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medicine Flashcards

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1
Q

Budd Chiari - triad?

A

Hepatic vein thrombosis - sudden onset abdominal pain, ascites, and tender hepatomegaly

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2
Q

Child-Pugh classification - used for? elements?

A

Cirrhosis severity -
Bilirubin
Albumin
Prothrombin time
Encephalopathy
Ascites

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3
Q

High-output heart failure - causes?

A

2Ps, 2As, 2Ts

Pregnancy and Pagets
Anaemia and arteriovenous malformation
Thyrotoxicosis and thiamine (wet beri-beri)

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4
Q

Symptoms of normal pressure hydrocephalus?

A

Incontinence (“wet”), gait instability (“wobbly”), and cognitive changes (“wacky”)

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5
Q

Pro-kinetic anti-emetic?

A

Metoclopramide

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6
Q

ECG features of hypokalaemia?

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

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7
Q

Investigation for unilateral sensorineural hearing loss?

A

MRI of internal acoustic meatus to exclude vestibular schwannoma

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8
Q

Monitoring requirements for trastuzumab (Herceptin)?

A

Echo - monitoring of left ventricular ejection fraction through serial echocardiograms before and during treatment

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9
Q

Contralateral homonymous hemianopia with macular sparing and visual agnosia - artery?

A

Posterior cerebral artery

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10
Q

Most sensitive blood test for diagnosis of acute pancreatitis?

A

Serum lipase - do serum lipase and CT if serum amylase not concordant with clinical picture

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11
Q

Symptoms of anterior cerebral artery stroke?

A

Contralateral hemiparesis and sensory loss, lower extremity > upper

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12
Q

Symptoms of middle cerebral artery stroke?

A

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

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13
Q

Symptoms of posterior cerebral artery stroke?

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

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14
Q

Symptoms of lateral medullary syndrome? Artery?

A

Cerebellar signs (ataxia, nystagmus)
Ipsilateral facial pain and temperature loss
Ipsilateral Horner’s
Contralateral limb/torso pain and temperature loss

PATH C (pain and temperature, Horner’s, cerebellar)
Posterior Inferior Cerebral Artery

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15
Q

Symptoms of Weber’s syndrome? Artery?

A

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Trying to BBQ with weak side, looking away
Branches of PCA supplying midbrain

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16
Q

Symptoms of lateral pontine syndrome? Artery?

A

Similar to lateral medullary syndrome (Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus)
but also…
Ipsilateral facial paralysis and deafness

PAT can C (but she can’t hear/move)
Anterior Inferior Cerebral Artery

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17
Q

Symptom of retinal/opthalmic artery stroke?

A

Amaurosis fugax

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18
Q

Symptom of basilar artery stroke?

A

Locked-in syndrome

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19
Q

Symptoms of lacunar stroke?

A

Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

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20
Q

Symptoms of middle cerebral artery stroke?

A

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

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21
Q

Symptoms of Multiple System Atrophy?

A

Parkinsonism (rigidity > tremor)
Autonomic disturbance:
Erectile dysfunction: often an early feature
Postural hypotension
Atonic bladder
Cerebellar signs

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22
Q

Symptoms of Progressive Supranuclear Palsy?

A

Postural instability and falls
Stiff, broad-based gait
Impairment of vertical gaze (down gaze worse than up gaze)
Speech disturbance
Parkinsonism (bradykinesia prominent)
Cognitive impairment (primarily frontal lobe dysfunction)

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23
Q

Symptoms of Corticobasilar Degeneration?

A

Unilateral parkinsonism
Aphasia
Astereognosis

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24
Q

List types of motor neurone disease - UMN, LMN or both?

A

Amyotrophic Lateral Sclerosis - mixed UMN/LMN (corticospinal tracts)
Primary Lateral Sclerosis - UMN (loss of Betz cells in cerebral cortex)
Progressive Muscular Atrophy - LMN mainly, distal to proximal (anterior horn cells)
Progressive Bulbar Palsy - bulbar palsy (CN IX-XII)

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25
Q

Mammogram screening programme?

A

Ages 47-73, every 3 years

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26
Q

ECG features in hypothermia?

A

Bradycardia
‘J’ wave (Osborne waves) - small hump at the end of the QRS complex
First degree heart block
Long QT interval
Atrial and ventricular arrhythmias

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27
Q

Drug given to reduce rate of CKD progression in ADPKD?

A

Tolvaptan

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28
Q

Medical management of subarachnoid haemorrhage?

A

Nimodipine to prevent vasospasm

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29
Q

Treatment pericarditis?

A

NSAIDs and colchicine

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30
Q

Treatment of chemically-mediated nausea?

A

Ondansetron, haloperidol, levomepromazine

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31
Q

Treatment of raised ICP nausea?

A

Cyclizine (also dexamethasone)

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32
Q

Treatment of reduced gastric motility nausea?

A

Metoclopramide, domperidone

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33
Q

Treatment of vestibular nausea?

A

Cyclizine

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34
Q

Treatment of visceral/serosal nausea?

A

Cyclizine, levomepromazine

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35
Q

Anti-emetic to use in Parkinson’s?

A

Domperidone

(Avoid metoclopramide, haloperidol, prochlorperazine)

36
Q

Tumour lysis syndrome laboratory features?

A

Abnormality in at least two of following, 3 days before or 7 days after chemo:
High uric acid (> 475umol/l or 25% increase)
High potassium (> 6 mmol/l or 25% increase)
High phosphate (> 1.125mmol/l or 25% increase)
Low calcium (< 1.75mmol/l or 25% decrease)

37
Q

Tumour lysis diagnostic criteria?

A

Lab features plus at least one of…
Increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure

38
Q

Tumour lysis syndrome prophylaxis?

A

High risk: IV allopurinol or IV rasbirucase
Low risk: PO allopurinol

39
Q

ECG features of hyperkalaemia?

A

Tall peaked T waves
Flattening or absence of P waves
Broad QRS complexes

40
Q

High risk of contrast-induced nephropathy - medication to hold?

A

Patients who are high-risk for contrast-induced nephropathy should have metformin withheld for a minimum of 48 hours and until the renal function has been shown to be normal

41
Q

Prevention of contrast-induced nephropathy?

A

Intravenous 0.9% sodium chloride at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure

42
Q

DOAC of choice in renal impairment?

A

Apixaban (mostly faecally excreted - aPOOxaban)

(LIVERoxaban
dabigatURINE)

43
Q

Glasgow-Imrie criteria - use and components?

A

Used to assess the severity and determine the prognosis of
patients with acute pancreatitis

  • PaO2
  • Age
  • Neutrophils (WBC)
  • Calcium
  • Renal Function (Urea)
  • Enzymes (LDH)
  • Albumin
  • Sugar (Glucose)
44
Q

Hinchey classification used for?

A

Classifying acute diverticulitis

45
Q

Alvarado score used for?

A

Predicting likelihood of acute appendicitis

46
Q

Ranson criteria used for?

A

Predicting mortality in acute pancreatitis

47
Q

Maddrey’s score used for?

A

Determining whether steroids are indicated in alcoholic hepatitis

48
Q

Rockall score used for?

A

Determining the risk of adverse outcomes in patients who have had an upper GI bleed (after endoscopy)

49
Q

Glasgow-Blatchford score used for?

A

Determining whether upper GI bleed patients can be managed as outpatients

50
Q

Salter-Harris classification - used for? Types?

A

Used to grade paediatric fractures that involve the growth plate

I - Straight through
II - Above growth plate
III - Lower (below growth plate)
IV - Through Everything
V - cRush

51
Q

Garden classification - used for? Types?

A

Classification of intracapsular neck of femur fractures

Type I - incomplete, undisplaced, includes valgus impacted fractures
Type II - complete, undisplaced
Type III - complete, partially displaced (but still has boney contact)
Type IV - complete, completely displaced

52
Q

Colles’ fracture - mechanism? displacement? deformity seen?

A

FOOSH, distal radius fracture, dorsal angulation/displacement, ‘dinner fork deformity’

53
Q

Smith fracture - mechanism? displacement? deformity seen?

A

Falling backwards onto palm of outstretched hand or falling onto flexed wrist, distal radius fracture, volar angulation/displacement, ‘garden spade deformity’

54
Q

Bennett’s fracture - location? mechanism? X-ray finding?

A

Intra-articular fracture of the first metacarpal joint
Impact on flexed metacarpal (fist fights)
Triangular fragment at ulnar base of metacarpal

55
Q

Monteggia’s fracture - location? mechanism?

A

Dislocation of the proximal radioulnar joint with an associated ulnar fracture
FOOSH with forced pronation

56
Q

Galeazzi fracture - location? mechanism?

A

Radial shaft fracture with associated dislocation of the distal radioulnar joint
FOOSH or direct blow to wrist

57
Q

Pott’s fracture - location? mechanism?

A

Bimalleolar ankle fracture
Forced foot eversion

58
Q

Barton’s fracture - location? mechanism?

A

Distal radial fracture (i.e. Colles’/Smith) with associated radiocarpal dislocation
Fall onto extended and pronated wrist

59
Q

Medical management of Myasthenia Gravis?

A

For initial symptomatic relief - pyridostigmine (long-acting acetylcholinesterase inhibitor)

Immunosuppression eventually required - prednisolone initially
Azathioprine, cyclosporine, mycophenolate mofetil may also be used

60
Q

Management of myasthenic crisis?

A

Plasmapheresis
Intravenous immunoglobulins

61
Q

plasmapheresis
intravenous immunoglobulins

A
62
Q

ARDS criteria for diagnosis?

A

Acute onset (within 1 week of a known risk factor)
Pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
Non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
pO2/FiO2 < 40kPa (300 mmHg)

63
Q

Acromioclavicular joint injury - grades and management?

A

Rockwood classification I - VI

Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling.

Grade IV, V and VI are rare and require surgical intervention.

Grade III depends on individual circumstances.

Basically, if coracoclavicular ligament disrupted –> consider surgery

64
Q

Maintenance therapy for UC after severe relapse/>=2 exacerbations in the past year?

A

Oral azathioprine or oral mercaptopurine (check TPMT)

65
Q

Induction for Crohn’s?

1st line
2nd line
Add-on therapy
Refractory or fistulating
Isolated peri-anal

A

1st line - glucocorticoids (topical/oral/IV)
2nd line - aminosalicylates
Azathioprine or mercaptopurine can be used as add-on therapy
Refractory or fistulating - infliximab
Isolated peri-anal - metronidazole

66
Q

Maintenance for Crohn’s?

A

Azathioprine or mercaptopurine (check TPMT)

67
Q

Types of shock? Which ones present with warm/cool peripheries?

A

Warm peripheries - SAN:
Septic
Anaphylactic
Neurogenic

Cold peripheries:
Cardiogenic
Haemorrhagic

68
Q

Indications for starting bisphosphonate treatment?

A
  1. Anyone with a BMD <-2.5 on DEXA
  2. Anyone 75 or Over with a Fragility Fracture
  3. Anyone on High Dose Corticosteroids (>7.5mg for >3months)
69
Q

Initial treatment of acute limb ischaemia?

A

Analgesia (e.g. IV opioids), IV heparin and vascular review

70
Q

Features of Type 1 Renal Tubular Acidosis?

A

Inability to secrete H+ in
Hypokalaemia
Renal stones
Can be idiopathic or caused by RA, Sjogren’s

71
Q

Features of Type 4 Renal Tubular Acidosis?

A

Caused by hypoaldosteronism
Hypokalaemia

72
Q

Medical management of delirium?

A

1st line - haloperidol or olanzapine
Parkinson’s - atypical antipsychotics e.g. quetiapine/clozapine, lorazepam

73
Q

Treatment of agitation and confusion in palliative care?

A

First choice: haloperidol
Other options: chlorpromazine, levomepromazine

In the terminal phase of the illness then agitation or restlessness is best treated with midazolam

74
Q

Vitreous haemorrhage:
Risk factors
Causes
Presentation
Associated symptoms
Fundoscopy

A

Risk factors - diabetes, bleeding disorders, anticoagulants
Causes - proliferative diabetic retinopathy, posterior vitreous detachment, ocular trauma
Presentation - acute or subacute painless visual loss or haze (commonest)
Associated symptoms - red hue in the vision, floaters or shadows/dark spots in the vision
Fundoscopy - haemorrhage in the vitreous cavity

75
Q

Differentiating causes of goitre - pain, hyper/hypothyroid, uptake scan?
Hashimoto’s
De Quervain’s
Graves’
Toxic multinodular goitre

A

Hashimoto’s - firm, non-tender (usually), may be very brief hyperthyroid phase followed by hypothyroid, uptake scan varies
De Quervain’s - painful goitre, 3-6w hyperthyroid –> 1-3w euthyroid –> hypothyroid, reduced uptake
Graves’ - painless goitre, hyperthyroid, diffuse & homogenous increased uptake
Toxic multinodular goitre - painless nodular, usually hyperthyroid, patchy uptake

76
Q

Weber classification ankle fracture - A/B/C?

A

Related to the level of the fibular fracture:

Type A - below the syndesmosis
Type B - fracture starts at the level of the tibial plafond and may extend proximally to involve the syndesmosis
Type C - above the syndesmosis which may itself be damaged

B and C = unstable

Tibiofibular syndesmosis = fibrous joint in which two adjacent bones (tibia and fibula) are linked by (a strong membrane or) ligaments (x4)

77
Q

Management of Weber A/B/C fractures?

A

First, immediate fracture reduction (usually under sedation in A&E)

Conservative (below knee backslab):
Weber A fractures or Weber B fractures without talar shift
Those unfit for surgical intervention

Surgical (ORIF):
Weber C fractures
Weber B fractures with talar shift
Open fractures

78
Q

Tarsal bones

A

Medial –> lateral starting at base of foot:

Talus, Calcaneus, Navicular, Medial Cuneiform, Intermediate Cuneiform, Lateral Cuneiform, Cuboid

(Tiger Cub Needs MILC)

79
Q

Carpal bones

A

Scaphoid, Lunate, Triquetrum, Pisiform
Trapezium, Trapezoid, Capitate, Hamate

SLTPTTCH

80
Q

Medical management of HOCM?

A

Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
(Endocarditis prophylaxis)

81
Q

Psoriatic arthritis - X-ray findings?

A

Periarticular erosions and bone resorption
Periostitis
‘Pencil-in-cup’ appearance

82
Q

Alzheimer’s - areas of brain affected?

A

Widespread cerebral atrophy mainly involving the cortex and hippocampus

83
Q

Parkinson’s - areas of brain affected?

A

Basal ganglia and substantia nigra

84
Q

ARDS diagnostic criteria?

A

Criteria (American-European Consensus Conference)
acute onset (within 1 week of a known risk factor)
pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
pO2/FiO2 < 40kPa (300 mmHg)

85
Q

Gold standard imaging for chronic pancreatitis?

A

CT with contrast to visualise calcification

86
Q

Osteoarthritis first line management?

A

Paracetamol (+/- topical NSAIDs)

87
Q

Cushing’s - ABG abnormality?

A

Hypokalaemic metabolic alkalosis

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