Medicine Flashcards by Jack Bocock

Which test is used to confirm Cushing’s disease over Cushing syndrome

High-dose dexamethasone suppression test

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Which tests should be used to monitor treatment in haemochromatosis

Ferritin (measure of total iron stores) and transferrin (measures how much serum iron is bound to protein in blood)

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First line test for acromegaly

Serum IGF-1 levels

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Features of pernicious anaemia

Dyspnoea and fatigue
Lemon tinge to skin (haemolysis)
sensory loss
Glossitis

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Atorvastatin dose for primary and secondary prevention

20 mg primary and 80 mg secondary

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Asthmatic features that suggest steroid responsiveness in COPD

hx of asthma
high blood eosinophil count
substantial variation in FEV1 over time (at least 400ml)
substantial diurnal variation in peak flow (at least 20%)

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First line bronchodilator in COPD managment

Short acting beta-2 agonist or short acting muscarinic antagonist (e.g. ipatroprium)

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According to NICE guidlines what treatment is recommended in step 3 of asthma management

SABA + low dose ICS + Leukotriene receptor antagonist (LTRA)

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According to NICE guidelines what treatment is recommended in step 4 of asthma management

LABA

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types of thyroid cancer in order of prevalence

Papillary
Follicular
Medullary (calcitonin)
Anakastic

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In an asymptomatic patient what are the cut off levels of blood glucose for diabetes diagnosis

Fasting blood glucose 7.0 mmol/l and above

Random glucose than or equal to 11.1 mmol/l (on two occasions)

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Management of stable angina

Aspirin and statin
Sublingual GTN for symptom relief
Either beta blocker or rate limiting CCB (nonDHP) such as Diltiazem or verapamil
Consider combination (using DHP CCB)
Consider long acting nitrate such as isosorbide mono-nitrate

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Initial management of anaemia in CKD

correct iron deficiency before starting erythropoiesis

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Third line intervention for poorely controlled hypertension

addition of thiazide like diuretic such as chlortalidone or indapamide

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factors that indicate need for needle aspiration in pneumothorax

either shortness f breath or 2cm rim of air

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Management of life threatening C. Diff infection

ORAL vancomycin and IV metronidazole

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Visual field defect in temporal lobe lesion

Superior homonymous quadrantanopia

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visual field defect in pituitary adenoma vs craniopharyngioma

pituitary –> upper quadrant (bitemporal)

craniopharyngioma –> inferior quadrant

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Painful skin rash and dry cough

sarcoidosis

erythema nordosum

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What are the 3 features of a Total anterior circulation stroke

Unilateral Weakness
Homonymous hemianopia
Higher cerebral dysfunction (dysphagia, visuospatial disorder)

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What is the criteria for a Posterior circulation stroke

one of:

Cranial nerve palsy and contralateral motor/sensory deficit
bilateral motor sensory deficit
conjugate eye movement (e.g. gaze palsy)
cerebellar dysfunction (ataxia, nystagmus, vertigo)
isolated hemianopia or cortical blindness

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Chest pain, relieved sitting forward and saddle-shaped ST elevation on ECG

pericarditis

Causes of pericarditis

Viral
Autoimmune inc. RA
Malignancy
Post MI
Medication

Imaging modality for acoustic neuroma

MRI of cerebellopontine angle

Preferred NOAC for patients renal impairment

Apixaban

Potentially toxic dose of paracetamol

>9500 mg (150 mg/kg * 60kg) | value above this start acetylcysteine immediately

Laboratory test for SLE with high sensitivity

ANA

Laboratory test for SLE with high specificity

anti-dsDNA and anti-Smith

Management for idiopathic intracranial hypertension

- Weight loss - Acetazolamide - Topiramate - Repeated LP

Secondary prevention for stroke

- Clopidogrel (aspirin = modified release dipyramidole if not tolerated) - High intensity statin

Antibodies for pernicious anaemia

Intrinsic factor antibodies (higher specificity than gastric parietal cell antibodies)

Inducing remission in acute Crohn's

IV hydrocortisone

Antithrombin treatment in MI

Fondaparinux should be offered to patients not at high risk of bleeding who are not having angiography immediately if immediate angiography or creatinine >265, then unfractionated heparin

suitable medication for use in palliative care for nausea and vomiting due to gastric dysmotility and stasis

Domperidone | metochlopramide

Most common cause of viral meningitis

Enteroviruses most common being Coxsackie B

Indicators of negative fluid balance

Hypotension Tachycardia Oliguria Sunken eyes and reduced skin turgor

Indicators of over-filled fluid balance

ascites, crackles, tachypnoea and elevated jvp

Management of ischaemic stroke and secondary prevention

``` Aspirin 300mg 2 weeks then convert to clopidogrel Statin (after 48hrs) Anticoagulation if AF (after 14 days) Maintain blood glucose between 4-11 Permissive hypertension ```

Most specific antibodies for limited cutaneous systemic sclerosis

anti-centromere antibodies

Ankylosing spondylitis x-ray findings

subchondral erosions and sclerosis of sacroiliac joints Squaring of lumbar vertebrae 'bamboo spine'

Why are allopurinol and azathioprine contraindicated together

causes bone marrow suppression | allopurinol = xanthine oxidase inhibitor therefore reducing the metabolism of active azathioprine

cardiac effects of anticholinergics

muscarinic blockade of vagal tone leading to tachycardia

Skin disorder associated with coeliac disease

Dermatitis Herpatiformis

Skin disorders associated with IBD

``` Eruthema nodosum Pyoderma gangrenosum (UC) ```

Skin changes seen in lupus

Butterfly/malar rash Livedo reticulatis Discoid rash Photosensitivity

MOA for LMWH

Low molecular weight heparin (LMWH) is an anticoagulant injected subcutaneously or intravenously and acts via activation of antithrombin III which in turn inactivates thrombin and factor Xa to produce its effect

Drugs that cause SIADH

``` SSRIs and tricyclics PPIs carbamazepine vincristine cyclophosphamide ```

Drugs that alter colour vision

Digoxin | Ethambutol

Clinical test used in neurology, patient is asker to close their eyes while standing

In the Romberg test, the standing patient is asked to close their eyes. An increased loss of balance is interpreted as a positive Romberg's test. The Romberg test is a test of the body's sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord

Clinical test ised to assess strength of hip abductor muscles

Trendelenburg

Nehrotic syndrome features

Nephrotic syndrome is defined by a triad of clinical features: oedema, substantial proteinuria (> 3.5 g/24 hours) and hypoalbuminaemia (< 30 g/L). It is often associated with hyperlipidaemia, thromboembolism and an increased risk of infection

Features of nephritic syndrome

Blood in the urine (urine appears dark, tea-colored, or cloudy) Decreased urine output (little or no urine may be produced) Swelling of the face, eye socket, legs, arms, hands, feet, abdomen, or other areas. High blood pressure.

First line managment of acute pericarditis

Combination of NSAIDs ans colchicine