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13-19-18-1 > Medicine > Flashcards

Medicine Flashcards

1
Q

What is the management of angina?

A

GTN

Beta blocker or CCB

If CCB then Verapamil or Diltiazem to be used

If used in combination with B blocker, DHP CCB such as Amlodipine

If monotherapy and cannot tolerate CCB or vice verda, add long-acting nitrate/ivabradine/nicorandil/ranolazine

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2
Q

Why should Verapamil and Bisoprolol not be co-prescribed?

A

Risk of heart block

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3
Q

Should you develop a cough upon commencing an ACEi, what is the next step in management?

A

Commence ARB instead

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4
Q

How do you manage T gondii?

A

Conservative if immunocompetent

Pyrimethamine and Sulfadiazine if immunocompromised

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5
Q

What electrolyte abnormality may you get in Rhabdomyolysis?

A

Hypocalcaemia - calcium binds to released myoglobin from damaged muscle

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6
Q

A patient’s asthma is poorly controlled with SABA and ICS, what treatment should be added in next?

A

LTRA

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7
Q

What would an ABG show in a patient with PE?

A

Respiratory alkalosis - hyperventilation driven

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8
Q

What makes up CURB65 score?

A

Confusion
Urea
Resp rate
BP
65 (> age)

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9
Q

What are the known contraindications to Thrombolysis?

A

active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension

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10
Q

What is the first-line treatment in Phaeochromocytoma?

A

Phenoxybenzamine

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11
Q

What are the management steps for uncontrolled COPD?

A

SABA or SAMA

?Asthma features
LABA + ICS

?No asthma features
LABA + LAMA

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12
Q

What is the MOA of gliptins?

A

DPP4 inhibitors, reducing peripheral breakdown of incretins

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13
Q

What is the MOA of GLP-1 mimics? Give an example.

A

Exenetide
Increase insulin secretion and inhibit glucagon secretion

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14
Q

How can TIBC differentiate between IDA and Anaemia of chronic disease?

A

TIBC measures number of available binding sites on TF for iron

Thus it is high in IDA and low in Anaemia of chronic disease

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15
Q

What is the typical seizure type of a temporal lobe seizure?

A

May occur with or without impairment of consciousness or awareness

An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as dejà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)

Automatisms may be noted

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16
Q

What is the typical seizure type of a frontal lobe seizure?

A

Head/leg movements, posturing, post-ictal weakness, Jacksonian march

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17
Q

What is the typical seizure type of a parietal lobe seizure?

A

Paraesthesia

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18
Q

Which blood group has an increased risk of gastric cancer?

A

Blood group A

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19
Q

How should you screen for HIV?

A

HIV p24 antigen and HIV antibody

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20
Q

What blood tests are used to monitor Haemochromatosis?

A

Ferritin and TF saturation

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21
Q

What ABX is best for Tx of Salmonella?

A

Ciprofloxacin

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22
Q

Which artery is affected in an inferior MI?

A

RCA

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23
Q

How do you manage a flare of mild/moderate UC?

A

> 6 stools +/- systemic upset..

Topical Aminosalicylate

+/- PO Corticosteroid if remission not achieved after 4 weeks

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24
Q

How do you manage a flare of severe UC?

A

IV steroids

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25
Q

How do you maintain remission in mild UC?

A

topical ASA / PO ASA / both

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26
Q

How do you manage severe UC for remission?

A

Oral Thiopurine e.g. Azathioprine / mesalazine

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27
Q

How many annual flares qualify as ‘severe UC’?

A

> 2 per year

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28
Q

What are the side effects of Phenytoin?

A

P - cytochrome P-450 induction
H - Hirsutism
E - Enlarged gums
N - Nystagmus
Y - Yellow-brown skin
T - Teratogen (fetal hydantoin syndrome)
O - Osteopenia
I - Inhibited folate absorption
N - Neuropathy

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29
Q

In a patient with DKA, who has begun on resuscitation fluids, what is the next appropriate step in treatment?

A

Fixed rate insulin (0.1U/kg) and long-acting continued

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30
Q

What is the inheritance of BET?

A

Autosomal dominantW

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31
Q

What are the features of BET?

A

Improved by alcohol
Improved by propranolol
Titubation
Worse on intentional movement
Autosomal dominant inheritance

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32
Q

Following an isolated seizure, how long can you not drive for?

A

6 months

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33
Q

Following a TIA, how long can you not drive for?

A

1 month

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34
Q

How long can you not drive for following transphenoidal pituitary resection?

A

6 months

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35
Q

Which pathogen causes Croup?

A

Parainfluenza virus

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36
Q

What are the side effects of Gliclazide (sulphonylureas)?

A

Hypoglycaemic episodes
Weight gain

Hyponatraemia
BM suppression
Hepatotoxicity (cholestatic)
Peripheral neuropathyH

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37
Q

How do sulphonylureas work?

A

bind to ATP-dependent K+ channel on cell

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38
Q

What are the features of hypocalcaemia?

A

Tetany
Perioral paraesthesia
Prolonged QT interval
Depression / cataracts

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39
Q

In T2DM, what second line therapy should be added once established on metformin?

A

DPP4i/Pioglitazone/SGLT2i/Sulfonylurea

If CVD risk - SGLT2i

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40
Q

In T2DM, when should a third-line agent be added?

A

HbA1c >7.5%

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41
Q

What ABX is used to treat Legionella?

A

Macrolides e.g. Clarithromycin

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42
Q

What pathogen causes LGV?

A

C trachomatis

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43
Q

How do you treat LGV?

A

Doxycyline

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44
Q

What are the features of Chancroid?

A

Painful genital ulcers w/ unilateral inguinal LN
sharply defined, ragged, undermined border

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45
Q

What are the features of the ulcer in syphilis?

A

Painless ulcer (chancre)

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46
Q

What are the features of the ulcers in HSV?

A

Multiple, painful ulcers w/ fever and localised to one site

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47
Q

When doing a urea breath test for H pylori, what medications may influence the test?

A

ABX within 4 weeks
PPI within 2 weeks

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48
Q

Which valve is most commonly affected by IE in IVDU?

A

Tricuspid valve

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49
Q

Which valve is most commonly affected by IE?

A

Mitral valve

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50
Q

How do you treat C jejuni?

A

Clarithromycin

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51
Q

What is the most commonly affected site in UC?

A

Rectum

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52
Q

What is the most commonly affected site in CD?

A

Ileum

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53
Q

Which vaccines are live attenuated? When may they be contraindicated?

A

Mnemonic: MOVIY

MMR
Oral polio
Varicella
Intranasal influenza
Yellow fever

CI in immunocompromised people

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54
Q

What is the most common cause of cardiac arrest post-MI?

A

VF

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55
Q

What is the common cause of bradyarrhythmia post MI?

A

Inferior MI affecting AV node thus AV block

56
Q

What is the mechanism of pericarditis post-MI? What are the features?

A

Fever; pleuritic pain; pericardial effusion; raised ESR

Dressler’s syndrome - 2-6 weeks post-MI w/ autoimmune reaction against antigenic proteins.

57
Q

What would the features of LV aneurysm be post-MI?

A

ST elevation and LV failure

58
Q

What are the features of LV free wall rupture?

A

HF with cardiac tamponade thus raised JVP + muffled heart sounds + pulsus paradoxus

59
Q

What might an early-mid systolic murmur suggest in a patient post-MI?

A

Acute MR due to ischaemia or rupture of papillary muscle

Acute hypotension and pulmonary oedema occurs

60
Q

Should a patient develop an ACE-related cough, how would you manage this?

A

Switch to ARB

60
Q

What is the contraindication to Donepezil?

A

Bradycardia

61
Q

What is the Mx of HF rEF?

A

ACEi + BB

62
Q

What is the second line treatment for HFrEF?

A

Aldosterone antagonist e.g. Spironolactone

63
Q

What is the third line option for HFrEF? Consider if they have each of the below.

Tachycardia

LVF

AF

Ethnicity

QRS

A

Sinus rhythm >75 min and LVF <35%
Ivabradine

LVF <35%
Sacubitril-Valsartan

Symptoms OR AF
Digoxin

Afrocarib
Hydralazine

Widened QRS
CRT

64
Q

What vaccination is used for those with heart failure?

A

Annual influenza vaccine + single Pneumococcal

65
Q

What do HBsAg and Anti-HBcAg IgM and HBcAg IgG indicate for Hep B?

A

Acute infection

66
Q

What do anti-HBsAG suggest?

A

Vaccine responder

67
Q

What do HBsAG and Anti-HBcAg IgG suggest?

A

Chronic infection of Hep B

68
Q

Which pathogen typically causes Pneumonia following influenza?

A

S aureus

69
Q

What does restrictive lung disease show on FEV1/FVC?

A

Restrictive raises / normal FEV1/FVC

70
Q

What drugs should be offered following an MI with reduced LVF?

A

DAPT
ACEi
BB
Statin
Aldosterone antagonist

71
Q

What are the key features of neuroleptic malignant syndrome?

A

Antipsychotics
Hours-days onset
Reduced reflexes, increased rigidity
Normal pupils

72
Q

How do you manage neuroleptic malignant syndrome?

A

Dantrolene

73
Q

What are the key features of serotonin syndrome?

A

SSRIs/MAOi/ecstasy

Hours onset
Increased reflexes
Clonus
Dilated pupils

74
Q

How do you manage serotonin syndrome?

A

Cyproheptadine
Chlorpromazine

75
Q

What are the features of life threatening asthma?

A

PEFR <33%
O2 sats <92%
Normal pCO2
Silent chest
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

76
Q

What dose do you commence someone on Levothyroxine for Hypothyroidism?

A

50-100mcg

> 50 y/o commence on: 25mcg

77
Q

What electrolyte and pH abnormality may be seen in Cushing’s disease?

A

Hypokalaemic metabolic alkalosis

78
Q

A COPD patient with FEV1 of 40% is which Stage COPD?

A

Stage 3 (30-50%)

79
Q

A COPD patient with FEV1 of 60% is which Stage COPD?

A

Stage 2 (50-80%)

80
Q

A COPD patient with FEV1 of 25% is which Stage COPD?

A

Stage 4 (<30%)

81
Q

How may you differentiate between infectious mononucleosis and strep throat?

A

EBV infection (infectious mononucleosis) results in a maculopapular rash following Amoxicillin Tx

Absence of Strep throat features e.g. Sandpaper rash

Sore throat
LN
Pyrexia

82
Q

How is Von Willebrand’s disease inherited?

A

Autosomal Dominant

83
Q

What may you see on a Coag blood test in a patient with VW disease?

A

APTT increased
Increased bleeding time
Normal platelets

84
Q

What are the adverse effects of Bleomycin?

A

Pulmonary fibrosis

85
Q

What are the adverse effects of Cyclophosphamide?

A

Haemorrhagic cystitis
TCC
Myelosuppression

86
Q

What are the adverse effects of Doxorubicin?

A

Cardiomyopathy

87
Q

What are the adverse effects of Methotrexate?

A

Mucositis
Pulmonary fibrosis
Liver fibrosis
Myelosuppression

88
Q

What are the adverse effects of Vincristine?

A

Peripheral neuropathy
Paralytic ileus

89
Q

What are the adverse effects of Cisplatin?

A

Ototoxicity
Peripheral neuropathy
Hypomagnesaemia

90
Q

When should you stop Statins prior to attempting to conceive (as a woman)?

A

3 months prior - risk of congenital malformations

91
Q

Which valve abnormality is associated with PCKD?

A

Mitral valve prolapse thus mitral regurgitation

92
Q

What is the most common pathogen to cause LRTI in a patient with Bronchiectasis?

A

H influenza

93
Q

In a hyperkalaemic patient, what should be given initially?

A

Calcium gluconate (stabilise)

then

Insulin/Dextrose infusion

94
Q

What features constitute Webers syndrome?

A

Ipsilateral cranial nerve III palsy + contralateral hemiparesis following posterior cerebral artery occlusion

95
Q

What pathogen causes the common cold?

A

Rhinovirus

96
Q

What is the criteria for IGT following 2 hour OGTT?

A

7.8-11.0

97
Q

Which PPI should not be co-prescribed in a patient on Clopidogrel?

A

Omeprazole

Prescribe Lansoprazole instead

98
Q

What are the features of an acute haemolytic transfusion reaction?

A

Fever
Abdominal pain
Hypotension

99
Q

What are the features of a TACO?

A

Pulmonary oedema
Hypertension

100
Q

When may you place a chest drain in infection?

A

Frank purulent pleural fluid
Pathogen isolated
pH <7.2

101
Q

How can you classify between exudate and transudate on a pleural tap?

A

Protein >30g/dL = exudate (e for 3)

Protein <20g/dL = transudate (t for 2)

Light’s criteria when 20-30

Exudate if:
Pleural protein / serum protein >0.5

Pleural LDH / serum LDH >0.6 (h for hex)

Pleural fluid LDH > 2/3 upper limit of serum LDH

102
Q

Why are irradiated blood products used?

A

Reduce risk of host vs graft disease

103
Q

A patient is scheduled for AM surgery for a TKR and takes Gliclazide and Metformin BD. Which, if any, changes to medication should take place?

A

Omit Gliclazide

104
Q

Which antidiabetic medications require changes prior to surgery?

A

Mnemonic: SIG

Omit gliclazide
Omit SGLT2i
Insulin (OD - 20% reduce cf BD 50% reduce)

105
Q

What are the features of Patau (13) syndrome?

A

Microcephaly
Cleft palate
Polydactyly
Scalp lesions

106
Q

What are the features of Edward (18) syndrome?

A

Micrognathia
Low set ears
Rocker bottom feet
Overlapping fingers

107
Q

What are the features of Fragile X syndrome?

A

Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism

No X.. ‘super man’

108
Q

What are the features of Noonan syndrome?

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

109
Q

What are the features of Williams syndrome?

A

Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

110
Q

Give 5 potential causes of Torsades des Pointes?

A

Congenital
Antiarrhythmics (amiodarone; sotalol; procainamide)
TCA
Antipsychotics
Erythromycin
Electrolyte derangement (hypocalcaemia; hypokalaemia; hypomagnesaemia)
Hypothermia
SAH

111
Q

Following commencement of ACEi, what increase in sCr is acceptable?

A

30% (up to)

112
Q

What are the symptoms of Pellagra? Which vitamin causes its deficiency?

A

3Ds
Dementia
Dermatitis
Diarrhoea

Deficiency of Niacin

113
Q

What is the gold-standard for diagnosis of Coeliac disease?

A

Jejunal biopsy

114
Q

what antihypertensive should be avoided in HOCM?

A

Ramipril

115
Q

What are the features of Wernicke’s encephalopathy?

A

Confusion, gait ataxia, nystagmus and ophthalmoplegia

116
Q

What are the features of Korsakoff’s syndrome?

A

Amnesia, confabulation and apathy

117
Q

Which cancer is calcitonin a marker for?

A

Medullary thyroid cancer

118
Q

What is the treatment for bacterial vaginosis in a patient with metronidazole allergy?

A

Topical clindamycin

119
Q

Haematuria shortly after (5 days) an URTI is suggestive of which condition?

A

IgA nephropathy

120
Q

What is the first line Tx in males for generalised tonic-clonic seizures?

A

Sodium valproate

121
Q

What is the first line Tx in females for generalised tonic-clonic seizures?

A

Lamotrigine / Leviteracetam

122
Q

What is the first line Tx for focal seizures?

A

Lamotrigine
Leviteracetam

123
Q

What is the first line Tx for absence seizures?

A

Ethosuximide

124
Q

What is the second line Tx for absence seizures?

A

Carbamazepine

125
Q

How long must you not drive for following MI with successful Angioplasty Tx?

A

1 week

126
Q

How much glucose should a patient have per day?

A

50-100g (independent of weight)

127
Q

If a patient presents with right sided hemiparesis, what visual field defect might they have?

A

Right homonymous hemianopia with macula sparing

128
Q

What is the most common symptoms of posterior circulation stroke?

A

Dizziness

129
Q

If a patient has a BP of 210/150mmHg presenting with a stroke, what should be done prior to thrombolysis?

A

Control hypertension - IV Labetolol

130
Q

Which drugs may interact with thyroxine?

A

Ferrous fumarate
Calcium carbonate

131
Q

Which antihypertensive may mask hypoglycaemic symptoms in a diabetic patient?

A

Beta blockers - reduce adrenaline-driven response of hypoglycaemia

132
Q

A patient with a ABPM of 142/86mmHg and QRISK of 9% should receive what treatment?

A

Advise and diagnose stage 1 HTN

HTN stage 2 or QRISK >10% requires Tx

133
Q

What are the causes of raised anion gap metabolic acidosis?

A

MUD PILES

Methanol
Uraemia
DKA

Propylene
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

134
Q
A

13-19-18-1 (6 decks)

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