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MBBS V > Medicine > Flashcards

Medicine Flashcards

1
Q

What is this rash called? Associated with what disease?

A

Erythema multiform (target lesions)

Herpes Simplex Virus

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2
Q

Right ear sensorineural hearing loss. Weber’s test?

A

Lateralises to left ear (normal ear)

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3
Q

Mx of haemodynamiccaly unstable PE?

A

Thrombolysis

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4
Q

Investigations for pheochromocytoma (2)?

A

Serum metanephrines

Confirmatory test: 24 hour urine metanephrines

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5
Q

Normal PT, low aPTT is what pathway and suggests what diseases (3)?

A

Instrinsic pathway

Unfractioned Heperin therapy

DIC

Haemophilia

Note: LMWH is monitored by Xa levels, not aPTT

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6
Q

Fever and this rash is what condition and caused by what?

A

Hand foot and mouth disease

Coxsackie A virus

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7
Q

COPD. Not managed alone with SABA. What next?

A

LAMA (tiotropium bromide) or LABA (salmeterol)

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8
Q

Meds that cause of high prolactin (3)

A

Dopamine antagonists: antipsychotics, metoclopramide

OCP

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9
Q

Most common CAP post viral illness?

A

Staph aureus

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10
Q

Do you use a T score or a Z score to dx osteoporosis? Cut off?

A

T score (compares to healthy population)

-2.5

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11
Q

Ipsilateral decreased pain and temperature sensation

Contralateral loss of pain and temperature sensation

Ataxia

Dysphagia

Hoarseness of voice

A

Lateral medullary syndrome / Wallenberg syndrome / PICA syndrome

(posterior inferior cerebellar artery)

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12
Q

Causes of microcytic anaemia (5)

A

TAILS

Thalassaemia

Anaemia of chronic disease

Iron deficiency

Lead poisoning

Sideroblastic anaemia

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13
Q

Example of class III antiarrhythmic

A

Potassium channel blockers

Amiodarone (but also blockers other classes)

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14
Q

ABx for moderate CAP?

A

Benzyl penicillin IV and azithromycin PO

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15
Q

HBsAg +

HBsAb (Anti-HBsAg) -

HBcAb (Anti-HBcAg) +

IgM Anti-HBc ++

What disease state?

A

Acute HBV infection

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16
Q

Differential dx (2)?

A

Impetigo (Staph aureus or GAS infection)

Eczema herpeticum (HSV 1 or 2)

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17
Q

Describe image. Diagnosis? Other features associated (4)?

A

Bihilar lymphadenpathy. (May have upper lobe involvement)

Sarcoidosis

African descent, erythema nodosum, lupus pernio (purple lesions of face), non caseating granulomas

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18
Q

Describe and dx?

A

Bilateral ground glass radio-opacities, ‘honey combing’

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19
Q

Thrombocytopenia + recent illness =?

A

Immune thrombocytopenic purpura (ITP)

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20
Q

Cardioselective beta blockers?

A

Bisprolol

Metoprolol XR

Carvedilol

Nebivolol

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21
Q

BCR-ABL is associated with which leukaemia?

A

CML

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22
Q

Ulnar nerve goes through what canal? (2)

A

Guyon’s canal as it passes through the wrist

Cuboidal as it goes through the elbow

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23
Q

South East Asia, high-grade biphasic fever, arthralgia, myalgia, headache, retro-orbital pain, Maculopapular, measles-like exanthem, lymphadenopathy. Dx?

A

Dengue fever

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24
Q

HBsAg +

HBsAb (Anti-HBsAg) -

HBcAb (Anti-HBcAg) +

IgM Anti-HBc -

What disease state?

A

Chronic HBV infection

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25
Q

What needs to be done for airway in ALS?

A

Conscious: are they talking?

Unconscious: ensure no obstruction, jaw thrust

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26
Q

High calcium

High PTH

Next investigations (2)?

Diff dx (3)?

A

Next investigations: Phosphate levels and urinary calcium

Diff dx:

Primary hyperparathyroidism (High calcium, high PTH, low phophate, high urinary calcium)

Familial hypocalciuric hypercalcaemia (High calcium, normal-high PTH, low urinary calcium)

Tertiary hyperparathyroidism (High calcium, High PTH, High phosphate as kidneys not working well)

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27
Q

Recurrent DVTs, Anticagulation for how long?

A

Life long

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28
Q

What is this and what organism is this associated with?

A

Kaposi’s sarcoma

Human herpesvirus 8 (HHV 8)

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29
Q

alpha-1-antitrypsin deficiency pulmonary function tests

A

Obstructive in young person

FEV1 reduced

FEV/FVC reduced

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30
Q

Investigations for DI? (3)

A

Low urine osmolarity

Water deprivation test (DI will cont to have dilute urine)

Give desmopressin (Central will concentrate urine, nephrogenic will continue to be dilute)

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31
Q

Splenomegaly + tear shaped cells on blood smear?

A

Primary myelofibrosis

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32
Q

Reactive arthritis features ?

A

Can’t see, Can’t pee, Can’t climb a tree

Reiter’s syndrome (urethritis, conjunctivitis and arthritis) following a gastro illness.

Typically develops within 4 weeks of initial infection

Asymmetrical oligoarthritis of lower limbs

Keratoderma blennorhagicum

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33
Q

Acoustic neuroma clinical features?

A

(Like Meniere disease but with cranial nerve disturbance)

Unilateral sensorineural hearing loss

Tinnitus

Vertigo

Unsteady gait

Cranial nerve disturbances, such as facial numbness or weakness

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34
Q

Features of Steven-Johnson Syndrome? (3)

A

Occurs 1-3 weeks post medication exposure

Painful skin sloughing

Positive Nikolsky sign (upper dermis sepeates fom dermis (and creates blister) when shearing force applied)

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35
Q

Contraindication for cholchicine?

A

Myelodysplasia

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36
Q

What is this disease? Three other associations?

A

Measles

3C’s: cough, conjuntivitis, Koplick spots

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37
Q

SVT mx? (3)

A

Vagal manoeuvres

Adenosine

Verapramil

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38
Q

Systemic disease risk factors for osteoporosis (4 + 1)?

A

CKD

Hyperparathyroidism

Hyperthyroidism

Premature menopause

+ any disease that requires corticosteroids (RA, SLE)

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39
Q

Most common CAP in immunosupressed?

A

Pneumocystis pneumonia

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40
Q

Unstable bradycardia mx?

A

Pacing + ICD

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41
Q

Mx of acute RF?

A

Acute eradication of GAS: oral penicillin V

Long term prophylaxis with benzothine penicillin G

10 years or until 21 years old (whichever is longer)

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42
Q

PT is a measure of what factors?

A

Extrinisc pathway (VII) + common pathway (I, II, V, X)

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43
Q

Effect of hypocalcaemia of membrance excitability?

Clinical features? (2)

A

Increases membrane excitability

Paresthesias, carpopedal spasm,

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44
Q

If this is confined to the face and trunk, what disease is this (and differential)?

A

Rubella (pruritus, tender lymphadenopathy)

Diff dx: measles (no pruritus, cough, coryza prodrome, conjunctivitis, Koplick spots)

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45
Q

Bihilar lymphadenopathy and erythema nodosum associated with what?

A

Sarcoidosis

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46
Q

Example of class IV antiarrhythmic

A

Channel blockers

Cardioselective dihydroridine: verapramil

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47
Q

Mx for serotonin syndrome?

A

Supportive care: IVT, antihypertensives, cooling measures

Chlorpromazine 25mg intravenous

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48
Q

What’s this visual field called and what causes it?

A

Left homogenous superior quadrantanopia

Caused by contralateral side temporal stroke

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49
Q

Provoked PE. Anticagulation for how long?

A

Provoked (provoking factor gone) = 3 months therapy

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50
Q

Dx and mx?

A

Seborrhoeic dermatitis

Topical ketoconazole

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51
Q

Thyroid cancer associated with MEN-2 gene?

A

Medullary (calcitonin cells)

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52
Q

Starting (and max) dose for metoprolol extended release?

A

23.75mg (up to 190mg)

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53
Q

Manage ‘wearing off’ effect in Parkinson’s Disease?

A

Decrease dose and more frequent levodopa

Change to modified-released levodopa

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54
Q

Reversal of clopidogrel?

A

Desmopressin

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55
Q

Acute management of ACS?

A

MONA BASH C

Morphine

Oxygen if O2 sats <90%

Nitrates (expect right ventriclar infarction)

Aspirin

Beta blocker

ACE inhibitor

Statin

Heparin

Clopidogrel

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56
Q

Long QT; drug causes (3)

A

Haloperidol + antipsychotics, macrolides (erthromycin), TCA

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57
Q

Aphasia types and which side the stroke is on?

A

Broca’s: Expressive (producing language)

Wernicke’s: Receptive (understanding language)

Dominant hemisphere (ie LHS if right handed) MCA stroke

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58
Q

Signs of vit B12 deficiency (5)

A

Decreased vibration sense, decrease proprioception sense, paraesthesias, cerebellar signs (ataxia), delirium

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59
Q

Normocytic anaemia blood smear shows bite cells + Heinz bodies. What disease?

A

Haemolytic anaemia - Glucose-6-phosphate dehydrogenase deficiency

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60
Q

Zones of adrenal gland and what they produce.

A
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61
Q

Most common CAP in alcoholics?

A

Klebsiella pneumoniae

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62
Q

Testing for HIV?

A

HIV antibody immunoassay (ELISA) + p24 antigen (or combinaion antigen/antibody test)

Positive 2-6 weeks post exposue; test at initial presentation and 3 months later

Confirmation: HIV 1/2 differentiation testing or NAAT

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63
Q

Mx for Graves disease (2)?

A

Carbimazole

PTU

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64
Q

MEN-2 gene associated with what cancers (2)?

A

Medullary thyroid cancer (calcitonin) and pheochromocytoma

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65
Q

Example of class II antiarrhythmic

A

Beta blockers

Metoprolol

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66
Q

Hodgkin’s lymphoma is associated with what cells?

A

Reed-Sternberg cells

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67
Q

Causes of high anion gap metabolic acidosis (6)?

A

KUSMAL

Ketoacidosis

Uraemia in kidney failure

S (aspirin)

Metformin

Alcohol

Lactic acidosis

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68
Q

Mx of sarcoidosis? (2)

A

50% spontanous remit

Corticosteroids

Infliximab

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69
Q

Thrombocytopenia + recent GIT illness + jaundice + renal damage = ?

A

Haemolytic uremic syndrome (HUS)

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70
Q

Intention tremor (worse in terminal stages of movement), not present at rest. Dx?

A

Cerebellar tremor + slurred speech, nystagmus,
incoordination, wide based gait

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71
Q

Which diabetes medication causes euglycamic DKA?

A

SGL2 inhibitors (-giflozin)

Empagliflozin, dapagliflozin

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72
Q

What could this rash be in a child?

A

Meningococcal meningitis (Neisseria Meningiditis): look for fever, neck stiffness, headache

Henoch-Scholein Purpura: look for recent URTI illness, rash on buttocks, arthalgia + limp, colicky abdominal pain

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73
Q

Mx for partial seizures and side effect?

A

Carbamazepine (hepatotoxicity)

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74
Q

What is this condition called and associated with (3)?

A

Erythema nodosum

SORE SHINS

Streptococci pharyngitis
Oral contraceptive pill (OCP)
Rickettsia
Eponymous (Behçet)
Sulfonamides
Hansen’s Disease (Leprosy)
IBD (Crohn’s disease)
Non-Hodgkin’s lymphoma
Sarcoidosis

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75
Q

What needs to be done for circulation in ALS?

A

Conscious: BP, HR, ECG, ABG, 2x large bore cannulas +/- IVT

Unconscious: Compressions 30:2 with bag and mask, defibrillator

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76
Q

aPTT is a measure of what factors?

A

Instrinsic pathway (VIII, IX, XI, XII) + common pathway (I, II, V, X)

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77
Q

Serology to test for Coeliac disease (2)?

A

Anti-tissue transglutamase antibodies

Anti-gladin antibodies

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78
Q

Alcohol cessation medicaiton (3)

A

Disulfiram (best) Prevents alcohol metabolism. Must NOT have alcohol with this medication (causes aldehyde reaction)

Acamprosate reduces withdrawal symptoms

Naltrexone (less pleasure from alcohol)

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79
Q

Tremor: bilateral, action-based, positive family history. Dx, mx?

A

Essential tremor

Propranolol

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80
Q

Extensive red/purple skin lesions over eyes and nasolabial folds, associated with what disease?

A

Lupus pernio, associated with sarcoidosis

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81
Q

Physical exam test for psoriasis?

A

Auspitz sign (rub of scale and pin point bleeding occurs)

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82
Q

Causes of polycythemia?

A

Polycythemia vera

Smoking, COPD, CHF, high altitude, or increased EPO production, in renal cell carcinoma

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83
Q

Best acute pain meds in renal impairment? (2)

A

Oxycodone and fentanyl

Avoid morphne and tramadol as renally cleared

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84
Q

Diabetes medications contraindicated in ESRF? (2)

A

Metformin (lactic acidosis)

SGLT-2 inhibitors (-gliflozin) (won’t work well and euglycaemic DKA increases). It is renal protective before ESRF

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85
Q

Causes of macrocytic anaemia (2)

A

Vit B 12 deficiency (ie pernicious anaemia), folate

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86
Q

Tests for acromegaly (2)

A

Insulin like growth factor

Oral glucose tolerance test

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87
Q

What is this and what disease is it associated with?

A

Lichenification and adult atopic dermatitis (eczema)

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88
Q

Starting (and max) dose for perindopril?

A

5mg daily (up to 10mg)

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89
Q

Unprovoked PE. Anticagulation for how long?

A

Unprovoked = 3 months therapy + review

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90
Q

Investigations for Conn’s syndrome (2)

A

Is it renal artery stenosis/fibromuscular dysplasia or conn’s syndrome? Aldosterone:Renin ratio

Confirmation test: Salt supression (give salt, does aldosterone go down) If not -> Conn’s syndrome

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91
Q

What is this, what does it represent and what conditions is it prominant?

A

S4

Hypertrophic ventricle (hitting stiff walls)

Aortic stenosis, chronic HTN

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92
Q

What is this disease?

A

Atopic dermatitis (eczema)

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93
Q

Small Cell Lung Cancer associated with what paraneoplastic syndrome? Where is the cancer located?

A

ACTH (Cushings)

Central location

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94
Q

Altered mental state in alcoholic.

Diff dx (4) and mx?

A

Hepatic encephalopathy (+asterixis: ammonia toxicity in any severe liver disease) - Mx: lactulose

Wernicke’s encephalopathy (+oculomotor issues, ataxia: thiamine B1 deficiency in alcoholic specifically)

Mx: IV thiamine

Korsakoff’s syndrome (+amnesia and confabulation, hallucinations)

Mx: oral thiamine to prevent progression but irreversible

Alcohol withdrawal (+agitation, alcohol abstinence ie post surgery)

Mx: benzodiazepines

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95
Q

Smudge cells are associated with what leukaemia?

A

CLL

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96
Q

Causes of upper lobe DPLD/ILD? (6)

A

SCHART

Sillicosis

Coal worker’s pneumatosis

Histiocytosis

Anklylosing spondylitis

Radiation

Tuberculosis

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97
Q

What is this, what does it represent and what conditions is it prominant?

A

S3

Blood filling a large space in dilated cardiomyopathy

Ischemic dilated cardiomyopathy/ heart failure with reduced ejection fraction

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98
Q

ACS; when can you use thrombotic agents (plaminogen activator: tPA)?

A

Within 30 minutes of presentation

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99
Q

3 differential dx for this rash?

A

Contact dermatitis

Atopic dermatitis

Psoriasis

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100
Q

Iron studies for iron deficiency anameia?

A

Ferritin reduced (expect acute phase reactant)

Transferrin increased

Total iron capacity increased

Transferrin saturation decreased

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101
Q

TB investigations:

Tuberculin vs sputum microbiology

A

Tuberculin skin test assesses previous exposure via vaccine/latent infection

Sputum microbiology for active infection

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102
Q

This started on neck and spread to armspits and groin.

What is the disease? What is it caused by?

A

Scarlett fever

GAS

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103
Q

New York classification of HF

A

I: no symptoms of CHF

II: comfortable at rest

III: only comfortable at rest

IV: symptoms at rest

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104
Q

Melanoma biopsy. Breslow depth: 0.5mm. What excision margin does it need?

A

Beslow depth <1.0 mm -> 1cm margin

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105
Q

Ventricular tachycardia mx?

A

Amiodarone

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106
Q

Prevention of oesophageal bleeding? (3)

A

Propanolol

Oesophageal banding

If bleeding will kill before other liver complications (ie Wernicke’s encephalopathy) -> TIPS

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107
Q

Vit B12 deficiency associated with what conditions? (3)

A

Crohn’s disease (poor abosprtion)

Pernicious anaemia (no absorption)

Bariatric sugrery (no absorbtion)

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108
Q

Plethora, bruising, dizziness. High Hb. Dx, Mx?

A

Polycythaemia Vera

Venesection

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109
Q

Stable but symptomatic 1st and Mobitx Type I mx?

A

Atropine

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110
Q

What is this disease?

A

Atopic dermatitis (eczema)

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111
Q

TB management and adverse effects?

A

RIPE

Rifampin (CYP inducer, RED bodily fluids)

Isoniazid (Peripheral polyneuropathy (synergistic with B6 deficiency), optic neuritis, hepatotoxic). Give B6 to prevent neuropathy

Pyrazinamide (Hepatotoxic, hyperuricemia + gout, arthralgia)

Ethambutol (Optic neuritis and red/green colour blindness)

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112
Q

Effect of hypercalcaemia of membrance excitability?

Clinical features? (4)

A

Decreases membrane excitability

Moans: abdo pain, pancreatitis

Bones: bone pain

Psych overtones: anxiety, depression, sleep disturbance

Stones: nephrolithiasis

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113
Q

Blood smear shows Auer rods?

A

AML

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114
Q

Initial mx of HIV ?

A

x2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)

x1 integrase strand transfer inhibitor (INSTI)

(dolutegravir+abacavir+lamivudine)

Start as soon as diagnosed

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115
Q

Dx, mx?

A

Ankylosing spondylitis

Exercise + NSAID

2nd line is biologicals (-mabs)

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116
Q

Mx of asthma (3)

A

Check technique of current medications

SABAs/short acting beta agonists (salbutamol)

Add low dose-ICS (beclomethasone)

Then add LABA (long acting beta agonists) (always with ICS)

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117
Q

Metabolic alkalosis causes (2)?

A

H+ out of the Head = vomiting

Diuretics

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118
Q

What is this called and what disease is it associated with?

A

Koplick spots

Measles

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119
Q

Whats this disease?

A

Tinea corporis

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120
Q

DKA managament?

A

Fluid replacement++

Potassium supplementation (despite apparent hyperkalaemia)

Low dose IV insulin

Regular monitoring of volume status, serum glucose, serum electrolytes, and acid-base status

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121
Q

What is this condition?

A

Mongolian spots

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122
Q

APO managament? (5)

A

O2

Sit patient forward

IV frusemide

GTN spray

ACE inhibitor

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123
Q

Mx for central and nephrogenic DI?

A

Central: desmopressin

Nephrogenic: thiazide diuretics

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124
Q

Rash on web spaces of hands and feet. Dx, Ix?

A

Scabies

Skin scraping for microscopy

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125
Q

Severe headache, N/V and eye redness, halos
around lights, unilateral reduced visual acuity. Dx, Ix?

A

Acute glaucoma
Acetazolamide

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126
Q

What is this rash called and how long will it take to form?

Differntial dx in children? (2)

A

Morbilliform drug reaction after 14 days post exposure

Measles (cough, coryza prodrome, conjunctivitis, Koplick spots)

Rubella (tender lymphadenopathy)

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127
Q

What’s this condition?

A

Cherry haemangioma

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128
Q

ECG bradycardia with irregular rhythm?

A

HB 2 Mobitz type 1

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129
Q

Signs of previous STEMI (2)

A

T wave inversion (weeks), Q waves (forever)

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130
Q

What disease is this and other features (3)?

A

Chickenpox (Varicella Zoster Virus)

Pruritis

Mild fever

Scalp, mouth involvement

Self limiting 8 days

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131
Q

Side effects of glucocorticoids (CORTICOSTEROIDS)

A

C: Cushing syndrome

O: osteoporosis

R: retarded growth

T: thin skin

I: immunosuppressive

C: cataracts

O: oedema

S: suppresses HPA axis

T: thin gastric mucosa

E: emotional (psychosis)

R: rise in BP

O: overweight

I: increased hair

D: diabetes

S: striae

132
Q

Mutation in JAK2 leads to what disease?

A

Polycythaemia vera

133
Q

Tx for TB (and side effects) (4)

A

RIPE

Rifampin (red body fluids)

Isoniazid (Peripheral polyneuropathy (synergistic with B6 deficiency), optic neuritis, hepatotoxic)

Pyrazinamide (hyperuraemia + GOUT)

Ethambutol (Optic neuritis and red/green colour blindness)

134
Q

What does CT show? Risk factors?

A

Subdural haematoma: bleeding into space between dura mater and arachoid layer

Trauma

135
Q

Med mx for hyperprolactinaemia?

A

Dopamine agonist (cabergoline)

136
Q

Miscarriages, chest pain, headaches, thrombocytosis (platelets++), increased megakaryocytes on bone marrow biopsy

A

Essential Thrombocytosis

137
Q

Child with high-grade fever which lasts for > 5 days (paracetamol doesnt help), red conjunctiva, cervical lymphadenopathy.

Dx and Mx

A

Kawasaki’s disease

High dose aspirin (usually contraindicated due to Reye’s syndrome)

138
Q

Causes of a normal anion gap metabolic acidosis? (2)

A

Loss of bicarb

Bicarb out the Bum (diarrhoea)

Bicarb loss in Renal Tubular Acidosis

139
Q

Starting (and max) dose for bisprolol?

A

1.25mg daily (up to 10mg)

140
Q

Steps on counselling smoking cessation?

A

Ask: quantity, dependence (smoking after waking up), what methods have they tried before

Advise: Personalised reasons for quitiing

Assess: Willingness to quit

Assist: refer to QUIT line, nicotine patches/gum, medical therapy (varenicline = nicotine agonist, bupropion = antidepressant)

Arrange: follow up review

141
Q

ACS; What complications after days-weeks (5)

A

Ventricular wall rupture

Papillary muscle rupture + mitrale regurg

Atrial thromboembolism

Dressler’s syndrome/Pericarditis

Congestive heart failure

142
Q

Name the dermatomes

A

S1 lateral foot!

143
Q

Mx of SBP?

A

Ceftriaxone

144
Q

Lateral STEMI leads and vessel?

A

I, aVL, V5, V6, Left circumflex

145
Q

Above knee DVT. Anticagulation for how long?

A

Provoked (provoking factor gone) = 3 months therapy

Unprovoked = 3 months therapy + review

146
Q

Flushed face (plethora) is present in what disease?

A

Polycythaemia vera

Polycythemia in COPD, chronic CHF, smoking, alcohol

147
Q

, repeat ABGWhat needs to be done for disability in ALS?

A

Conscious: blood glucose, GCS, pupils, check for 4Hs and 4Ts (temperature, aucultation and trachea placement, ECG, urine toxins, ABG, CXR, CTPA)

148
Q

What’s this called?

A

Port Wine stain

149
Q

Risk factor for Hodgkin’s lymphoma?

A

EBV (Human herpes virus 4)

150
Q

HBsAB (Ani-HBsAg) positive means what?

A

We won! Either cleared infection or immunised

151
Q

Asymmetrical resting tremor, enhanced with distraction. Dx?

A

Parkinsonian tremor

152
Q

What is Alteplase?

A

thrombolytic plasminogen activator (fibrinolytic therapy - bust-a-clot)

153
Q

SPB prophylaxis (4)?

A

Fix the ascites:

Salt restriciton

Diuretic (esp. spironolactone)

Paracentesis

Consider Bactrim

154
Q

Below knee DVT. Anticagulation for how long?

A

Provoked (provoking factor gone) = 6 weeks therapy

Unprovoked = 3 months therapy + review

155
Q

Investigations for Graves (2)?

A

TRAbs (Anti-TSH receptor AB)

Anti-TPO

156
Q

Avoid what medication as 2nd line in diabetes?

A

Gliclazide (Sulfonylureas)

Risk of severe hypoglycaemia, weight gain

157
Q

Most common leukaemia of children?

158
Q

Classes of antiarrhythmics

A

Some Block Potassium Channels

Class I Sodium channel blockers

Class II Beta blockers

Class III Potassium blockers

Class IV Calcium channel blockers

159
Q

What is this disease?

A

Diabetic retinopathy

160
Q

Medical mx of delirium?

A

Oral anti-psychotic (riseperidone)

Then IM

Never benzodiazepines (unless alcohol withdrawl)

161
Q

Whats this disease and how to tx?

A

Impedigo

Amoxycillin

162
Q

Neurological claudication/spinal stenosis.

What are the symptoms?

What makes it worse/better?

A

Bilateral pain in buttocks and thighs

Occasional paraesthesias in legs

Worse pain when back is extended (standing)

Less pain bending forwards (ie walking uphill)

163
Q

Reversibility of FEV/FVC ?

A

12% and more than 200 mL in adults

164
Q

Tx for acne (2 + 1 females)?

A

Retinoids (avoid in pregnancy)

Topical benzoyl peroxide

OCP

165
Q

What’s this visual field called and what causes it?

A

Left homogenous inferior quadrantanopia

Caused by contralateral side parietal stroke

166
Q

Clinical features (1) and lab finding (1) of Conn’s syndrome?

A

Hypotension

Hypokalaemia

167
Q

Acoustic neuroma hearing tests?

A

Sensorineural hearing loss

Rinnes test AC>BC (normal but may be reduced bilaterally)

Weber’s test latersalises to normal ear

168
Q

Melanoma biopsy. Breslow depth: 1.3mm. What excision margin does it need?

A

Beslow depth 1-2 mm -> 1-2cm margin

169
Q

Causes of lower lobe DPLD/ILD? (6)

A

RASIO

Rheumatoid arthritis

Aspestosis

Scleroderma

Idiopathic pulmonary fibrosis

Other (meds): methotrexate, chemotherapy, nitrofurantoin (ABx for UTIs), amiodarone

170
Q

What’s this? Tx?

A

Ventricular tachycardia

Unstable: electrical cardiovert

Stable: amiodarone

171
Q

Cholesteatoma hearing tests?

A

Rinne’s test BC > AC in affected ear (abnormal)

Weber’s test lateralises to diseased ear (abnormal)

172
Q

Older lady, new onset pain in shoulders, hips and neck, morning stiffness. Weight loss, night sweats. Dx, Ix, Mx?

A

Polymyalgia rheumatica

ESR ++

Ensure no giant cell arteritis (jaw claudication, severe headache, visual symptoms, scalp tenderness or malaise)

Prednisolone

173
Q

HBcAB (Anti-HBcAg) + means what?

A

C means Contact, we have had expoure either currently or in the past

174
Q

Triad of Wernicke’s encepahlopathy and mx?

A

Opthalmoplegia

Ataxia

Confusion

IV thiamine

175
Q

ACS; when can you go to cath lab for PCI?

A

Within 60 minutes from presentation

176
Q

Central diabetes insipitus. What will the investigations show (2) and what is a cause?

A

Water deprivation test shows (continued) low urine osmolarity. Give desmopressin and urine osmolarity increases++

Caused by craniopharyngioma

177
Q

Melanoma biopsy. Breslow depth: 3mm. What excision margin does it need?

A

Beslow depth 2-4mm -> 2cm margin

Consider SLNB

178
Q

Asthma not controlled by SABA + ICS. What’s next?

A

ICS+LABA (Symbicort; budesonide and formoterol)

179
Q

Mx of pheochomocytoma?

A

Phenoxybenzamine (alpha blocker)

180
Q

Grey, frothy and malodorous, oily dirrhoea?

A

Coeliac’s disease

Anti-tissue transglutaminase antibodies

Anti-gladin antibodies

181
Q

New onset rash (+buttocks), recent URTI illness in child. What is the disease? What other features should you look out for?

A

Henoch-Schonlein Purpura

Arthritis and a limp

Abdominal pain

Nephritic syndrome

182
Q

Limited scleroderma diagnostic test?

A

Anti-centromere antibodies

183
Q

Treating nausea and vomiting in Parkinson’s disease?

A

Domperidone

Avoid metoclopramide (dopamine antagonist)

184
Q

Melanoma biopsy. Breslow depth: 5mm. What excision margin does it need?

A

Beslow depth >4mm -> 2cm margin

185
Q

Preserved EF Heart failure (diastolic HF), what drug improves mortality?

A

Low dose spironolactone

186
Q

Widened sacro-iliac joints on pelvic x-ray. Dx?

A

Ankylosing spondylitis

187
Q

Mx for COPD (6)

A

Smoking cessation

Pulmonary rehab

Short acting beta agonsists

Long acting muscurinic antagonists (tiopropium bromide) AND/OR Long acting beta agonist (salmeterol)

If exacerbations still: ICS+ LABA

(Consider O2 if sat <88%)

188
Q

Investigation for Hashimoto’s thyroiditis?

189
Q

Side effect of diuretics (2)?

190
Q

Floaters, flahsng lights, descending curtain of vision loss. Dx? Mx?

A

Retinal deattachment

Emegency opthalmoloical referral + repair

191
Q

Conductive hearing loss

Foul smelling ear discharge

Persistent otitis media

Otalgia

Vertigo

Facial weakness

Dx? Ix? Mx? Complications?

A

Cholesteatoma

CT of temporal bones looking for invasion

Surgery

Destructon of ossicles, intracranial invasion, facial nerve paralysis

192
Q

Non modifable risk factors for osteoporosis? (3)

A

Women

Post menopausal

Family history

193
Q

Starting (and max) dose for irbesartan?

A

75mg (up to 300mg daily)

194
Q

A 72 year old woman with a background of ischaemic heart disease and chronic kidney disease is admitted for a right total hip replacement. She is commenced on an unfractionated heparin infusion for VTE prophylaxis. Five days after surgery you notice that her left lower limb is tender and swollen and her platelet count is 70 (baseline 210). Dx and Mx?

A

Heparin Induced Thrombocytopenia Syndrome (HITS)

Cease heparin and change to non heparin (fondaparinux)

195
Q

Post ACS mx (6)

A

Statins, aspirin, beta blocker, ACE inhibitor, dual antiplatelet (1 year)

196
Q

Provoking factors for PE and DVT? (6)

A

Major surgery

Hospitalisation with immobilisation

Oestrogen therapy

Pregnancy

Postpartum period

Malignancy

197
Q

Hypercalcaemia + low PTH.

Investigations (2)?

Diff dx (3)?

A

Worried about PTHrP from tumours, bone mets for malignancy and granulomatous diseases (sarcoidosis, TB)

Investigation with PTHrP levels + 1,25 vit D levels

Tumour secreting PTHrP (SCC of lung, renal carcinoma): High PTHrP

Sarcoidosis, TB: High 1,25 vit D

Mets: consider whole body bone scan

198
Q

COPD: next management after SABA?

A

LAMA (tiopropium bromide)

199
Q

What’s this disease?

200
Q

Haemolytic anaemia bloods (4)

A

Normocytic anaemia

Decreased haptoglobin

Increased LDH

Increased bilirubin

201
Q

Band forms are associated with what leukaemia?

202
Q

Most common CAP in COPD

A

Haemophilus influenzae

203
Q

Examination findings for psoriasis (Skin + 2 others)?

A

Erythermaous well demarced patch on extensor surfaces with overlying silvery plaque

Nail pitting

Onycholysis (nail bed seperation)

204
Q

Positive Purified Protein Derivative TB test, next step and mx?

A

Is it latent or active? CXR and sputum culture

Latent -> Isoniazid

Active -> RIPE

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

205
Q

What is this skin condition?

A

Suborrheic keratosis

206
Q

Most common CAP?

A

Strep. Pneumoniae

207
Q

Investigation for Cushing’s (2+1+1)

A

Is it a high cortisol issue (Cushing’s syndrome)?

Low dose dexamethosone supression test good as outpatient (give dexamethosone (cortisol), check early morning serum cortisol levels -> if elevated, it is cushings.

+ either (confirmation)

24 urinary cortisol (best but needs to be inpatient)

OR midnight salivary cortisol

Is it ACTH depndent?

Serum ACTH level (if high, it is pituitary or exogenous)

If ACTH depndent; is it pituitary or lung?

High dose dexamethosone supression test (give loads of dexamethosone, pituitary will be supressed, lung actopic ACTH won’t be)

208
Q

Normal Rinne’s test?

A

Air conduction > bone conduction

209
Q

Non-small cell lung cancer types and paraneoplastic syndromes? (3)

A

Adenocarcinoma = peripherally located, no syndrome

SCC = PTHrP (hypercalcaemia)

Carcinoid tumour = serotonin syndrome

210
Q

Symptoms of Gastroperesis?

A

Nausea, vomiting, early satiety, upper abdominal pain, and bloating

Acute on chronic course

211
Q

Abrupt onset of severe eye pain, redness, blurry vision/vision loss, headache, nausea, halos around lights, fixed mid-dilated pupil, conjunctival redness, corneal edema.

Dx? Ix? Mx?

A

Acute Angle Closure Glaucoma

Gonioscopy (slit lamp)

Emergent Opthalmology referral

Eye drops: Beta blocker (e.g., timolol) or α2 agonist (e.g., apraclonidine)

Systemic: acetazolamide

212
Q

When to needle thoracocentesis in (non tension) pneumothorax?

A

Primary pneumothorax (no significant smoking history or evidence of underlying lung disease), size >2cm and/or breathless

Secondary pneumothorax (significant smoking history or evidence of underlying lung disease), size 1-2cm

If <1cm: high flow oxygen and observation for 24 hours

If >2cm or breathless: chest drain

213
Q

Which type of PUD is likely to cause haematemesis?

A

Gastroduodenal artery

214
Q

Tumour marker for papillary and follicular thyroid cancer?

A

Thyroglobulin

215
Q

Clinical signs of :

Ignore half of their body

Dressing apraxia

Visual-spartial neglect

A

Non dominant (RHS if right handed) hemisphere Parietal MCA stroke

216
Q

What’s this skin condition?

A

Acinic/Solar keratosis, premalignant for SCC

217
Q

This rash is present on the extensor surfaces or buttocks.

What is this called and what disease it is associated with?

A

Dermatitis herpetitformis (herpetiform vesicles/like herpes)

Coeliac disease

218
Q

What needs to be done for breathing in ALS?

A

Conscious: O2 sats probe, 15L non rebreather mask

Unconscious: Ear to mouth, check breaths and chest rising

219
Q

What disease are these associated with?

A

Herpes Simplex Virus

(Erythema multiforme/target lesions)

220
Q

Bilateral symmetrical progressive weakness, sensory loss, and areflexia.

Diagnosis?

A

Guillain-Barre Syndrome (GBS)

Preceding diarrhoeal illness (e.g. Campylobacter jejuni infection)

Bilateral facial paralysis

Progressive weakness

221
Q

Features of CXR?

Dx?

Complication?

A

Bilateral hazy opacities, loweer lobe predominance

Pleural plaques

Asbestosis

Mesothelioma

222
Q

Best test for hereditary spherocytosis?

A

Osmolarity frgility test

223
Q

Dx? Mx?

A

Basal cell carcinoma

Moh’s surgery as on aesthetic spot

Alternatives: cryotherapy, laser blation, 5-Fluorouracil

224
Q

What is this rash and what is is caused by?

A

Erythema infecioseum, Parovirus B19 (+arthritis)

225
Q

ACS cintraindication to fibrinolytics?

A

Significant hypertension

226
Q

What is this called and what disease?

A

Herald patch in Pityriasis rosea

227
Q

4H’s and 4T’s ALS?

A

Hypoxia, hypovolaemia, hypo/hyperkalamaemia, hypo/hypoerthermia, hypoglycaemia

Thromboembolism, tension pneumothorax, cardiac temponade, toxins

228
Q

Starting (and max) dose for nebivolol?

A

1.25mg (up to 10mg) daily

229
Q

Unstable tachycardia Mx?

A

Synchronised cardioversion

230
Q

Deficiency in ADAM TS13 is what disease?

A

Thrombotic thrombocytogenic purpura (TTP)

231
Q

Symmetrical weakness

Symmetrical loss of proprioception and vibration sense

Unsteady wide-based gait

A

Subacute combined degeneration of the spinal cord (secondary to vitamin B12 deficiency)

232
Q

Low PT, normal aPTT is what pathway and suggests what diseases? (3)

A

Extrinsic pathway

Warfarin use

Vit K deficiency

FVII deficiency

233
Q

Most common HAP?

A

Pseudomonas pneumonia

234
Q

What is this disease?

A

Retinal vein occlusion

235
Q

What could this disease be (5)?

A

Roseola infantum (HHV6) - high fever, fever ceases then rash on trunk

Rubella - puritus

Measles - widepsread non-pruritic rash, cough, conjunctivitis, Koplick

Scarlet fever - rash on face, pits, groin

Erythema infeciosum

Chicken pox- veicles, pruritus

236
Q

Thrombocytopenia + fever + jaundice + neuro sx + renal damage = ?

A

thrombotic thrombocytopenic purpura (TTP)

237
Q

HBsAg -

HBsAb (Anti-HBsAg) +

HBcAb (Anti-HBcAg) +

What disease state?

A

Resolved HBV infection

HBsAg - (not currently infected)

HBsAb (Anti-HBsAg) + (we won!)

HBcAb (Anti-HBcAg) + (has had contact)

238
Q

Right ear conductive hearing loss. Weber’s test?

A

Lateralises to right ear (diseased ear)

239
Q

When can you give atleplase (thrombolytic therapy/plasminogen activator) in ischemic stroke?

A

4.5 hours from symptom onset, from when they went to sleep or last seen normal

240
Q

Investigation for hypercalcaemia (2)?

A

Check corrected with albumin.

PTH

Normal or low PTH -> malignancy

High PTH -> hyperparathyroidism

241
Q

What indicates a current HBV infection? How to determine acute or chronic?

A

HBsAg + (current infection)

HBcAb (Anti-HBcAg) + (has had contact)

Determine with IgM HBcAb (Anti-HBcAg)

242
Q

Meniere disease symptoms

A

Middle-age

Recurrent attacks of vertigo,

Progressive sensorineural hearing loss

Nausea, vomiting

Tinnitus

Aural fullness

243
Q

Mechanism of action of SGL2 inhibitors (-giflozin; empagliflozin, dapagliflozin). Adverse effects (2)?

A

Inhibits resorption of urinary glucose.

Euglycaemic DKA, UTIs

244
Q

Asthma not controlled by SABA alone. What’s next?

A

Low dose ICS (beclomethosone)

245
Q

Example of class I antiarrhythmic

A

Sodium channel blocker

Lignocaine

246
Q

Mx for acinic keratosis (2)?

A

Cryotherapy

5-fluorouracil (5-FU)

247
Q

ACS; What complications within 48 hours (4)

A

Heart blocks

Ventricular tachycardia

Sudden cardiac death

Acute LVHF (pulmonary oedema, cardiac death)

248
Q

Mx of thyrotoxic phase of sub acute thyroditis?

A

Beta blocker

NO ANTITHYROID DRUG

249
Q

Vestibular neuritis features?

A

Younger people

Acute onset

Vertigo

No hearing loss

250
Q

What is this and it is associated with what disease?

A

Kolionychia + iron defieicny anaemia

251
Q

Telangiectasia of lips is associated with?

A

Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

252
Q

CT shows what and risk factors?

A

Extradural (epidural) haematoma: bleeding in between dura mater and skull, bi-convex (bleeding on outside and inside of skull)

Trauma related (blow to head); rupture of middle meningeal artery

253
Q

On metformin already. Which 2nd line diabetes medication would not cause you to gain weight?

A

SGLT2 inhibitors (-giflozin)

Empagliflozin, dapagliflozin

254
Q

Test’s for Coeliac disease?

A

Anti-tissue transglutaminase antibodies

Anti-gladin antibodies

Confirm with endoscopy and biopsy of duodenum

255
Q

Pattern of inheritance of haemophilia?

A

X-linked recessive; means a male patient will only inherit it from his mothers side.

Father will NOT pass to his son but may pass gene to daughter (who will become carrier).

256
Q

Philadelphia chromosome (t22:9) associated with which leukaemia?

257
Q

AV nipping in what disease?

A

hypertensive retinopathy

258
Q

What is this disease?

A

Retinal artery occlusion

259
Q

Biggest cause of preserved ejection fraction/diastolic failure ?

Others (2)

A

LV hypertrophy from HTN

Aortic stenosis

Constrictve hypertrophy (sacroidosis, amyloidosis, haemochromotosis)

260
Q

CA 125 is associated with which cancer?

A

Ovarian cancer

261
Q

New name for wegener’s granulomatosis?

A

Granulomatosis with polyangiitis

262
Q

HBsAg positive means what?

A

Currently infected

(If negative may have cleared in past)

263
Q

Torsades de pointes mx?

264
Q

HBsAg -

HBsAb (Anti-HBsAg) +

HBcAb (Anti-HBcAg) -

What disease state?

A

Vaccinated against HBV

265
Q

Unilateral eye pain and redness with this on fluorescein staining. Dx?

A

Herpes simplex keratitis

266
Q

How to give adrenaline in anaphylaxis, where, how much?

A

1:1000 0.5mL, midlateral thigh

267
Q

Investigation for Addison’s (2)

A

Is it low cortisol? Early morning salivary cortisol

Is the deficiency in pituitary or adrenal? ACTH stimulating test (if pituitary, then cortisol will decrease)

268
Q

Reversal agent for benzodiazepines?

A

Flumenazil

But not in emergency setting/overdose. Needs intubation.

269
Q

Tx for SIADH?

A

Fluid restrict

270
Q

What is this condition?

A

Infantile haemangioma

271
Q

Best diabetes medication for CHF?

A

SGL2 inhibitors (-giflozin)

Empagliflozin, dapagliflozin

Cardiac protective

272
Q

Test for ascites and diff dx?

A

SAAG serum-ascitic albumin gradient

([albumin]serum – [albumin]ascitic fluid)

High gradient >11g/L -> transudate, theres more protein in blood (Liver ascites, right CHF)

Low gradient <11g/L -> Exudative (malignancy, SBP, nephrotic syndrome)

273
Q

Contraindications in AF + WPW (4)

A

Adenosine

beta blocker, calcium channel blocker, digoxin

274
Q

Urine and serum (osmolarity and sodium) in SIADH?

A

Urine high osmolarity

Urine high sodium

Serum low osmolarity

Serum low sodium

275
Q

Long QT; Electrolyte disturbances (1)

A

Hypokalaemia

276
Q

Reversal agent for opioids?

277
Q

Indigestion (dyspepsia), mild epigastic pain radiating to left shoulder, occuring immediately after meals, weight loss, melena. Dx, Ix, Mx?

A

Chronic gastric peptic ulcer

Bets test: Endoscopy and biopsy (gastric ulcers have higher risk of malignancy)

H. Pylori rapid urease breath test

Triple therapy to eradicate H Pylori: PPI + amoxycillin + clarithromycin

Rescope (+/- biopsy) gastric ulcers in 6 weeks to ensure eradication as higher risk of malignancy

278
Q

Complication in infective endocarditis from IVDU?

A

Pulmonary emboli (due to septic emboli from tricuspid valve)

279
Q

Modifiable risk factors for osteoprosis (4)?

A

Smoking

Alcohol use

Low BMI and malnutrition

Sedentary

280
Q

Inferior STEMI leads and vessel

A

II, III, aVF; right coronary

281
Q

What’s this? Mx?

A

Supraventricular tachycardia (>150 beats per minute, narrow complex)

Vagal manoeurves

Adenosine

Verapramil

282
Q

Acute GI bleed mx (4)

A

Endoscopy

Fluid resuscitation + blood transfusion

Terlipressin

Octreotide

283
Q

Sub-Saharan Africa, fever, jaundice, thrombocytopenia, renal dysfunction. Dx, Ix?

A

Malaria

Thick and thin blood films

284
Q

Starting (and max) dose for valsartan?

A

40mg (up to 160mg) daily

285
Q

2/5 for all movements on the right side and 5/5 for the left side.

There is loss of vibration and proprioception on the right limbs.

There is deviation of the tongue to the left with mild atrophy.

A

Left medial medullary infarct (anterior spinal artery)

286
Q

ABx for uncomplicated cystitis

A

Trimethoprim 3 days

287
Q

ABx for mild CAP?

A

Amoxicillin and doxycycline

288
Q

Prophylaxis of tumour lysis syndrome?

A

Allopurinol

289
Q

Renal involvement, history of asthma, dyspnoea + petechieal rash? Dx and what bloods?

A

Churg-Strauss disease (Eosinophilic granulomatosis with polyangiitis)

pANCA

Eosinophilia

290
Q

Features of APO on CXR?

A

ABCDE

Alveolar oedema

Kerley B lines and bats wing hilar shadowing

Cardiomegaly

Diversion of upper lobes

Effusions

291
Q

Amiodarone adverse effects? (7)

A

BITCH

Bradycardia/Blue man
Interstitial Lung Disease
Thyroid (hyper and hypo) (due to excess iodine in amIODarone)
Corneal (ocular)/Cutaneous (skin)
Hepatic/Hypotension when IV (due to solvents)

292
Q

Target BP for diabetics?

A

140/90

130/80 if they have diabetes + proteinuria.

293
Q

Cannon ‘a’ wave dx?

A

Complete heart block

a wave is contraction of atrium. Cannon a signifies contraction of the atrium against a closed tricuspid valve ie in complete heart block

294
Q

Dominant ‘a’ wave dx?

A

Pulmonary stenosis and tricuspid stenosis

295
Q

Janeway’s nodes location on hand. Painful or not painful?

A

Janeway’s nodes are painless and on palmar surface of hands

296
Q

Osler’s nodes location on hand. Painful or not painful?

A

Osler’s nodes are painful and on dorsum of hands

297
Q

Where does frusemide work?

A

Ascending loop of Henle

298
Q

Where do thiazides work?

A

Distal tubule

299
Q

Where does spirinolactone work?

A

Collecting ducts

300
Q

Tx of cluster headaches? (3)

A

High flow oxygen, subcut sumatriptan and for prophylaxis verapamil (get CG before)

301
Q

Man comes in with lower limb weakness. Likely vascular territory affected?

A

ACA (lower limbs >> upper limbs)

302
Q

Mx of ascites?

A

Spironolactone

303
Q

Older person with meningitis. Empirical ABx?

A

Ceftriaxone + dexamethosone + listeria cover (benzylpenicillin)

304
Q

Most common cause of death after a MI in 24 hours?

A

Ventricular fibrillation

305
Q

How to determine severity of pneumonia?

A

CURB-65

Confusion (disorientation, impaired consciousness)

Urea > 7 mmol/L (20 mg/dL)

Respiratory rate ≥ 30/min

Blood pressure: systolic BP ≤ 90 mm Hg or diastolic BP ≤ 60 mm Hg

Age ≥ 65 years

CURB-65 score ≤ 1: The patient may be treated as an outpatient.

CURB-65 score ≥ 2: Hospitalization is indicated.

CURB-65 score ≥ 3: ICU-care should be considered.

306
Q

Mx of Crohn’s disease?

A

Acute: corticosteroids

Maintainence: Azathioprine

Stop smoking

307
Q

Mx of UC?

A

5-ASA drugs

308
Q

Painful rash. Dx and Mx?

A

Hepes zoster (Shingles) caused by VZV/HHV3

Oral acyclovir

309
Q

Triad in Meniere’s disease?

A

Vertigo, tinnitus and hearing loss (sensorineural)

310
Q

Dx of LBBB or RBBB?

A

Widened QRS complex.

V1 downwards R wave = LBBB

V1 upwards R wave = RBBB

311
Q

ECG changes in hyokalaemia?

A

In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT

U waves

Sine T wa=ve

Flattened T waves

312
Q

When to refer a burn? (6)

A

all deep dermal and full-thickness burns.

superficial dermal burns of more than 10% TBSA in adults, or more than 5% TBSA in children

superficial dermal burns involving the face, hands, feet, perineum, genitalia

any inhalation injury

any electrical or chemical burn injury

circumforencial burns or deep torso burns need escharotomy

313
Q

Fluids for burns?

A

Parkland formula

total body surface area of the burn % x weight (Kg) x4

314
Q

Assessing total body surface aea of burns?

A

Wallace’s Rule of Nines:

head + neck = 9%

each arm = 9%

each anterior part of leg = 9%

each posterior part of leg = 9%

anterior chest = 9%

posterior chest = 9%

anterior abdomen = 9%

posterior abdomen = 9%

315
Q

Budd-Chiari syndrome is associated with what clinical features (3)?

A

Clot in the portal vein

Sudden onset abdominal pain, ascites, and tender hepatomegaly

316
Q

Carcinoid syndrome features?

A

Abdominal pain, diarrhoea and flushing

317
Q

What’s this? Mx?

A

Keratoacanthoma. Rapidly growing, resemble SCC but is benign.

Surgical excision.

318
Q

Loss of right lower limb motor. What stroke?

A

Left lucunae pure motor stroke

319
Q

Left horner’s syndrome, horseness of voice, dysphagia, loss of temp and pain over left face. Loss of pain and temp over right arm and leg. Ataxia. Dx?

A

Left lateral medullary/PICA/Wallenberg syndrome

320
Q

Most common type of thyroid cancer?

A

Papillary cancer (is popular)

321
Q

Proximal muscle weakness, dysphagia, rash over upper eye lids and this rash. Dx? Ix?

A

Dermatomyositis, raised CK

322
Q

Mx of paracetamol overdose?

A

If within 4 hours -> activated charcoal

If within 8 hours, get 4 hour paracetamol level to see if NAC is needed

If unknown or >8 hours, give NAC

323
Q

Mx of Bell Palsy?

A

<72 hours onset of symptoms -> prednisolone

>72 hours -> do nothing, 85% spontaneously remit in 3 weeks

324
Q

Red flags for headache?

A

Severe unrelenting headache

Thunderclap

Focal neuro deficit

Seizures

Impaired consciousness

Signs of raised ICP: LOC, vomiting, bradycardia, worse in mornings, worse when lying down

Signs of meningism: neck rigidity, photophobia, fever

Eye pain

325
Q

Acute onset vertigo in otherwise healthy person with recent URTI.

No hearing loss, no tinnitus.

A

Vestibular neuritis

326
Q

Gradual onset sensorineural hearing loss, tinnitus, dizziness.

Potential for cranial nerve involvement.

A

Acoustic neuroma

MBBS V (6 decks)

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