transfusion for type 2 / 3 vWD
  • or consider cryoprecipitate (if factor concentrate inappropriate) (contains fibrinogen, factor 8, vWF)
  • consider transamin
44
Q

Hemophilia bleeding

A
  • factor concentrate
  • consider novoseven
    90microgram/kg/dose every 2-3h until bleeding stops
  • PCC transfusion
  • DDAVP may be used for mild hemophilia
  • consider transamin
  • long-term consider steroids / CYC in acquired hemophilia to remove inhibitors
45
Q

vWD diagnosis

A
  • mucocutaneous bleeding
  • vWF antigen levels and vWF activity
  • may also check factor 8 activity in severe (type 3 vWD)
  • acquired vWD in malignancies (eg MPN), congenital vWD is autosomal dominant
46
Q

Hemophilia diagnosis

A
  • prolonged APTT
  • factor activity levels
  • 1:1 mixing study - not improve with mixing means presence of antibody
47
Q

(Severe) Bleeding in
- Dabigatran
- Xaban
- warfarin
- thrombolytics

A
  • Idarucizumab 2.5gram iv infusion 2h apart
  • PCC 50 IU/kg (+ consider novoseven 90mcg/kg)
  • iv vitamin K 5-10mg + PCC 50 IU/kg
  • cryoprecipitate (up to 10 units per dose) + transamin x1 dose
48
Q

SBP dx and Mx

A
  • WCC >500, ANC >250
  • Rocephin 5 days
  • lactulose; watch out for HE
  • iv albumin 1.5g/kg on D1, 1g/kg on D3
  • withhold beta-blockers
  • consider long-term ciprofloxacin if recurrent attacks
49
Q

Post-needle stick blood checking

A

HBV - 24 wks
HCV - 6-8, then 24wks if first blood test is -ve
HIV - 6, 12, 24 wks

50
Q

Definition of resistant HT

A
  • blood pressure that remains above goal in spite of concurrent use of 3 antihypertensive agents of different classes with good compliance
  • ideally, one of which should be a diuretic, and all 3 at their maximally tolerated dose
    (Remember to check compliance)
51
Q

Differences between SJS / TEN / DRESS

A
  • SJS and TEN have epidermal necrosis and detachment with mucosal involvement
    DRESS has rash progressing to erythema with eosinophilia and prominent systemic involvement; may also have mucosal involvement
  • SJS and TEN differ in BSA (>30% for TEN, <10% for SJS; middle is overlap)
  • systemic steroid for DRESS with slow taper
52
Q

Empirical Abx for pneumonia

A

CAP - Augmentin + Zithromax / Doxycycine +/- Tamiflu
HAP - consider augmentin; or Tazocin
Bronchiectasis - Tazocin

53
Q

Empirical Abx for CAPD peritonitis

A

Cefazolin / Vancomycin + Ceftazidime / Amikacin
with nystatin
with fluimucil if use aminoglycosdes
heparin flush into each PDF

54
Q

Empirical Abx for necrotizing fasciitis

A

Meropenem + Levofloxacin + linezolid

mero - GNB, strep, anaerobes
levo - vibrio
linezolid - group A strep, MRSA

May consider clindamycin if strep sensitivity known
Consider daptymycin if high vancomycin MIC needed for MRSA

55
Q

Empirical Abx for septic arthritis

A
  • consider cloxacillin or rocephin as initial Tx
  • Cloxacillin + Rocephin if more frail / Hx of UTI
  • Vancomycin + rocephin if known MRSA carrier
  • doxycycline adjuvant for 7 days if known gonorrhoea arthritis
56
Q

Vaccine for splenectomy

A

Meningococcal, pneumococcal, hemophilus vaccine
(and all the other regular vaccines incl COVID)

57
Q

Contact tracing for hemophilus and meningococcus

A
  • Hemophilus - rifampicin / Hib vaccine
  • Meningococcus - rifampin / rocephin
58
Q

Fever in returning traveler

A
  • CBC/dc LRFT RG clotting c/st
  • CXR, NPS x flu, covid, resp virus
  • smear for malaria
  • serology for - dengue, rickettsia, Mpox (lesion)
  • urine c/st
  • stool c/st, ova and cyst
  • consider - coxiella (q fever) serology, psittacosis serology, borrelia (lyme disease) serology
  • cryptosporidia, giardia, strongyloides and coccidiodomycosis in diarrheoa
  • others incl - legionella, TB, HAV and HEV
59
Q

AIDS defining illness

A
  • occurs at CD4 <200
  • pTB usu at CD4 >200
  • PCP, non-TB mycobacerium, cryptosporidiosis, toxoplasmosis, esophageal candidiasis, disseminated CMV, Kaposi sarcoma, CNS lymphoma
60
Q

PCP vaccine

A

Age >65
- single dose PCV13 (conjugate vaccine)
- single dose 23vPPV (polysaccharide vaccine)

High risk
- PCV13 → 23vPPV 1 year later (can also give reverse if 23vPPV was given first)

61
Q

Horner syndrome

A

partial ptosis, miosis (small pupil) +/- anhidrosis
classically pancoast tumor

62
Q

Specific causes for CN3, CN6 palsy

A

CN3 - PCOM aneurysm, tentorial herniation
CN6 - NPC, raised ICP (false localizing sign), basal meningitis

63
Q

Cardinal features of Parkinson’s Disease

A
  • Bradykinesia + resting tremor / rigidity (in the past also incl postural instability)
64
Q

Obstructive vs restrictive lung disease on spirometry

A
  • obstructive - FEV1/FVC <70%
  • restrictive - FEV1/FVC >70%, and FVC <80%
65
Q

Grading of COPD by FEV

A

GOLD 1 - FEV1 >80%
GOLD2 - FEV1 50-80%
GOLD 3 - FEV1 30-50%
GOLD 4 - FEV1 <30%
(cf diagnosis of COPD - by RATIO of FEV1/FVC <70%)

66
Q

Gauging symptoms of COPD

A

mMRC (Modified Medical Research Council) and CAT (COPD assessment tool)
- mMRC 0-4 - 2 is slower than same age ppl or stop for breath on level walking; 4 is homebound and SOB with dressing
- Group B COPD is mMRC 2+ or CAT >10

67
Q

Vaccination suggested for COPD patients

A
  • Influenza
  • COVID
  • PCV13 → 23vPPV
  • Shingrex (if age >50)
  • Pertussis (if not vaccinated in childhood)
68
Q

Diagnosis of asthma

A
  • clinical diagnosis
  • VARIABLE symptoms of SOB / cough / wheezing
  • eg by exercise / change in weather / URI; diurnal variation

PFT
- variability of lung function
- post-BD increase in FEV1 >12% and >200ml (not in acute attack)

Others incl - atopy march, daily PEF variability >10%, improvement of parameters after treatment; worse with provocation (eg exercise)

69
Q

Assessment of asthma control

A

Compliance, technique & environment; review diagnosis (eg COPD, EGPA)

GINA assessment
- daytime symptoms >2x per week
- night waking
- SABA reliever >2x per week
- activity limitation

ACT score (asthma control test)

70
Q

Pseudogout causes

A

3H - haemochromatosis, hyperparathyroidism, hypomagnesaemia

71
Q

Indications for urate lowering therapy in gout

A

2+ attacks in 1 year or polyarticular attack
Gouty tophi (target <0.3 instead of 0.36)
Radiological joint changes
Renal calculi or eGFR <60

72
Q

Typical RA features on PE

A

Swan neck deformity
Boutonneire deformity
Z deformity of thumb
Volar subluxation
Ulnar deviation

Rheumatoid nodules
Splenomegaly - felty syndrome

73
Q

Management of adult Still’s disease

A
  • NSAID at antiinflammatory dose
  • Anakinra if mod-severe disease
    P20-60 if Anakinra is not available
  • long-term tail steroids and step up DMARDS
74
Q

Management of HLH

A
  • treat underlying disease (eg lymphoma, infection, autoimmune disease)
  • HLH94 - etoposide + dexamethasone
75
Q

Drugs that may worsen lupus / drug-induced lupus

A
  • hydralazine, methyldopa, diltiazem, procainamide
  • isoniazid, quinidine, minocycline
  • chlorpromazine
  • anti-TNF (esp. infliximab), interferons
76
Q

Rhabdomyolysis management

A
  • volume repletion (NS 1-1.5L/h if anuric), then 1D1S to maintain u/o 200ml/h
  • continue fluid until CK <5000
  • add NaHCO3 50 mmol/L to every other bag of IVF to keep urine pH >6.5;
    Stop if ABG pH >7.5, or HCO3 >30 or hypoCa
  • dialysis for AKI
  • Ca replacement should be avoided unless symptomatic
77
Q

Risk factors for / causes of fall in the elderly

A
  • neurological (eg Parki, stroke; cerebellar disease; neuropathy; myopathy less)
  • cognitive impairment, poor safety awareness (eg dementia)
  • poor eyesight and environment hazards
  • cardiac postural hypotension, arrhythmias, AS
  • meds - postural hypotension (eg alpha blockers / diuretic), sedating (eg anti-histamines, BZD, psychiatric med)
  • OA knees, fraility, sarcopenia
78
Q

empirical Abx for skin and soft tissue infection (not NF)

A

consider cefazolin 1 gram q6h
or ampicillin 2g q4h + cloxacillin 500mg q6h (simple infection; sepsis dose 2g q4h)

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