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ZMSRA > MEDICINE > Flashcards

MEDICINE Flashcards

1
Q

Chronic myeloid leukemia is associated with

A

Philadelphia chromosome

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2
Q

Presentation chronic myeloid leukemia

A

Presentation (60-70 years)

anaemia: lethargy

weight loss and sweating are common

splenomegalymay be marked → abdo discomfort

an increase in granulocytes at different stages of maturation +/- thrombocytosis

decreased leukocyte alkaline phosphatase

may undergo blast transformation (AML in 80%, ALL in 20%)

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3
Q

Light’s criteriastate that a pleural effusion is an exudate if:

A

-Effusion lactate dehydrogenase (LDH) level greater than 2/3 the upper limit of serum LDH
Pleural fluid LDH divided by serum LDH >0.6
Pleural fluid protein divided by serum protein >0.5

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4
Q

ITP labs

A

Isolated thrombocytopenia [low platelets]

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5
Q

ITP management

A

first-line treatment for ITP is oral prednisolone
pooled normal human immunoglobulin (IVIG) may also be used
it raises the platelet count quicker than steroids, therefore may be used if active bleeding or an urgent invasive procedure is required

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6
Q

Features of myeloma

A

CRABBI
High Ca
Renal impairment
Anaemia
Bleeding
Bony pain/ fractures
Infectiom

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7
Q

Roleux formation
Heinze bodies
Howell jolly
Schistocytes

A

Roleux formation - myeloma
Heinze bodies - G6PD
Howell jolly - post splenectomy / hyposplenic disorder
Schistocytes - fragmented rbcs seen in metallic hv or hemolytic anemia

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8
Q

Nefrotic syndrome in children and young adults

A

Minimal change glamorillo nefrightens

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9
Q

Mx salicylate od

A

urinary alkalinization with IV bicarbonate
haemodialysis

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10
Q

Von Willebrand Disease features

A

Most common inherited bleeding disorder
Autosomal dominant
epistaxis and menorrhagia

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11
Q

VWD labs

A

prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin

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12
Q

What are the high risk characteristics of symptomatic pneumothorax?

A

haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax

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13
Q

Management of pneumothorax

A

<2cm - Conservative
> 2cm ambulatory device or needle drajn
High risk characteristics and > 2cm- chest drain

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14
Q

Most common organisms isolated from patients with bronchiectasis:

A

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

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15
Q

CA125
CA199
CA153

A

CA 125 Ovarian cancer
CA 19-9 Pancreatic cancer
CA 15-3 Breast cancer

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16
Q

CA125
CA199
CA153

A

CA 125 Ovarian cancer
CA 19-9 Pancreatic cancer
CA 15-3 Breast cancer

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17
Q

Bleomycin side effects

A

Lung fibrosis

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18
Q

Anthracyclines (doxorubicin)

A

Cardiomyopathy

19
Q

Vincristine side effects

A

Peripheral neuropathy

20
Q

Carcinormbryonic antigen associated with

A

Colorectal cancer

21
Q

Monitoring parameters for statins

A

LFTs at baseline, 3 months and 12 months

22
Q

Monitoring parameters for ACEi

A

U&E prior to treatment
U&E after increasing dose
U&E at least annually

23
Q

Amiodarone monitoring parameters

A

TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months

24
Q

Peutz-Jeghers syndrome features

A

Autosomal dominant condition
hamartomatous polyps in the gastrointestinal tract
pigmented freckles

25
Q

What is beta thalassemia

A

disorders characterised by a reduced production rate of either alpha or beta chains

thalassemia major, thalassemia intermedia, and thalassemia minor.
Disproportionate microcytic anaemia - think beta-thalassaemia trait

Hypersplenomegaly and gallstones. mostly found in thalassemia major and intermedia patients.

beta thalassemia major usually present within the first two years of life with severe anaemia, poor growth, and skeletal abnormalities during infancy.

26
Q

What size the P450 system

A

Enzymes that metabolise stuff
Inducers increase activity leading to increased clearance of certain drugs
Inhibitors decrease clearance of drugs

27
Q

P450 inducers

A

CRAP GPs - because crap GPs induce rage ;)

Carbamazepine, Rifampicin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbitone, Sulphonylureas (also St. John’s Wort and smoking)

28
Q

P540 inhibitors

A

SICKFACES.COM - I remember the alcoholic binge part because a hangover = sick face!

Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Alcohol (binge), Chloramphenicol, Erythromycin, Sulphonamides, Ciprofloxacin, Omeprazole, Metronidazole

29
Q

When is acetylcysteine used in paracetamol OD

A

Plasma paracetamol concentration above graph
there is a staggered overdose

patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol even if the plasma-paracetamol concentration is not yet available
patients who present > 24 hours if they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal

30
Q

Management b12 deficiency

A

if no neurological involvement 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
if a patient is also deficient in folic acid then it is important to treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord

31
Q

Features b12 deficiency

A

macrocytic anaemia
sore tongue and mouth
neurological symptoms
the dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
neuropsychiatric symptoms: e.g. mood disturbances

32
Q

Labs in haemochromatosis

A

transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC

33
Q

Hepatitis A Features

A

Prodromal phase; flu-like symptoms, gastrointestinal symptoms (such as anorexia, nausea, vomiting, and abdominal right upper quadrant discomfort), and occasionally headache, cough, pharyngitis, constipation, diarrhoea, itch, and urticaria. Usually, there are no specific signs on examination.
Icteric phase; jaundice, pale stools, and dark urine (if there is cholestasis), pruritus, fatigue, anorexia, nausea, and vomiting — symptoms often improve once jaundice occurs. Hepatomegaly, splenomegaly, lymphadenopathy, and hepatic tenderness are often present on examination.
Convalescent phase; includes malaise and hepatic tenderness

34
Q

Hepatocellular carcinoma features

A

hard/craggy mass
longer history of abnormal liver function blood tests as this cancer occurs most commonly in patients with chronic liver disease.

35
Q

CKD stages

A

1 Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)
2 60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)
3a 45-59 ml/min, a moderate reduction in kidney function
3b 30-44 ml/min, a moderate reduction in kidney function
4 15-29 ml/min, a severe reduction in kidney function
5 Less than 15 ml/min, established kidney failure - dialysis or a kidney transplant may be needed

36
Q

Subacute thyroiditis / known as De Quervain’s thyroiditis phases

A

phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal

37
Q

De Quervain’s thyroiditis ix

A

thyroid scintigraphy: globally reduced uptake of iodine-131

38
Q

Graves disease features

A

eye signs (30% of patients)
exophthalmos
ophthalmoplegia
pretibial myxoedema
thyroid acropachy, a triad of:
digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation

39
Q

Graves disease antibodies

A

TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)

40
Q

Graves disease causes tender or non tender goitor

A

Non tender

41
Q

COPD stable management

A

SABA/SAMA
-> non steroid responsive add LABA+LAMA
-> steroid responsive LABA + ICS
Triple therapy if remains unresponsive LABA+ LAMA+ ICS

42
Q

Lights criteria

A

Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal

43
Q

Diagnosis of asthma

A

Patients >= 17 years
patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma
all patients should have spirometry with a bronchodilator reversibility (BDR) test
all patients should have a FeNO test

Children 5-16 years
all children should have spirometry with a bronchodilator reversibility (BDR) test
a FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test

Patients < 5 years
- diagnosis should be made on clinical judgement

44
Q

Local anaesthetic toxcity mx

A

IV 20% lipid emulsion

ZMSRA (12 decks)

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