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YEAR 6: PACES > Medicine 11 > Flashcards

Medicine 11 Flashcards

1
Q

List some causes of bloody diarrhoea.

A

Vascular: ischaemic colitis
Infective: shigella, salmonella, E. coli, C. difficile
Inflammatory bowel disease
Neoplastic: colorectal cancer, polyps

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2
Q

List the different types of laxative with examples.

A 
Bulking: fybogel, methylcellulose
Osmotic: movicol, lactulose 
Stimulant: senna, bisacodyl, docusate sodium, sodium picosulphate, co-danthramer
Softeners: liquid paraffin
Enemas: phosphate (osmotic) 
Suppositories: glycerol (stimulant)
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3
Q

Outline the management options for achalasia.

A

Medical: CCBs, nitrates
Interventional: endoscopic balloon dilatation, botulinum toxin injection
Surgical: Heller cardiomyotomy

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4
Q

Outline the management of new-onset dyspepsia.

A

OGD if > 55 years and red flags (anorexia, weight loss, anaemia, recent onset, melaena, dysphagia)
Conservative measures for 4 weeks
- stop drugs (NSAIDs, CCB)
- lose weight, stop smoking, reduce alcohol
- OTC antacids and alginates
Test H. pylori if no improvement (breath or serology)
- positive –> eradication
- negative –> PPI for 4 weeks, consider OGD if no improvement

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5
Q

Describe the eradication therapy used to treat H. pylori.

A

Lansoprazole 30 mg BD + amoxicillin 1 g BD + clarithromycin 500 mg BD

Lansoprazole 30 mg BD + amoxicillin 1 g BD + metronidazole 400 mg BD

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6
Q

Outline the management of peptic ulcer disease.

A

CONSERVATIVE: lose weight, stop smoking, reduce alcohol, stop NSAIDs/steroids
MEDICAL: OTC antacids, H. pylori eradication, PPI/H2RA
SURGERY: vagotomy, antrectomy, subtotal gastrectomy

NOTE: antrum contains most gastrin-producing cells (types of operation: BIlroth 1 and 2)

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7
Q

List some causes of cirrhosis.

A 
Alcoholic liver disease 
Viral hepatitis 
NASH
Genetic: Wilson's, HH, a1AT 
Autoimmune: PSC, PBC, AIH 
Drugs: methotrexate, amiodarone, nitrofurantoin 
Neoplasia: HCC, metastases 
Vascular: Budd-Chiari, right heart failure, constrictive pericarditis
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8
Q

Outline the management of cirrhosis.

A

Alcohol abstinence
Cholestyramine for pruritus
Screening (HCC and varices)
Treat cause (interferon for HCV, ursodeoxycholic acid for PBC or penicillamine for Wilson’s disease)

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9
Q

List some causes of portal hypertension.

A

Pre-hepatic: portal vein thrombosis
Hepatic: CIRRHOSIS, schistosomiasis, sarcoidosis
Post-hepatic: Budd-Chiari, RHF, constrictive pericarditis

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10
Q

List some precipitants for decompensation of chronic liver failure.

A 
Haemorrhage (e.g. varices) 
Electrolyte abnormality (e.g. hypokalaemia)
Alcohol
HCC 
Infection (SBP, pneumonia, UTI)
Constipation (MOST COMMON cause)
Hypoglycaemia 
Drugs (e.g. sedatives, anaesthetics)
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11
Q

Which infections should patients be screened for before starting dialysis?

A

Hep B
Hep C
HIV

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12
Q

What is a key distinction between bullous pemphigoid and pemphigus vulgaris?

A 
Pemphigus = oral involvement 
Pemphigoid = NO oral involvement
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13
Q 
Define the following terms used to describe skin lesions.
Macule 
Nodule 
Papule 
Plaque
Vesicle
A

Macule - change in skin colour without change in elevation (called a patch if > 1 cm)
Nodule - raised lesion with a rounded surface > 1 cm
Papule - solid raised lesion < 1 cm in diameter
Plaque - elevated plateau of skin > 1 cm
Vesicle - fluid-filled lesion < 1 cm

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14
Q

Describe the criteria by which left ventricular hypertrophy by voltage criteria?

A

Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is > 35 mm, then LVH is present

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15
Q

List some complciations of peptic ulcer disease.

A

Bleeding (haematemesis/melaenia)
Iron deficiency anaemia
Perforation and peritonitis
Malignancy

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16
Q

Which red flag symptoms would warrant an OGD in patients with suspected peptic ulcer disease?

A

Anaemia
Weight loss
Dysphagia

NOTE: if no red flags and < 55 years, investigate with H. pylori breath test, stool antigen test and bloods (FBC)

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17
Q

List some surgical management options for urinary tract calculi.

A

Extracorporeal shockwave lithotripsy (small stone < 20 mm)
JJ stent (hydronephrosis)
Ureteroscopy and laster/fragmentation (proximal stone)
Percutaneous nephrolithotomy/ureterolithotom (large stone > 20 mm)

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18
Q

Which medications are used to treat hepatitis C?

A

Pegylated interferon
Ribavirin
Boceprevir (protease inhibitor)
Sofosbuvir (NS5B inhibitor)

NOTE: all patients should be investigated to identify their HCV genotype

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19
Q

What treatment options are used for diabetic retinopathy with maculopathy and proliferative diabetic retinopathy?

A

With maculopathy - intravitreal anti-VEGF injections
Proliferative - panretinal photocoagulation

NOTE: you can’t use photocoagulation on the macula because it will impair vision

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20
Q

How is post-operative atelectasis treated?

A

Salbutamol nebulisers
Chest physiotherapy

NOTE: incentive spirometers are used to prevent atelectasis

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21
Q

Outline the treatment options for plaque psoriasis.

A

Avoid precipitants (alcohol, smoking, stress)
Emollients
Steroids - FIRST LINE
Vitamin D analogues (calcipotrol) - FIRST LINE
Coal tar
Dithranol
Phototherapy (PUVA)
Systemic (ciclosporin, methotrexate, retinoids and biologics (infliximab, etanercep))

NOTE: for PUVA, psoralens are either applied or given orally and then a UV lamp is shone over the affected skin

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22
Q

Outline the steps in the pharmacological management of COPD.

A

STEP 1: SABA

STEP 2 (steroid responsive): LABA + ICS
STEP 3 (steroid responsive): LABA + ICS + LAMA
STEP 2 (steroid non-responsive): LABA + LAMA 
Use combo inhalers where possible

NOTE: conservative management includes stopping smoking, annual influenza and one-off pneumococcus vaccine, pulmonary rehab

23
Q

Which causes of interstitial lung disease may respond to steroid treatment?

A

Sarcoidosis
Connective tissue diseases (e.g. rheumatoid arthritis)
Extrinsic allergic alveolitis

24
Q

List some advantages and disadvantages of peritoneal dialysis.

A

PROS: simple to perform, can be done at home, less haemodynamic instability (good if cardiovascular disease)
CONS: body image, peritonitis, weight gain, exit site infection

25
Q

List some pros and cons of Tesio lines.

A

PROS: well concealed (unliked fistula), can be used straight away
CONS: increased infections risk, lower flow rates, adverse events on insertion (pneumothorax, line infection, retraction)

26
Q

Outline the aspects of managing chronic kidney disease.

A

General: correct reversible causes, stop nephrotoxic drugs, phosphate restriction
Hypertension: ACE inhibitor
Oedema: frusemide
Bone disease: phosphate binders, calcichew, vitamin D analogues
Anaemia: EPO

27
Q

Outline the criteria for diagnosing DKA.

A

Glucose > 11
Ketones > 3
pH < 7.3
Bicarbonate < 15

28
Q

Which infection is associated with tonsillar squamous cell carcinoma?

A

HPV

29
Q

How should a patient on oral morphine with inadequate pain control have their dose changed?

A

Divide total daily dose by 2 (give you BD dose of oral morphine)
1/6 of the BD dose is the breakthrough dose

E.g. inadequate control with 30 mg BD + 10 mg PRN (used 3 times) = 90 mg per day –> 45 mg BD + 15 mg PRN

30
Q

Which investigation can be used to explore the extent of skin involvement in vitiligo

A

Woods lamp inspection

Areas of hyper and hypopigmentation will fluoresce (e.g. vitiligo, pityriasis versicolor, tinea capitis)

31
Q

Which medication is usually used first-line for patients with SLE primarily affecting the skin and joints?

A

Hydroxychloroquine

32
Q

How does urine sodium help you assess fluid status?

A

< 20 mmol/L = hypovolemia

> 40 mmol/L = SIADH

33
Q

Define cranial nerve.

A

Nerves that emerge directly from the brain (not the spinal cord)

34
Q

Which cranial nerve supplies a contralateral innervation as opposed to an ipsilateral innervation?

A

Trochlear - it crosses the midline before innervating the contralateral superior oblique

NOTE: all cranial nerves are considered peripheral nerves

35
Q

List some the components of a falls screen.

A 
Bloods (FBC, U&E, CRP)
Glucose 
ECG 
Urinalysis 
Lying-standing BP
36
Q

Describe the mechanisms responsible for the following types of transfusion reaction:
Febrile non-haemolytic
Haemolytic
Allergic
Transfusion-related acute lung injury
Transfusion-associated circulation overload

A

Febrile non-haemolytic: host antibodies against donor leucocyte antigens/pre-formed cytokines within donor plasma
Haemolytic: host antibodies against donor RBC antigens
Allergic: allergic reaction to plasma proteins
Transfusion-related acute lung injury: activation of donated leucocytes in the lungs
Transfusion-associated circulation overload: rapid volume expansion

37
Q

Which nerves innervate the lower limbs?

A

Femoral (L2-4)
Obturator (L2-4)
Sciatic (L3-S3)

38
Q

Under which conditions in DKA do you avoid giving K+ supplementation with the fluids?

A

Anuria

K+ > 5.5 mmol/L

39
Q

List some risk factors for falls in the elderly.

A 
Muscle weakness 
Gait abnormalities 
Visual impairment 
Postural hypotension 
Arthritis 
Cognitive impairment 
Drugs (e.g. antihypertensives, sedative, anti-arrhythmics)
40
Q

What are the main features of Yellow Nail Syndrome?

A

Yellow nails
Lymphoedema
Pleural effusion
Bronchiectasis

41
Q

What are the main features of anterior cord syndrome?

A

Motor paralysis at the level of the lesion
Loss of pain/temp at and below the level of the lesion
Normal fine touch/proprioception (dorsal columns are fine)
Autonomic dysfunction (hypotension)
Areflexia
Flaccid anal sphincter
Urinary retention

NOTE: caused by anterior spinal artery infarction

42
Q

List some differentials for Marfan syndrome.

A

Ehlers-Danlos syndrome
Pseudoxanthoma elasticum
Homocystinuria

43
Q

What are the main aspects of managing non-alcoholic fatty liver disease?

A 
Weight loss (aim for 10% over 6 months)
Good diabetes control 
Good cholesterol control
Hepatitis immunisations 
Alcohol abstinence
44
Q

List some different types of long and short-acting insulin.

A

LONG: glargine (lantus), detemir (levemir), degludec (tresiba)
Short: actrapid, lispro (humolog), aspart (novolog), glulisine

45
Q

What is pulsus paradoxus?

A

> 10 mm Hg drop in systolic blood pressure with inspiration
Associated with pericarditis and pericardial effusion
Interpreted as a sign of impending circulatory collapse due to tamponade

46
Q

In which circumstance would a DPPIV inhibitor be considered a better second-line agent than a sulphonylurea?

A

Overweight patients - sulphonylureas cause weight gain

47
Q

State the origin of each cranial nerve.

A 
Cerebrum: I and II
Midbrain: IV
Midbrain-Pontine Junction: III
Pons - V 
Pontine-Medulla Junction: VI, VII, VIII
Medulla: IX, X, XI, XII
48
Q

Outline the steps in the management of asthma.

A 
STEP 1: SABA
STEP 2: SABA + ICS
STEP 3: SABA + ICS + LTRA 
STEP 4: SABA + ICS + LABA 
STEP 5: Switch ICS/LABA to MART (continue SABA +/- LTRA)
STEP 6: Increase to moderate-dose ICS
49
Q

Damage to which part of the brain causes apraxia?

A

Posterior parietal lobe

50
Q

What are the main features of digoxin toxicity?

A 
Nausea
Diarrhoea 
Confusion 
Bradycardia
Hyperkalaemia

WARNING: AKI can lead to digoxin toxicity

51
Q

List some causes of bulbar palsy.

A 
Brainstem stroke 
Brainstem tumours 
Syringomyelia 
MND
Neurosyphylis
Poliomyelitis
GBS

NOTE: investigation include MRI, serology and CSF analysis

52
Q

Which nerves pass through the cavernous sinus?

A 
III
IV
V (1 and 2)
VI
Internal carotid artery
53
Q

List some examples of seronegative spondyloarthitides.

A

Ankylosing spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis

YEAR 6: PACES (22 decks)

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