May Flashcards
Klebsiella penumoniae is what type of bacteria?
Gram negative rod
Normal gut flora
Features of klebsiella pneumonia
Adults - alcoholics, diabetics Red currant jelly sputum Cavitating upper lobe pneumonia Common after aspiration Lung abscess and empyaema
Features of Kartagener’s syndrome
Quiet heart sounds
Dextrocardia
Recurring chest infections, sinusitis, bronchiectasis
Subfertility
Differentiate kartagener’s syndrome from Cystic fibrosis
Sweat test positive for CF
When does carcinoid syndrome commonly occur?
In liver metastases - release of serotonin
Or lung carcinoid
Features of carcinoid syndrome
Flushing Abdominal discomfort diarrhoea bronchospasm hypotension Right valvular stenosis ACTH and GHRH giving Cushings syndrome Pellagra
Investigations for carcinoid syndrome
Urinary 5-HIAA
Plasma chromogranin A y
Management of carcinoid syndrome
Octreotide - somatostatin analogue
Cyproheptadine to help diarrhoea
Features of steroid responsiveness
Any previous, secure diagnosis of asthma or of atopy
A higher blood eosinophil count
Substantial variation of FEV1 over time (at least 400ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)
Iron study profile for haemochromatosis
Raised transferrin saturation
Raised ferritin
Low TIBC
Drugs causing pulmonary fibrosis
bleomycin, cyclophosphamide, nitrofurantoin, methotrexate and penicillamine
Amiodarone
Adverse effects of atorvastatin
Myopathy
Liver impairment
Adverse effects of trimethoprim
Myelosuppression
Neural tube defects
What conditions are treated by hydroxychloroquine?
SLE and rheumatoid arthritis
Adverse effects of hydroxychloroquine
Visual disturbances
Mechanism of ciclosporin
Inhibits calcineurin causing immunosuppression
Adverse effects of ciclosporin
Gum hypertrophy
Nephrotoxicity
Hepatotoxicity
Symptoms of pericarditis
chest pain: may be pleuritic. Is often relieved by sitting forwards
other symptoms include non-productive cough, dyspnoea and flu-like symptoms
pericardial rub
tachypnoea
tachycardia
Cause of pericarditis
Viral infection - Coxsackie Tuberculosis Uraemia Trauma Post MI, Dresslers Connective tissue disease Hypothyroid Malignancy
Risk factor for pericarditis
Systemic Lupus erythematosus
Treatment for pericarditis
Treat underlying cause
NSAIDs
Colchicine
Diagnosis: cholestatic jaundice raised IgM and positive anti-mitochondrial antibodies
Primary Biliary cholangitis
Treatment for primary biliary cholangitis
Ursodeoxycholic acid
Adverse effects of thiazide diuretic - bendroflumethiazide
hypercalcaemia, as well as hyponatraemia, hypokalaemia and hypomagnesaemia.
Features of hypercalcaemia
Stones Bones Groans Thrones Tones Psychiatric Moans
Causes of Upper Zone Fibrosis
Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis
CHARTS
Which other structural abnormality is associated with coarctation of the aorta?
Bicuspid aortic valve
Systolic murmur - heard under left scapula
First line treatment for Allergic Bronchopulmonary Aspergillosis in CF?
Prednisolone
2nd line - antifungal
Term given to multiple large, round, well-circumscribed masses in both lungs seen on Chest X-ray and condition
Cannonball metastases
Renal cell carcinoma
Can be choriocarcinoma or prostate but less common
Diagnosis- painful rash on shins and cough
Sarcoidosis
Features of sarcoidosis
acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
skin: lupus pernio
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)
Which condition is most commonly associated with HOCM and can be demonstrated on ECG?
Wolff Parkinson White
Features of autonomic neuropathy
- Postural hypotension
- Loss of respiratory arrhythmia
- Erectile dysfunction
Condition associated with autonomic neuropathy
Type 2 diabetes
Neuropathy associated with Vitamin B12 deficiency
Sensory neuropathy
Neuropathy associated with botulism and lead poisoning
Motor
Predisposing factors for sleep apnoea
Obesity
Macroglossia - acromegaly, hypothyroidism, amyloidosis
large tonsils
Marfan’s
Symptoms and consequence of sleep apnoea
Daytime somnolence
Compensated respiratory acidosis
Hypertension
Assessment of sleep apnoea
Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)
Diagnostic tests for sleep apnoea
Sleep studies - polysomnography
What is measured in sleep studies?
EEG, respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry
Management of sleep apnoea
Weight loss
Continuous Positive Airway Pressure
Which antibiotics increase risk of tendonitis?
Fluoroquinolones - ciprofloxacin
First line treatment for back pain?
NSAIDs - naproxen
Features of carpal tunnel
pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night
What nerve is compressed in carpal tunnel?
Median
Causes of carpal tunnel
ARMPIT Acromegaly Rheumatoid Arthritis Myxoedema (hypothyroidism) Pregnancy Idiopathic Trauma
Examination findings in carpal tunnel
Weakness of thumb abduction
Wasting of thenar eminence
Tinels sign
Phalens sign
What is tinel’s test and how is it interpreted?
Tapping over the wrist causes paraesthesia - positive - carpal tunnel
What is Phalen’s sign?
Full flexion of wrists - prayer sign - causes symptoms of carpal tunnel
Management of carpal tunnel
corticosteroid injection wrist splints at night surgical decompression (flexor retinaculum division)
Which pathogen is associated with malaria and homozygous sickle cell disease?
Non typhi salmonella
What event is an anterior shoulder dislocation most commonly associated iwth?
FOOSH
Fall onto Outstretched Hand
Most common causative organism of osteomyelitis
Staph aureus
Back pain relieved by sitting and leaning forward
Spinal stenosis
what tests are required before starting a prescription of amiodarone?
TFT, LFT, U&Es, CXR
Next step in adult with episodic wheezing and SOB, normal spirometry
Adults with suspected asthma should have both a FeNO test and spirometry with reversibility
Aspiration pneumonia is more common on which sideR
Right
Management of recurrent pleural effusion
recurrent aspiration
pleurodesis
indwelling pleural catheter
drug management to alleviate symptoms e.g. opioids to relieve dyspnoea
Side effect of PPIs- omeprazole
hyponatraemia
Most common presenting group with Primary Biliary Cholangitis
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
Which medication should be avoided in VT?
Verapamil
Tests required before commencing treatment with arithromycin
ECG
LFTs`
Clear chest and acute onset shortness of breath - diagnosis
Pulmonary embolism
