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Finals - Things to Go Over > Make a Medic - Medicine & Surgery > Flashcards

Make a Medic - Medicine & Surgery Flashcards

1
Q

What is PRES? Where does it affect? Common causes?

A

Posterior Reversible Encephalopathy Syndrome (PRES) is a constellation of symptoms that results in oedema of the posterior occipital and parietal lobes.

Manifestations include headache, changes in vision, confusion and seizures.

It can be caused by severe hypertension, and it should resolve once the blood pressure is under control.

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2
Q

Initial management of acute HF

A

Sitting the patient upright, administering high flow oxygen and offloading the fluid with IV diuretics (usually furosemide 40-80 mg)

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3
Q

Management of Furosemide resistant HF. How may this present on an ABG?

A

Non-invasive ventilation. T1RF

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4
Q

What type of NIV is useful for each type of respiratory failure? Why?

A

T1RF - CPAP - CPAP is to splint open collapsed airways, thereby recruiting more alveoli for oxygenation. It is appropriate for type I respiratory failure when poor oxygenation is the main issue.

T2RF - BiPAP - BiPAP is useful for both oxygenation of the blood and removing carbon dioxide, so it is a useful treatment for type II respiratory failure.

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5
Q

Where are venous ulcers typically found?

A

gaiter region of the leg

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6
Q

Characteristics of venous ulcers

A

shallow, relatively painless with irregular boundaries and a wet sloughy appearance

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7
Q

Characteristics of arterial ulcers

A

clearly defined borders, are extremely tender and the pain worsens with elevation of the leg (this reduces blood flow to the ischaemic tissue by removing the beneficial effect of gravity).

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8
Q

Characteristics of neuropathic ulcers

A

painless and will tend to arise at pressure points across the foot (e.g. balls of the foot).

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9
Q

What is preferred method of VTE prophylaxis in hospital? When is this contraindicated? What should be used instead?

A

VTE prophylaxis in hospital is usually given as a low-molecular weight heparin (e.g. tinzaparin), however, it is contraindicated in renal impairment (eGFR < 30 mL/min) as it is primarily renally excreted. Patients with renal impairment should, therefore, be started on IV unfractionated heparin instead.

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10
Q

Scoring system for severitty of an upper GI bleed

A

Glasgow-Blatchford scale

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11
Q

Scoring system post-endoscopy to determine how likely a patient is to have another bleed

A

Rockall score

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12
Q

How does gliclazide lead to increased insulin secretion?

A

They act on SUR1 receptors, which are associated with the KATP channel, and lead to its closure. They increased intracellular K+.

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13
Q

1st line treatment for MODY

A

Sulphonylurea

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14
Q

Immediate management of addisonian crisis

A

IV hydrocortisone and IV fluids

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15
Q

Criteria for diagnosis of Adrenal insufficiency following synACTH administration

A

Individuals with adrenal insufficiency will not demonstrate a sufficient rise in cortisol (< 420 nmol/L).

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16
Q

How can ACTH level be used to guide whether it is priamry or secondary adrenal failure?

A

If the ACTH level is low, then the adrenal insufficiency is due to secondary adrenal failure.

Causes of secondary adrenal failure include hypopituitarism and exogenous glucocorticoid administration.

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17
Q

4 types of MND

A

There are four main types of motor neurone disease depending on the types of motor neurones affected:

amyotrophic lateral sclerosis (upper and lower motor neurones)
primary lateral sclerosis (upper motor neurones only)
progressive bulbar palsy (cranial nerves IX, X and XII)
progressive muscular atrophy (lower motor neurones only).

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18
Q

Triad of Wernicke’s

A

confusion, ophthalmoplegia and ataxia.

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19
Q

Treatment of Wernicke’s

A

Pabrinex is a medication that contains thiamine and should be given to all alcoholic patients, irrespective of whether they have presented with signs of Wernicke’s encephalopathy.

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20
Q

Treatment of beta blocker OD

A

Atropine (if patient is bradycardic)

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21
Q

Treatment of benzo OD

A

Flumazenil

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22
Q

Treatment of malignant hyperthermia following suxamethomium

A

IV dantrolene

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23
Q

Treatment of cyanide poisoning

A

Hydroxocobalamin

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24
Q

Treatment of paraccetemol OD

A

NAC

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25
Q

What is used to look for CF during the heel prick test?

A

Immunereactive trypsinogen

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26
Q

What is a Hartmann’s procedure? When is it used? What stoma are they left with?

A

A Hartmann’s procedure is an emergency procedure that is used to manage acute presentations caused by diseases of the sigmoid colon (e.g. diverticular complication or bowel obstruction). As the conditions are usually suboptimal for an anastomosis to heal, patients are left with an end colostomy and a rectal stump which can be reversed at a later stage.

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27
Q

What is a left hemicolectomy used for? What does it involve removal of?

A

A left hemicolectomy can be used for descending colon cancers and utilises a colocolic anastomosis. This involves removal of the inferior mesenteric artery.

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28
Q

What type of cancer is an abdomino-perineal resection used for? What does it involve the removal of?

A

For rectal cancer that is less than 5 cm from the anal verge, an abdomino-perineal resection is used. This involves the removal of the anus and results in a permanent end colostomy situated in the left iliac fossa.

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29
Q

What type of cancer is an anterior resection used fro? What type of stoma is used? Why?

A

An anterior resection is the operation of choice for any rectal tumours that are more than 5 cm from the anal verge. The operation leaves the anus intact, an anastomoses the distal end of the colon to the remaining portion of rectum, thereby preserving continence. Due to the poor blood supply of the rectum, a temporary defunctioning loop ileostomy is created to protect the distal bowel and allow time to heal. This can be reversed electively at a later stage.

NOTE: an anterior resection involves the removal of the inferior mesenteric artery up to its origin at the aorta. This is significant in oncological surgery as the lymphatic drainage of the tumour follows the arterial supply and is a crucial route of metastasis.

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30
Q

What type of cancer is a right hemicolectromy used for? What type of stoma is formed?

A

A right hemicolectomy is the operation of choice for caecal or ascending colon cancers. The cancer is resected, and the bowel loops re-joined using an ileocolic anastomosis; this is commonly a side-to-side stapled anastomosis. This procedure involves the removal of the relevant branches of the superior mesenteric artery (right colic, ileocolic and right branch of the middle colic).

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31
Q

Which procedure involves removal of SMA?

A

Right hemicolectomy

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32
Q

Which procedure involves removal of IMA?

A

Left hemicolectomy + Anterior resection

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33
Q

Clinical features of osmotic demyelination syndrome. When do they present?

A

Spastic quadriparesis, pseudobulbar palsy and reduced GCS. They tend to manifest about 3-5 days after overcorrection of sodium.

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34
Q

When should a lap chole be done in acute cholehycstitis?

A

within 1 week of diagnosis

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35
Q

When should a lap chole be done in biliary colic?

A

6-12 weeks after Sx onset

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36
Q

Mackler’s triad for boerhaave syndrome

A

vomiting, chest pain and subcutaneous emphysema

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37
Q

CXR findng of boerhaave

A

pneumomediastinum

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38
Q

Definitive imaging for diagnosis of boerhaave syndrome

A

CT scan of the chest, abdomen and pelvis with oral and IV contrast - Leakage of oral contrast from the oesophagus into the mediastinum confirms the diagnosis

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39
Q

Most common sources of gram negative sepsis

A

urinary tract and the biliary system.

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40
Q

What does the presence of a new-onset left sided varicocele in an older man (over the age of 40 years) suggest?

A

It could be the presenting symptom of an underlying renal cell carcinoma that is compressing the venous drainage of the left testicle into the left renal vein.

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41
Q

1st line treatment for BPH

A

Tamsulosin (alpha blocker)

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42
Q

Criteria for tonsillectomy

A

≥7 episodes of tonsillitis in the past 12 months

● ≥5 episodes of tonsillitis per year for 2 years

● ≥3 episodes of tonsillitis per year for 3 years

● ≥2 peritonsillar abscesses at any point in the patient’s life (≥1 in children)

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43
Q

Treatment of thyroglossla cyst

A

Thyroglossal cysts are managed by surgical excision, typically with a Sistrunk procedure, which involves complete removal of the cyst and part of the hyoid bone

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44
Q

Dual antiplatelet therapy post STEMI

A

aspirin 75 mg OD AND clopidogrel 75 mg OD OR ticagrelor 90 mg BD for 1 year. Aspirin 75 mg OD will continue as a single antiplatelet agent lifelong.

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45
Q

How does infective endocarditis affect the spleen? How might this present?

A

The vegetations in bacterial endocarditis can give rise to septic emboli which can get lodged in the renal glomeruli and cause microscopic haematuria. They can also lead to splenic infarcts and splenomegaly.

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46
Q

Equivalent dose of 40mg furosemide for bumetanide

A

1mg PO

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47
Q

What does a low BP and high HR indicate? How should you manage this?

A

As this patient’s blood pressure is stable and their heart rate is high, it is likely that the rise in heart rate is attempting to compensate for their hypovolaemia. Given that hypovolaemia is the key issue that is driving this tachycardia, a fluid bolus will help replenish the intravascular volume and, hence, balance the equation such that the heart rate will come down.

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48
Q

What agents should avoided in those with severe aortic stenosis? Why?

A

Vasodilatory agents should be avoided, such as isosorbide mononitrate.

This is because, by causing vasodilation, these agents reduce the preload of the heart and can therefore further reduce cardiac output in a patient whose left ventricular outflow is already compromised. This could lead to a dangerous fall in blood pressure and a reduction in myocardial perfusion.

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49
Q

Most common cause of aortic stenosis in a younger patient

A

bicuspid aortic valve

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50
Q

Most pathognomic ECG finding for pericarditis

A

PR depression

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51
Q

Pericarditis following STEMI

A

Dressler syndrome

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52
Q

Medical management of encephalopathy

A

Lactulose

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53
Q

Classification for oesophagael or gastroesophagael pathology

A

Paris and Prague classification

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54
Q

LP finding of GBS

A

Albuminocytologic dissociation is a CSF analysis result that is often associated with GBS

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55
Q

Tumour marker for medullary thyroid cancer

A

Calcitonin (produced by parafollicular C cells)

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56
Q

1st line treatment for prolactinoma

Why is it used?

A

The first-line treatment option for prolactinoma is a dopamine agonist such as bromocriptine or cabergoline. It is used because dopamine has a negative effect on the production of prolactin by the anterior pituitary gland.

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57
Q

How do subdural haemorrhages present on CT

A

On a CT head scan, subdural haemorrhages will have a crescentic appearance. If acute, the bleed will appear white or bright grey, whereas if it is chronic (older than around one week) it will appear dark grey.

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58
Q

How do extradural haemorrhages present on CT?

A

It has a lentiform (Concave) appearance on CT head scans as it is bound by the dura

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59
Q

MOA of co-careldopa

A

L-DOPA and DOPA decarboxylase inhibitor

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60
Q

Preventative medications for migraines

A

propranolol, topiramate and amitriptyline.

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61
Q

Generic management of acute asthma attack. What can be considered if ineffective?

A

high-flow oxygen, back-to-back salbutamol nebulisers, 6-hourly ipratropium bromide nebulisers and steroids (usually oral prednisolone or IV hydrocortisone)

If these measures are ineffective, adjuncts to treatment include IV magnesium and IV aminophylline.

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62
Q

fibrotic lung condition associated with prolonged exposure to inorganic dusts (e.g. coal dusts). Ix?

A

Pneumoconiosis. HRCT shows Fibrosis and honeycombing

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63
Q

What might be seen on a blood gas if sample is delayed?

A

Raised PaCO2

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64
Q

How to determine whether an inguinal hernia is indriect or direct?

A

To determine whether the hernia is direct or indirect, the hernia should be reduced, a finger should be placed over the deep inguinal ring (just above the midpoint of the inguinal ligament) and the patient should be asked to cough (increase intra-abdominal pressure). If the hernia reappears, it suggests the hernia is direct (passing through a weak point in the posterior wall of the inguinal canal). If it does not reappear, it is suggestive of an indirect inguinal hernia. The majority of inguinal hernias will be indirect.

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65
Q

What is subacromial impingement syndrome? How does it present?

A

Inflammation of the rotator cuff tendons as they pass through the subacromial space. It classically presents with progressive pain which is exacerbated by abduction, notably between 60° - 120° (known as a painful arc).

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66
Q

1st line management of adhesive capsulitis, if not successful try?

A

Physio, then intra articular steroid injections

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67
Q

Initial Ix for intermittent caludication

A

ABPI

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68
Q

What is intermittent claudication? What is it caused by?

A

ntermittent claudication (pain in the calves that occurs when walking and is relieved by rest). Claudication affecting the calf is caused by stenosis of the superficial femoral artery.

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69
Q

Fontaine classifcation for intermittent claudication

A

Stage A: Asymptomatic.
Stage B1: Mild intermittent claudication.
Stage B2: Moderate to severe intermittent claudication.
Stage C: Ischemic rest pain.
Stage D: Ulceration or gangrene (tissue loss).

NB: n Fontaine B1, patients can walk over 200 metres before experiencing symptoms of intermittent claudication. In Fontaine B2, patients experience symptoms when walking less than 200 metres.

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70
Q

HHV-3`

A

Shingles (Varicella Zoster)

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71
Q

HHV-4

A

EBV

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72
Q

HHV-5

A

CMV

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73
Q

HHV-8

A

Kaposi

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74
Q

What is PFO a common association in?

A

patients who have a stroke under the age of 50 years

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75
Q

Best Ix for prostate cancer

A

Multiparametric MRI scan

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76
Q

Why do persistent varicoceles warrant further Ix?

A

they could be the first presentation of an underlying intra-abdominal neoplasm (e.g. renal cell carcinoma that is impinging on the renal vein)

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77
Q

When may surgical excision for fibroadenomas be offered?

A

Surgical excision may be offered for fibroadenomas that are over 3 cm in diameter.

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78
Q

What is the best investigation for confirming a diagnosis of bacterial tonsillitis.

A

a throat swab for culture

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79
Q

What echocardiogram findings are highly suggestive of takotsubo?

A

apical ballooning

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80
Q

What is takotsubo characterised by? What is seen on their ECG?

A

sudden dysfunction of the ventricular myocardium in response to stress

Evidence of myocardial ischaemia on their ECG and blood tests

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81
Q

What is bifascicular block? What does it manifest as?

A

Bifascicular block is a combination of a right bundle branch block with a left bundle hemiblock (remember, the left bundle divides into the anterior and posterior hemi bundles).

This manifests as a right bundle branch block (triphasic QRS complexes (RSR’ pattern) in V1-2 and wide, slurred S waves in V6 and the limb leads) with axis deviation on the ECG

MARROW ON ECG

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82
Q

What is trifascicular block?

A

a combination of bifascicular block with 1st degree heart block (prolonged PR interval)

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83
Q

How does pain differ between peripheral vascular disease and spinal stenosis?

A

The pain in peripheral vascular disease tends to be crampy, compared to pain from spinal stenosis which tends to be dull and aching.

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84
Q

1st line treatment for mild PAD

A

treatment of RFs, smoking cessation, supervised exercise programme

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85
Q

In middle-aged men presenting with sudden-onset abdominal pain, what should always be considered as a potential diagnosis, especially when there is evidence of haemodynamic compromise?

A

AAA

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86
Q

What blood tests suggest a possible diagnosis of hypercalcaemia of malignancy?

A

hypercalcaemia with a suppressed PTH axis

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87
Q

Maximum rate of correction of sodium in first 24 hours

A

8-10mmol/L per day

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88
Q

Difference between presentation of botulism and GBS

A

GBS ascends, botulism descends

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89
Q

What does C denote in staging of Barrets? How does this affect treatment?

A

length of oesophagus

If <3 with gastric, repeat OGD and if same discharge

if <3 with gastric, repeat OGD and if intestinal now repeat OGD every 3-5 years

if <3 with intestinal repeat every 3-5 years

if >3 repeat every 2-3 years

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90
Q

What lobes does herpes simplex typically affecgt?

A

Temporal lobes

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91
Q

Management of an infective exacerbation of COPD

A

consists of four main components: oxygen, nebulisers (salbutamol and ipratropium bromide), steroids and antibiotics.

The steroid that is most commonly used for IECOPD is 30 mg Prednisolone OD for 5-7 days. Doxycycline and co-amoxiclav are the antibiotics of choice for IECOPD.

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92
Q

Which lung cancer is most likely to cause a cavitating lesion?

A

Squamous CC

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93
Q

1st line investigation for choleycstitis

A

US abdo

Following by CT CAP

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94
Q

What does Hartmann’s procedure involve?

A

resecting the sigmoid colon with formation of an end colostomy and a closed rectal stump

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95
Q

What is a high output stoma? How is it managed?

A

A high output stoma is generally defined as having a stoma output of 1.5-2 L or greater and results from the inability of the small bowel to reabsorb fluid and electrolytes efficiently

The management involves administering IV fluids and using loperamide or codeine to increase bowel transit time. Oral fluids should be restricted

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96
Q

Hypoechoic lesion on liver?

A

Think abscess

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97
Q

How is urobilinogen affected in cholangitis

A

low

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98
Q

Post surgical fever timeframe

A

1-2 days post op: respiratory or part of physiological inflammatory response to surgery
3-5 days post-op: respiratory or urinary tract
5-7 days: surgical site infection, venous thromboembolism, anastomotic leak

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99
Q

Mx of Dupuytren’s

A

Non-operative: hand exercises, needle aponeurotomy

· Operative: fasciectomy +/- skin grafting

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100
Q

How do boutonniere deformity and swan neck deformity differ?

A

Boutonniere deformity is characterised by flexion at the proximal interphalangeal (PIP) joint and extension at the distal interphalangeal (DIP) joint.

Swan neck deformity is characterised by hyperextension of the PIP joint and flexion of the DIP joint.

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101
Q

What to do if high suspicion of scaphoid fracture that is not detected on initial X-ray?

A

should be treated as if they have a scaphoid fracture (splint) and reassessed at 10-14 days with a repeat X-ray

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102
Q

Treatment of choice for ESBLs

A

Meropenem

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103
Q

When should a varicocele reduce? What happens if it doesn’t?

A

when lying down, if not red flag and urgent referral to urology

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104
Q

How to differ between epididymal cysts and hydroceles?

A

Both transilluminate but hydrocele cannot be felt separately from the testis

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105
Q

gold standard investigation for diagnosing deep vein thrombosis

A

USS Doppler

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106
Q

1st line surgical management for varicose veins

A

Endothermal radiofrequency ablation

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107
Q

Criteria for elective surgical repair for AAA patients

A

Symptomatic
Larger than 4 cm and grown by more than 1 cm in the last year
Larger than 5.5 cm

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108
Q

What is the most common arrest rhythm seen in patients who have had a myocardial infarction

A

Polymorphic ventricular tachycardia descending into ventricular fibrillation (VF)

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109
Q

Initial Ix for Wilson’s

A

Serum caeruloplasmin is a useful initial investigation as low levels would be suggestive of Wilson’s disease.

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110
Q

gold standard imaging modality for PSC.

A

A magnetic resonance cholangiopancreatography (MRCP) is a specialised MRI scan that provides high resolution images of the biliary tree

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111
Q

1st line pharmacological Mx of IIH

A

acetazolamide - this is a carbonic anhydrase inhibitor that has a diuretic effect

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112
Q

What is Lhermitte’s sign? When is it seen?

A

Lhermitte’s sign refers to paraesthesia that is felt in the upper limbs and trunk, often down the spine, when a patient flexes their neck. It occurs because of disruption to neuronal signalling pathways and is most commonly associated with multiple sclerosis (MS).

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113
Q

Gold standard imaging modality in MS

A

MRI brain

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114
Q

An elderly patient presenting with gradual, painless loss of vision is the classical presentation of

A

Cataract

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115
Q

Worse vision in bright light, and loss of red reflex

A

cataract

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115
Q

How is LMWH monitored

A

APTT or Factor Xa assay

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116
Q

How is unfractionated heparin monitored

A

APTT ratio

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117
Q

What does appendicitis need for diagnosis?

A

Can be diagnosed on clinical suspicion alone

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118
Q

Most appropriate Ix if persistent fever following appendicectomy

A

CT abdo

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119
Q

pain after a twisting movement and a positive McMurray’s test

A

Meniscal tear

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120
Q

Signs of aciute limb ischaemia

A

6 P’s: Pain, Pallor, Pulseless, Perishingly cold, Paraesthesia and Paralysis

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121
Q

What are the late signs of acute limb ischaemia? What do they suggest? Mx?

A

paraesthesia and paralysis - suggest irreversible damage and non-viability of affected limb. The only surgical treatment indicated in such patients is amputation.

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122
Q

ABG pattern in aspirin OD

A

Respiratory alkalosis –> metabolic acidosis

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123
Q

What medication to use if BP resistent to fluid resus in septic shock?

A

Vasopressors e.g. metaraminol

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124
Q

most common cause of neutropenic sepsis

A

Gram-positive organisms such as Staphylococcus aureus and Staphylococcus epidermidis

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125
Q

Tumour lysis syndrome diagnostic criteria

A

● Uric acid ≥476 micromol/L or 25% increase from baseline

● Potassium ≥6.0 mmol/L or 25% increase from baseline

● Phosphate ≥1.45 mmol/L or 25% increase from baseline

● Calcium ≤1.75 mmol/L or 25% decrease from baseline.

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126
Q

1st line Mx for large renal calculus (>20mm)

A

Percutaneous nephrolithotomy

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127
Q

1st line Mx for small renal calculus (<20mm)

A

Extracorporeal shockwave lithotripsy

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128
Q

What does leakage of CSF of the catheter in subdural suggest?

A

Catheter is in subarachnoid space, HIGH RISK OF CARDIAC ARREST

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129
Q

5 main types of MI

A

Type 1: Caused by ischaemia due to a sudden coronary artery occlusion (e.g. thrombus)
Type 2: Caused by ischaemia due to increased oxygen demand or decreased supply without any acute coronary event.
Type 3: Referred to cases of sudden death in patients with preceding features suggestive of a myocardial infarction but without available biomarkers.
Type 4: Associated with percutaneous coronary intervention or stent thrombosis.
Type 5: Associated with cardiac surgery (e.g. CABG).

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130
Q

What is PPI use ASx with an increassed risk of>

A

Fractures, C diff, hyponatraemia, gastric cancer

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130
Q

extensive mucosal ulceration across their oesophagus, stomach and duodenum?

A

Think GastrinOMA - zollinger ellison syndrome

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131
Q

Barrets transition

A

Keratinising squamous - non ciliating columnar

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132
Q

Refractory ascites Mx

A

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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133
Q

Following paracentesis to treat ascites, appropriate Mx?

A

Human albumin solution

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134
Q

What can Paget’s disease present with?

A

can present with bone pain, and warmth due to increased metabolic activity. Although it is often asymptomatic

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135
Q

1st line treatment for symptomatic paget’s disease of the bone

A

bisphosphonates e.g. zoledronic acid

136
Q

SIADH results

A

concentrated urine, where urine osmolality is over 100 mOsmol/kg and urinary sodium is over 20 mEq/L due to excess ADH causing increased water retention.

137
Q

Lateralising shoulder girl pain associated with upper limb neurological symptoms should raise suspicion of

A

brachial plexus injury

138
Q

If Horner’s syndrome present, what Ix?

A

CXR

139
Q

Important hearing finding in Bell’s

A

Hyperacusis in affected side ear

140
Q

What does monophonic (single tone) wheeze indicate?

A

Bronchial obstruction. Can be an underlying sign of malignancy, especially if asx with poorly resolving pneumonia

141
Q

What is excessive stoma output classified as? How can it be treated

A

over 1 L in 24 hours for 3 or more consecutive days. The management of excessive stoma output, in the first instance, involves the administration of an antidiarrhoeal agent (e.g. loperdamide) and a proton pump inhibitor (e.g. omeprazole) which decreases stomach acid generation.

142
Q

What is an important Ix in acute pancreatitis?

A

ABG - shows paCO2 (important for severity assessment)

143
Q

right upper quadrant discomfort with an obstructive picture on his LFTs, following TPN

A

cholestasis

144
Q

Segond fracture is an avulsion fracture of the proximal lateral tibia and is pathognomonic of

A

ACL tear

145
Q

What is Foucher’s sign?

A

Baker’s cysts feel firm when the knee is held in full extension, and softer when flexed

146
Q

What are Baker’s cysts? What do they occur secondary to?

A

sac of synovial fluid which can form in the popliteal fossa secondary to damage to the joint

147
Q

What is the most appropriate initial investigation to confirm AAA? WHat is gold standard?

A

US abdo, then CT angio is gold standard

148
Q

Sx of SLE mnemonic

A

‘SOAP BRAIN MD’ – Serositis, Oral ulcers, Arthritis, Photosensitivity, Blood (low counts of all parameters), Renal (proteinuria), ANA positive, Immune system (anti-dsDNA), Neurological features (seizures), Malar rash and Discoid rash

149
Q

Initial Ix for pyelonephritis

A

US KUB

150
Q

Antidote for sevofluorone toxicity

A

Dantrolene (prevents malignant hyperthermia)

151
Q

Heart failure with preserved ejection fraction is defined as?

A

heart failure with a left ventricular ejection fraction of more than 50%

152
Q

Classes of antiarrythmic drugs

A

Class I antiarrhythmics work by blocking the voltage-gated sodium channel (e.g. flecainide, propafenone and lidocaine).

Class II antiarrhythmics are beta-blockers (e.g. bisoprolol, metoprolol).

Class III antiarrhythmics are potassium channel blockers (e.g. amiodarone, sotalol). It is worth noting that amiodarone also has some effect on sodium channels, beta-adrenergic receptors and calcium channels.

Class IV antiarrhythmics are calcium channel blockers (e.g. verapamil, diltiazem).

153
Q

severe abdominal pain, rectal bleeding and diarrhoea

A

Think ischaemic colitis, a condition in which sudden reduced blood flow via the inferior mesenteric artery results in bowel ischaemia

154
Q

Useful invesitgation in ischaemic colitis

A

VBG

155
Q

SE of ondansetron

A

Constipation

156
Q

Most commonly affected site in ischaemic colitis

A

Transverse colon

157
Q

first-line treatment option for tumour-related hypercalcaemia

A

Bisphosphonates

158
Q

Haematological tumours, as well as granulomatous disease (TB, sarcoidosis), are able to cause hypercalcaemia via?

A

increased calcitriol production. Activity of ectopic 25(OH)D-1-hydroxylase expressed by macrophages or tumour cells leads to the formation of excessive amounts of 1,25(OH)₂D (i.e. active vitamin D).

159
Q

What should be performed before starting steroid therapy in bell’s?

A

Otoscopy to check for the presence of a vesicular rash in the outer ear that would be suggestive of Ramsay-Hunt syndrome

160
Q

How does LEMS differ from MG?

A

LEMS differs from myasthenia gravis in that the weakness improves with repetitive use

161
Q

Grading system for internal haemorrhoids

A

Grade I: does not prolapse

Grade II: spontaneously reduces

Grade III: can be reduced manually

Grade IV: irreducible

162
Q

Describe the Trendelenburg test

A

xamines the strength of hip abductors when standing on one leg. When standing on one leg, the hip abductors on the same side contract to stabilise the pelvis and maintain neutral tilt. If the hip abductors are weak, the pelvis is not stabilised and thus tilts toward the side of the raised leg: the sound side sags. If the pelvis tilts toward the right, this indicates weakness in left hip abductors, due to superior gluteal nerve injury or wasting of the gluteus medius/minimus

163
Q

What condition predisposes to atypical presentations?

A

Elderly and Diabetes

164
Q

Which LNs does transitional cell carcinoma of the kidney metastasise too?

A

Para-aortic

165
Q

Where do most nosebleeds arise from?

A

Little’s area

166
Q

Mx of PVD

A

Mild: Supervised Exercise programme and modification of RFs
Moderate or severe (ABPI<0.8): Vascular surgery referral

NB: Medical maangement is usually a single antiplatelet agent

167
Q

Normal threshold for blood transfusion? Exception?

A

Under most circumstances, the threshold for blood transfusion is 70 g/L, however, in the context of ACS the threshold rises to 80 g/L

168
Q

widespread concave ST elevation that is usually seen in leads V2-5 with no flu like Sx

A

Think Benign early repolarisation if there is no flu like Sx and pleuritic chest pain to think pericarditis

169
Q

ABx that c auses long QT syndrome

A

Clarithromycin

170
Q

What may constrictive pericarditis present with signs of?

A

Heart failure

171
Q

If a patient with gstro-oesophageal reflux disease has failed to respond adequately to a trial of a PPI, they should begin a trial of?

A

Histamine antagonist - e.g.nizatidine

172
Q

abdominal pain, shock and normal abdominal examination findings

A

Acute mesenteric ischaemia

173
Q

Initial screening test for cushing

A

late night salivary cortisol sample

174
Q

patients with suspected metastatic spinal cord compression initial Mx

A

High dose dex

175
Q

Essential Ix post stroke/TIA

A

ambulatory ECG monitoring, a carotid artery Doppler scan and an echocardiogram.

176
Q

What is pneumoconiosis? Give an example

A

Pneumoconiosis is an umbrella term used to describe interstitial lung disease that occurs secondary to the inhalation of inorganic allergens (e.g. coal dust, asbestos, silica). Asbestosis is a form of pneumoconiosis that specifically occurs following exposure to asbestos

177
Q

IPF Mx

A

Pirfenidone - antifibrotic

178
Q

Abx asx with IPF

A

Nitrofurantoin

179
Q

gold standard investigation for acute diverticulitis

A

Contrast CT abdomen and pelvis

180
Q

first-line imaging modality for patients with suspected gallstone disease

A

US abdo

181
Q

gold standard investigation for ascending cholangitis

A

ERCP

182
Q

four main indications for haemodialysis in the context of acute kidney injury

A

intractable hyperkalaemia, treatment-resistant fluid overload (pulmonary oedema), acidosis and uraemic symptoms (nausea, pruritus, malaise, encephalopathy).

183
Q

What is gangrene?

A

tissue necrosis usually resulting from an inadequate blood supply

184
Q

Whhat is wet gangrene?

A

When necrosed tissue becomes infected, usually has a foul smell due to anaerohes

185
Q

Treatment of gangrene

A

Urgent debridement and IV ABx

186
Q

Difference between acute and subacute bacterial endocarditis

A

Bacterial endocarditis can be described as either acute or subacute. Acute bacterial endocarditis is when previously normal heart valves become damaged by very virulent organisms such as Staphylococcus aureus. Subacute bacterial endocarditis occurs in patients with pre-existing valvular damage (e.g. due to rheumatic heart disease). The abnormal valves provide ground on which less virulent bacteria, such as Streptococcus viridans, can form vegetations.

187
Q

Which artery affected in ischaemic colitis

A

IMA

188
Q

Mx of IBS

A

Pain: Mebeverine hydrochloride is an anticholinergic that has antispasmodic effects on the gastrointestinal tracts.
Constipation: Ispaghula husk is a bulk-forming laxative that is used to treat symptoms of constipation associated with IBS
Diarrhoea: Loperamide

189
Q

What is a convenient test for monitoring patients with NAFLD who are at risk of developing liver fibrosis

A

Enhanced liver fibrosis (ELF)

190
Q

Gold-standard investigation for the diagnosis of chronic pancreatitis

A

CT pancreas

191
Q

Damage to wernicke’s

A

Receptive aphasia, fluent non-sensical speech

192
Q

Damage to Broca’s

A

Productive aphasia, non-comprehensible speech

193
Q

What can be used to reduce the viscosity of sputum?

A

Carbocisteine

194
Q

Criteria for long term oxygen therapy

A

It should be offered to all COPD patients who have stopped smoking and have a resting PaO2 on air of less than 7.3 kPa. It should also be offered to patients with a PaO2 of 7.3-8 kPa if they also have one of either secondary polycythaemia, peripheral oedema or pulmonary hypertension.

195
Q

What other condition can long term oxygen therapy be considered for besides copd

A

IPF, same criteria

196
Q

Ix for perianal abscess

A

MRI

197
Q

Mx of perianal abscess

A

Treatment is usually surgical, with incision and drainage being first line, usually under local anaesthetic. The wound can then either be packed or left open, in which case it will heal in around 3-4 weeks;

Abx may be used adjunct

198
Q

Ottawa ankle rules

A

inability to weight bear immediately after the injury and in A&E, along with tenderness at the lateral malleolus (or posterior edge of fibula) and medial malleolus (or posterior edge of tibia).

199
Q

Best Ix for varicose veins

A

Duplex US scan

200
Q

Surgical Mx for dupuytrens

A

Fasciectomy

201
Q

Describe Schober’s test

A

Schober’s test is a clinical test that is used to help identify patients with ankylosing spondylitis. A mark is made on the skin overlying the L5 spinous process and a second mark is made around 10 cm above the first. The patient is then asked to bend over and touch their toes. If the distance between the lines increases by less than 5 cm, it is considered a positive result (and, hence, suggestive of a significantly reduced range of spinal motion). You would expect to see a positive result in ankylosing spondylitis.

202
Q

first-line management for ankylosing spondylitis is

A

NSAIDs

203
Q

Wasting of thenar eminence

A

Carpal tunnel syndrome

204
Q

What should app patients who are due to undergo PCI be started on?

A

IV unfractionated heparin

205
Q

Bifid p waves aka? seen in?

A

P mitrale, seen in mitral stenosis - sign of left atrial enlargement

206
Q

Beck’s triad of cardiac tamponade. Mx?

A

low blood pressure, muffled heart sounds and raised JVP. Pericardiocentesis

207
Q

Leriche syndrome triad

A

buttock claudication, erectile dysfunction and absent or weak femoral pulses.

208
Q

Where does Leriche syndrome affect?

A

narrowing of the distal aorta and the proximal common iliac arteries (aortic bifurcation)

209
Q

Mx of AVT in asthma

A

Verapamil

210
Q

Common complication of TIPS procedure

A

Hepatic encephalopathy

211
Q

What blood test marker can help distinguish upper and lower GI bleeds

A

Urea

212
Q

heart failure secondary to severe hypertension. Mx?

A

In this circumstance, IV nitrates (e.g. sodium nitroprusside) are the first-line option to reduce blood pressure

213
Q

What anticoagulant should patient with an NSTEMI be started on

A

Fondaparinux

214
Q

first-line treatment option for generalised tonic-clonic seizures, myoclonic seizures and tonic or atonic seizures

A

Sodium valproate

215
Q

Most common cause of COPD exacerbation

A

H.Influenzae

216
Q

What is a good option for patients who have high oxygen requirements and are unable to tolerate NIV?

A

High flow nasal oxygen therapy

217
Q

HER2 positive medication

A

Trastuzumab (herceptin)

218
Q

Indications for bariatric surgery

A

The indications for bariatric surgery on the NHS are a BMI of over 40 kg/m2 or a BMI between 35 and 40 kg/m2 and a significant comorbidity like hypertension or type 2 diabetes, when all other weight loss methods have failed (lifestyle and medical)

219
Q

Ix for carpal tunnel syndrome

A

EMG

220
Q

Important signs in carpal tunnel syndrome

A

The reproduction of symptoms when tapping the flexor retinaculum is describing Tinel’s sign which, alongside Phalen’s sign, is classically associated with carpal tunnel syndrome

221
Q

Pts are at risk of what with nephrotic syndrome

A

VTE

222
Q

What is congestive hepatopathy? How can it present?

A

term used to describe liver dysfunction that occurs in patients with congestive heart failure

Can present with jaundice and enlarged liver on abdo exam. Mx is by treating HF

223
Q

Features of chronic venous insufficiency that may be seen adjunct to venous ulcers

A

varicose veins, lipodermatosclerosis (fibrosis of subcutaneous fat), atrophie blanche and haemosiderin deposition.

224
Q

How to differentiate NSTEMI and unstable angina

A

Raised troponin

225
Q

facial flushing, diarrhoea, palpitations and shortness of breath due to bronchospasm. Dx? Mx?

A

Carcinoid syndrome, It may be managed surgically by excising the tumour or medically with somatostatin analogues (e.g. octreotide).

226
Q

CSF of a patient with tuberculous meningitis is likely to show a

A

raised protein concentration, high lymphocyte count and low glucose concentration.

Typically has a long prodrome of constitutional upset

227
Q

What can recurrent gallstones lead to?

A

Gallstone ileus and therefore SBO due to the formation of a fistua

228
Q

Mx of gallstone induced SBO

A

Enterotomy - incision and removal of gallstone from small bowel

229
Q

distal radius fracture with dorsal displacement of the distal fracture component

A

Colles fracture

230
Q

What abx to be used in women with UTI with renal impairment

A

Trimethoprim

231
Q

What Mx contraindicated in aortic stenosis

A

GTN

232
Q

persistent headache, breast pain and amenorrhoea?

A

Potential prolactinoma

233
Q

What CXR finding is an absolute contraindication to NIV?

A

Pneumothorax

234
Q

Which respiratory failure to use BiPAP and CPAP for

A

CPAP - T1
BiPAP - T2

235
Q

COPD Mx

A

Offer SABA or SAMA to use as needed.

If the patient is limited by symptoms or has frequent exacerbations and:
Has no asthmatic symptoms:
Offer LABA + LAMA
Has asthmatic features or features of steroid responsiveness:
Offer LABA + ICS

Consider LABA + LAMA + ICS

236
Q

Mainstay of treatment for acute mesenteric ischemia

A

Emergency theatre

237
Q

Ix for bowel obstruction

A

CT CAP

238
Q

Mx of perforated peptic ulcer

A

Initially NBM and NG tube

then laparotomy

239
Q

Necrotising fasciitis occurring in the genital, perineal or perianal regions is also known a

A

Fournier’s gangrene

240
Q

For this reason, patients with significant anaemia secondary to their CKD are often prescribed what?

A

EPO injections

241
Q

Test used for sjogrens

A

Schirmers

242
Q

1st line Ix for acute angle closure glaucoma

A

Slit lamp gonioscopy

243
Q

Gold standard Ix for open angle glaucoma

A

Goldman tonometry

244
Q

Mx pathway of non-obstructive renal stones

A

Non-Obstructive Renal Stones

· < 10 mm: Analgesia, reassurance, watch and wait

o If persistent stone/symptoms: offer shock wave lithotripsy

· 10-20 mmc: Ureteroscopy or shock wave lithotripsy

o If treatment failure, can consider percutaneous nephrolithotomy

· > 20 mm: Percutaneous nephrolithotomy

245
Q

Mx pathway of non-obstructive ureteric stones

A

Non-Obstructive Ureteric Stone

· < 10 mm: Analgesia, alpha blockers (e.g. tamsulosin, alfuzosin)

· > 10 mm: Ureteroscopy or shock wave lithotripsy

o Treatment failure: percutaneous nephrolithotomy

246
Q

Surgical options for BPH

A

If the prostate is smaller than 30 g, transurethral incision of the prostate may be considered. However, if the prostate volume is 30-80 g, then a trans-urethreal resection of the prostate (TURP) is indicated.

Trialled if dual medical therapy has failed

247
Q

Examples of definitive airways

A

endotracheal tubes (nasotracheal/orotracheal), tracheotomy and cricothyrotomy

248
Q

Dual antiplatelet therapy following MI with low bleeding risk

A

Aspirin and Ticagrelor

249
Q

Dual antiplatelet therapy following Mi with high bleeding risk

A

Aspirin and Clopidogrel

250
Q

early diastolic decrescendo murmur

A

Aortic regurg

251
Q

pan-systolic murmur, loudest at the axilla on chest auscultation.

A

Mitral regurg

252
Q

ejection-systolic (whooshing sound) murmur, loudest at the carotids on chest auscultation.

A

Aortic stenosis

253
Q

mid-diastolic murmur, with an early opening snap on chest auscultation.

A

Mitral stenosis

254
Q

pan-systolic murmur, loudest at the lower left sternal edge.

A

Tricuspid regurg

255
Q

In patients with ischaemic symptoms, ST depression in leads V1-V4 should raise the suspicion of a>

A

Posterior MI - affects posterior descending artery

256
Q

ECG manifestations of hypokalaemia

A

flattened T waves, U waves, prolonged PR interval and a long QT interval.

257
Q

Bifid p waves on ECG

A

Mitral stenosis

258
Q

bile acid sequestrant that is used in the treatment of cholestatic pruritus.

A

Cholestyramine

259
Q

Management of severe flarew of UC

A

IV steroids

260
Q

Type 1 hepatorenal syndrome

A

Type 1 HRS is characterised by a rapid, progressive impairment in renal function in a patient with advanced liver disease in the absence of another identifiable cause of the renal impairment.

261
Q

Type 2 hepatorenal syndrome

A

more stable and less progressive impairment in renal function in a patient with advanced liver disease in the absence of another identifiable cause of the renal impairment

262
Q

Mx of hepatorenal syndrome

A

human albumin solution and terlipressin

263
Q

1st line Mx in a patient with hypogonadotrophic hypogonadism

A

Testosterone gel daily

264
Q

1st line 1x for neck lump that has normal blood tests

A

US

265
Q

RET oncogene

A

MEN 2A/B

266
Q

Mx of status epilepticus

A

The first-step in the management of status epilepticus is the administration of IV lorazepam 4 mg. If IV access is unavailable, rectal diazepam or buccal midazolam are suitable alternatives. If the seizure has not resolved after another 10 mins, a second dose of lorazepam 4 mg should be given. If this also fails to terminate the seizure, a phenytoin infusion should be started. If this, too, is ineffective, an anaesthetic should initiate general anaesthesia.

267
Q

What examination should be performed in a patient with suspected cauda equina?

A

a digital rectal examination in patients with suspected cauda equina to check for saddle anaesthesia and reduced anal tone. It should be investigated urgently with a whole spine MRI scan.

268
Q

NF 1 Presentation

A

Cafe-au-lait spots (hyperpigmented patches), axillary/groin freckles, phaeochromocytomas and cutaneous neurofibromas

269
Q

NF 2 presentation

A

bilateral vestibular schwannomas, meningiomas and ependyomas.

270
Q

What is Cor Pulmonale? What can cause it?

A

Cor pulmonale is a term used to describe right-sided heart failure that occurs secondary to underlying respiratory disease. Widespread lung disease (e.g. interstitial lung disease) causes vasoconstriction of the pulmonary blood vessels resulting in an increase in pulmonary artery pressure and, hence, right ventricular pressures. This leads to right heart failure which manifests with peripheral oedema.

271
Q

Common SE of salbutamol

A

Tachycardia and increased lactate

272
Q

Mx of large breast cyst causing discomfort

A

FNA

273
Q

Mx of intraductal papilloma

A

Wide local excision

274
Q

Presentation of intraductal papilloma

A

lump behind the nipple with blood-stained nipple discharge

NOT MALIGNANT but need to undergo triple assessment before diagnosis

275
Q

forearm and lateral elbow pain due to overuse.

A

Lateral epicondylitis or ‘Tennis elbow’

276
Q

forearm and medial elbow pain due to overuse of the flexor muscles of the forearm.

A

Medial epicondylitis or ‘Golfer’s elbow’

277
Q

evere pain that is out of proportion with the appearance of the affected limb. The pain is exacerbated by passive movement

A

Compartment syndrome

278
Q

Ix for compartment syndrome

A

Clinical diagnosis

Can use compartmental needle manometry to aid Mx

urgent fasciotomy in those with an absolute pressure > 40 mm Hg or a difference of < 30 mm Hg between the compartment and diastolic blood pressure.

279
Q

Bilateral symptoms of blurred vision, glare and washed-out colour vision

A

Cataracts

280
Q

first-line treatment for open angle glaucoma

A

Topical latanoprost

281
Q

Ix for hydrocele

A

Urgent US

282
Q

old-standard investigation for a suspected urinary tract calculus

A

Non contrast CT KUB

283
Q

SE of susxamethonium

A

Malignant hyperthermia - give dantrolene
Apnoea - propofol and ventilate

Monitor cholinesterase

284
Q

What Ix should all patients with ACS undergo prior to discharge?

A

Echocardiogram - assess ventricular function and determine whether they have developed a degree of heart failure

285
Q

Important Ix after pacemaker insertion

A

CXR to check for pneumothorax and correct positioning

286
Q

What type of vitamin D should be supplements in chronic CKD

A

Alfacalcidol (has already been activated)

287
Q

pANCA AKA

A

Anti-myeloperoxidase (anti-MPO)

288
Q

symmetrical, bilateral ground-glass opacities and traction bronchiectasis

A

Non-specific interstitial pneumonia (NSIP) is a pattern of interstitial lung disease

289
Q

What are both serum markers of right heart strain in the context of an acute PE

A

Raised troponin and BNP, requires thrombolysis

290
Q

grading of haemorrhoids and Mx

A

● Grade I: Do not protrude/prolapse outside the anal canal but may bleed

● Grade II: Protrude/prolapse with defecation but reduce spontaneously

● Grade III: Protrude/prolapse with defecation. Do not reduce spontaneously but can be reduced manually

● Grade IV: Permanent protrusion/prolapse which cannot be reduced manually

2/3 - rubber band ligation is first line
4 - surgical haemorrhoidectomy

291
Q

Mx of rectal prolapse

A

REctopexy

292
Q

Best Ix for toxic megacolon

A

CT CAP

293
Q

most common cause of TIAs

A

carotid artery atherosclerosis

294
Q

deranged U&E in the context of acute urinary retention which is highly suggestive of

A

hydronephrosis and a post-renal AKI. In this case, an ultrasound should be performed to check for hydronephrosis. If this remains untreated, it can lead to chronic kidney damage.

295
Q

1st line mx of prolactinoma

A

Cabergoline, then TSS

296
Q

Main complication of chest drain removal? How can this risk be reducved?

A

main complication with chest drain removal is the risk of causing a pneumothorax if air were to leak into the pleural space. This risk can be reduced by asking the patient to perform the valsalva manoeuvre - this raises the intrathoracic pressure and reduces the risk of air from the atmosphere entering the pleural space during removal of the chest drain.

297
Q

Yellow nail syndrome triad

A

pleural effusion, lymphoedema and yellow nails

298
Q

Migratory consolidation on CXR with flu-like illness

A

Cryptogenic organising pneumonia

299
Q

Triple assessment scan

A

US scan if <35
Mammogram if >35

300
Q

What type of additional Ix van be done for haemorrhoids if DRE is inconclusive

A

Proctoscopy

301
Q

1st line Ix for females with ?appendicitis

A

US abdo

302
Q

Mx of warfarin in patients undergoing major surgical procedures

A

Due to the long half-life of warfarin, patients undergoing major surgical procedures must stop warfarin at least 5 days before surgery to reduce the risk of major bleeding in the perioperative period. Surgical patients with active cancer are also, however, at high risk of developing thromboembolic disease so should receive an alternative form of anticoagulation (usually low-molecular weight heparin).

303
Q

Important Ix in mx of diverticulitis

A

CT CAP

304
Q

Differentials for sudden loss of vision

A

Central Retinal Vein Occlusion:
Retinal haemorrhages
Widespread through all quadrants

Branch Retinal Vein Occlusion:
Retinal haemorrhage confined to one quadrant

Central Retinal Artery Occlusion:
Cherry red spot (dark spot on pale retina)

Vitreous Haemorrhage:
Dark spots in visual field
Red hue in vision
Associated with floaters without pain

Retinal Detachment:
Associated with flashing lights and floaters

305
Q

Most common cause of nephrotic syndrome seen in adults? What condition is it often associated with?

A

FSGS, HIV

306
Q

Alternative to haemodialysis in criticaill ill patients

A

Haemofiltration, less likely to cause haemodynamic instability

307
Q

Initial and best Ix for SBO

A

Initial - abdo x ray
Best - CT CAP with contrast

308
Q

slurred upstroke (delta wave) of the QRS complex, the broad QRS complex and short PR interval

A

WPW

309
Q

Quincke’s sign

A

Nail bed pulsation

310
Q

De Musset’s sign

A

Head bobbing

311
Q

What bacteria is asx with colorectal cancer

A

Strep bovis

312
Q

Alternative to PEG feeding in patietns who have HF or can’t tolerate endoscopy

A

Radiologicaloly inserted gastrostomy (RIG)

313
Q

What varices can cirrhosis result in?

A

oesophageal varices, rectal varices, caput medusae and splenomegaly.

314
Q

Causes of SAAG less than 11

A

The causes of a SAAG that is less than 11 g/L are usually exudative (e.g. infection, pancreatitis, peritoneal metastases)

315
Q

Causes of SAAF greater than 11

A

causes of a SAAG greater than 11 g/L are generally transudative (e.g. cirrhosis, heart failure).

NOTE: Nephrotic syndrome is an exception to this rule because it gives rise to a low SAAG due to the loss of albumin in the urine (thereby resulting in a low serum albumin concentration).

316
Q

What are patients with frequent comiting or poor oral intake at risk of?

A

Starvation ketosis

Managed wth IC fluids and antiemetics

317
Q

How big increments should you increase levothyroxine dose in

A

25 micrograms

318
Q

XRay findings of vit d deficiency

A

Looser’s zones - transverse lucencies with sclerotic borders that traverse part of the way through a bone and is perpendicular to the cortex. The pubic rami are commonly affected and they are sometimes referred to as ‘pseudofractures’.

319
Q

1st line treatment of Parkinson’s

A

Co-careldopa is a combination of levodopa and a DOPA-decarboxylase inhibitor (carbidopa). It is often used as the first-line treatment in Parkinson’s disease.

320
Q

Mx of patients with an infective exacerbation of COPD

A

oxygen, nebulisers (salbutamol and ipratropium bromide), antibiotics (e.g. doxycycline) and steroids (usually prednisolone)

321
Q

Useful marker of chronic CO2 retainers

A

Bicarbonate

322
Q

Bulk forming laxative example

A

Ispaghula husk

323
Q

hest X-ray reveals a gastric air bubble above the diaphragm

A

Hiatus hernia

Managed with nissen fundoplication

324
Q

restriction of both active and passive movement, especially in flexion and external rotation.

A

Adhesive capsulitis

325
Q

What can stanford type A dissection lead to?

A

Cardiac tamponade

326
Q

Mx of SBO

A

Non-surgical treatments preferred, except when lactate is high - then emergencfy surgery

Gastrografin is preferred non-surgical management

327
Q

What additional heart sound is heard in diastolic cardiomyopathy? What often causes it

A

S3, chronic alcohol excess

328
Q

What medication should be avoided in acute heart failure but is used in the management of chronic heart failure

A

Beta blocker

329
Q

echocardiogram findings in mitral regurg

A

dilated left atrium

330
Q

Chronic mestenteric ischaemia is caused by narrowing of which artery

A

Superior mestenteric artery

NOTE: Inferior mesenteric artery leads to ischaemic colitis

331
Q

Anatomy of adrenal gland

A

Adrenal cortex:
Zona Glomerulosa (outermost) → Aldosterone
Zona Fasciculata (middle) → Cortisol
Zona Reticularis (innermost) → Androgens

The adrenal medulla produces catecholamines such as adrenaline and noradrenaline.

332
Q

cardinal symptoms of Parkinson’s disease are

A

bradykinesia, rigidity, tremor and postural instability

333
Q

Unique cause of viral meningitis. Presents with low CSF glucose

A

Mumps

334
Q

Mx of perforated peptic ulcer

A

Laparaqtomy

335
Q

Describe the trendelenberg test

A

The Trendelenberg test assesses the strength of gluteus medius and minimus – the abductors of the thigh. When standing on one leg, the abductors of the weight-bearing leg contract to keep the pelvis level. If the abductors are weak or there is a nerve injury then the pelvis will slump towards the weight-bearing side when the patient stands on one leg. The abductors are supplied by the superior gluteal nerve, hence this patient must have a lesion of the left superior gluteal nerve

336
Q

Indications for carotid endartectomy in patients with recent TIA

A

symptomatic patients (i.e. TIA affecting the hemisphere supplied by the stenosed carotid artery) with 50-99% stenosis of the common or internal carotid artery on ultrasound should be admitted for further imaging and urgent consideration for carotid endarterectomy

337
Q

Indications for rapid sequence induction

A

The main indications for RSI are:

Insufficient fasting (e.g. in emergencies)
Inability to protect own airway before administration of anaesthesia (e.g. intracranial injury)
Abdominal pathology (e.g. obstruction or GORD)
Delayed gastric emptying (e.g. opioids)
Pregnancy

338
Q

Mx of bowel obstruction due to complicated malignancy with widespread mets

A

Defunctioning colostomy

339
Q

What can be done to manage hypercapnic patients>

A

Increase minute ventilation. This can be achieved by either increasing the respiratory rate or the tidal volume.

Minute Ventilation = Tidal Volume x Respiratory Rate

Finals - Things to Go Over (6 decks)

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