Medicine Flashcards
What can you do during endoscopy to help stop variceal bleeding?
Band ligation
What can you do to stop general upper GI bleeding (not varisces)
Adrenaline injection
What can you use for bleeding prophylaxis after endoscopy
Propanolol
How can you tell between hepatocellular carcinoma and pancreatic cancer?
ALT/AST will be raised in hepatic cancer
Just ALP and GGT in pancreatic cancer
Both can have weight loss, anorexia and jaundice
First line management of NAFLD
Lose weight
Most common cause of NAFLD
Obesity
What actually IS non-alcoholic fatty liver disease?
Fat build up in the liver
Can result in inflammation
Can progress to fibrosis and cirrhosis
Which is greater, ALT or AST in NAFLD?
ALT > AST
Signs of NAFLD
Increased liver echogenicity on USS
ALT > AST
Heptomegaly
RF such as obesity
Ix for NAFLD
Blood tests
Liver USS
ELF liver testing
What can induce UC flares?
Smoking cessation
Illness
Stress
AMA is linked with which disease?
PBC
AI hepatitis blood results
ALT/AST > ALP
AMA negative
Features of autoimmune hepatitis
Fever
Jaundice
ANA
Inflammation beyond limiting plate on liver biopsy
Management of AI hepatitis
Steroids or other immunosuppressants
When is a transjugular intrahepatic portosystemic shunt performed?
Refractory bleeding in oesophageal varices
Which 2 veins are joined in a TIPS procedure?
Hepatic vein and portal vein
Management of acute oesophageal variceal harmorrhage
ABC FFP and vit K to correct clotting Terlipressin Prohylactic antibiotics (typically quinolones) ENDOSCOPY! TIPS
Prophylaxis of variceal haemorrhage
Propranalol
Band ligation
1st line management of PBC
Ursodeoxycholic acid (slows progression and improves symptoms)
Complications of PBC
CIRRHOSIS
Which antibodies in PBC
AMA
Sx of PBC
Itching
Jaundice
Raised ALP
Clubbing?!
In transudative ascites the SAAG is high or low?
HIGH ( >11 )
Causes of exudative ascites
Infection
Cancer
SAAG in exudative ascites will be >11 or <11?
<11!
How might Budd-Chiari syndrome present?
Sudden abdo pain
Ascites
Tender hepatomegaly
Risk factors of oesophageal cancer
GORD
Smoking
Achalasia
Alcohol
Squamous oesophageal cancer usually occurs in which portion of the oesophagus?
Upper 2/3!
Dx of oesophageal cancer
Endoscopy
Barium swallow
Main risks of oesophageal surgery?
Bleedings Anastomotic leaks (can result in mediastinitis = high mortality)
N B symptoms in CLL suggests?
Richter’s transformation
CLL transforming into large cell lymphoma!
1/3 rule of CLL
1/3 bleeding
1/3 infection
1/3 transform
Clinical features of ARDS
Multi organ failure
Acute dyspnea
Rising ventilatory pressures
Patient is acutely unwell, should you give the flu vaccine?
No, you should wait
What is a flail chest injury?
Segment of rib breaks off and becomes detached
RF of flail chest injury
Pneumothorax
Bloody diarrhoea
Painful abdomen
SNT abdomen
AF
Mesenteric ischaemia
Diagnosis of mesenteric ischaemia
Lactate
CT scan
Signs of ischaemic colitis
Transient, less severe than mesenteric ischaemia
See thumb printing of bowel on abdo xray
What is intestinal angina also known as?
Chronic mesenteric ischaemia
Triad of chronic mesenteric ischaemia
Severe, long term colicky post prandial abdo pain
Weight loss
ABDOMINAL BRUIT!
Why do patients with chronic mesenteric ischaemia get weight loss?
Poor blood supply to the bowel leads to poor absorption
Which fissure is across the right lobe and delinieates the UL and ML?
Horizontal fissure
What is aphasia
Inability to comprehend or formulate language
Major causes of aphasia
CVA
Head trauma
Brain tumours
What can infective endocarditis put you are risk of?
CVA because infective emboli can break off and block vessels
Name of primary heart tumour
Atrial myxoma
Most commonly affected valve in IE
Mitral valve
Most common cause of infective endocarditis
S.Aureus in IVDU
HIV needlestick protocol
Oral anti-retroviral therapy for 4 weeks
Cause of bacterial vaginosis
Overgrowth of gardenerella vaginalis
Symptoms of trichomonas
Frothy dischargeand vulvitis, vaiginitis or cervicitis
Type of cell seen on microscopy in bacterial vaginosis
Clue cells
Signs of bacterial vaginosis
Clue cells on microscopy
Raised (>4.5) pH
Clear, thin, fishy discharge
Treatment of bacterial vaginosis
Oral metronidazole
Migraine triggers
CHOCOLATE COCP Hangover Orgasms Chocolate
Really acidotic in a cirrhosis patient =>
Alcoholic ketoacidosis
Management of alcoholic ketoacidosis
Infusion of saline and IV thiamine
DKA features
Ketonuria
Hyperglycaemia
HHS features
Hyperglycaemia
ABSENCE of ketones
Hypovolaemia
Hyperosmolarity
Features of an Addisonian crisis
Hypotension
Hypoglycaemia
N+V
Drowsiness
Exacerbating factors of Addison’s disease
Infection or steroid withdrawal
Above the waist ulcers most likely which type of herpes?
Herpes type 1
Below the waist herpes most likely which type?
Herpes type 2
Treatment of colicky pain due to mechanical obstruction
Hyoscine butylbromide
Drugs for N+V
Cyclizine
Haloperidol
Metoclopramide
Antiplatelet treatment for percutaneous coronary intervention
Aspirin
Ticagrelor
Investigation for PSC
MRCP
Well’s score of 1 and a swollen leg, what should you do?
D-dimer in 4hr
It’s very sensitive for DVT!
1st line treatment of VTE?
Rivoroxaban (DOAC)
If a DVT is ‘likely’ 2< what should you do?
Proximal leg vein ultrasound
If positive -> anticoagulant
If proximal leg vein ultrasound is negative, what should you do?
D-dimer
What can cause thoracic outlet syndrome?
Osseous structure (rib) or soft tissue growth can impair the brachial plexus or arterial system Either going to get tingling or a pale limb
Management of Bell’s palsy
Prednisolone
Artificial tears and eye taping
Which key drug can increase WCC?
Steroid
Prednisolone
Glucocorticoid
Why do steroids increase WCC initially?
Cause demargination of neutrophils from the endovascular lining
Signs of idiopathic intracranial hypertension
Chronic, generalised headaches
Visual disturbance
Papilloedema
High opening pressure on LP
Biggest modifiable risk factor in idiopatic intracranial hypertension
Weight
Delayed puberty and absent sense of smell since birth =>
Kallman’s syndrome
Hormone levels in Kallman’s syndrome
Low/normal FSH
LOW TESTOSTERONE
What is varenicline used for?
Smoking cessation
MSM should be offered additional immunisation for …
Hepatitis A
Mid shaft humeral fractures are assocaited with injury to which nerve?
Radial nerve
How can you assess the radial nerve?
Extend the wrist
Cut off for acute graft rejection
<6mo
How might acute graft rejection present?
Symptoms of infection LIF pain Fever Rigors Renal failure
Best initial management of acute graft rejection
Increase steroid dose
What is a typical Addisonian picture?
Low sodium
High potassium
Low BP
Symptoms of acute adrenal insufficiency
Delerious and hypotensive after surgery after being on long term corticosteroid therapy
Mx of adrenal crisis
Hydrocortisone 100mg IV
1L of normal saline over 1hr
Cellulitis with haemorrhagic bullae implies
Necrotising fasciitis
Most common location of necrotising fasciitis
Perineum
Fournier’s gangrene
Mx of necrotising fasciitis
Urgent surgical debridement
IV antibiotics
Iron study levels in haemochromatosis
Raised transferrin saturation, raised ferritin, low TIBC (because left over capacity is reduced)
First line Mx of PBC
Ursodeoxycholic acid
Complication of PBC
Cirrhosis -> portal hypertension -> ascites -> variceal haemorrhage
Mx of itching in PBC
Cholestyramine
Which cause of pneumonia is assocaited with erythema multiforme?
Mycoplasma pneumoniae
Anaemia and raised bilirubin =>
Haemolysis
Mx of mycoplasma pneumoniae?
Doxycycline
Mx of hypothyroidism
Levothyroxine
Mx of hyperthyroidism
Block and replace
Carbimazole
Levothyroxine
Long term steroid use increases risk of…
Fractures
Low platelets
Petechial rash
Bleeding
ITP
First line treatment of ITP
Oral prednisolone
Treatment of localised impetigo
Hydrogen peroxide 1% cream who are systemically well (new first line)
Topical fusidic acid
Shouldn’t be in school because it’s highly contagious
What is osteomalacia?
Poor bone mineralisation due to lack of vitamin D
Long term steroid use is associated with…
Osteopenia
Osteoporosis (difference = T score remember)
Avascular necrosis
Cushings
First line T1DM management
Basal bolus regime = 2 doses of determir
How often should HbA1C be monitored in T1DM?
Every 3-6mo
What is the target HbA1C?
48mmol
Cut off BMI for considering adding metformin to T1DM management?
25
Which drug can you give to reduce vasospasm in SAH?
Nimodipine
What is the surgical treatment of ruptured berry aneurysm ?
Insertion of a coil by interventional radiologists
Complications of SAH (after initial stuff)
Vasospasm
Seizures
Hydrocephalus
Rebleeding
What is xanthachromia?
Blood in the CSF, detected 12hr post bleed to confirm SAH
What is the medical management of incomplete miscarriage?
Vaginal misoprostol
Treatment of leptospirosis
Doxycycline
HIV patient, getting clumsy and non-compliant with medication
Leukoencephalopathy
Usually secondary to JC virus
Hyperacute T waves indicate what?
Early myocardial ischaemia
Investigations for pumonary oedema
Bedside observations Arterial blood gas ECG Troponin if concerned about a new cardiac event Serum BNP Chest Xray
Mx of pulmonary oedema
Take an ABCDE approach
Sit the patient up
Administer oxygen
Ensure IV access
IV Furosemide
Consider non-invasive ventilation such as CPAP if failed medical therapy (usually in an intensive care setting)
Consider further therapies in the intensive care setting such as invasive ventilation and inotropic support if the above fails
1st line management of diabetic neuropathy
Pregabalin
Management of pericarditis
Naproxen and bed rest
Complications of hypomagnesaemia
Ventricular arrhythmias - magnesium is an essential cofactor in the cardiac Na/K-ATPase pump. Weakness Paresthaesia Seizures Coma Hypocalcaemia - because low magnesium interferes with PTH release. Hypokalaemia Chondrocalcinosis
Causes of unilateral optic disc swelling
Vascular – Diabetes or central retinal vein occlusion
Inflammatory – Uveitis or sarcoidosis
Infective – Herpes, toxoplasmosis or viral
Multiple sclerosis
Lymphoma
Features of tetralogy of Fallot
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect
What type of drug is octeotride?
Somatostatin analogue
Extra-intestinal features of IBD
Dermatological manifestations: erythema nodosum, pyoderma gangrenosum.
Ocular manifestations: anterior uveitis, episcleritis, conjunctivitis.
Musculoskeletal manifestations: clubbing, a non-deforming asymmetrical arthritis, a sacroiliitis.
Hepatobiliary manifestations: primary sclerosing cholangitis (this is much more common in ulcerative colitis than in Crohn’s disease).
Other features include AA amyloidosis (secondary to chronic inflammation).
Hyperkalaemia ECG changes in order of severity
Tall tented T-waves Flattened P-waves Prolonged PR interval Widened QRS complexes VF/asystole
Viral causes of gastroenteritis
Rotavirus: most common cause of infantile gastroenteritis
Norovirus: most common cause of viral infectious gastroenteritis in all ages in England and Wales
Adenoviruses: commonly cause infections of the respiratory system but can also cause gastroenteritis, particularly in children.
Bacterial causes of gastroenteritis
Staphylococcus aureus: usually found in cooked meats and cream products
Bacillus cereus: mainly found in reheated rice.
Clostridium perfringens: usually found in reheated meat dishes or cooked meats
Campylobacter
E.coli including E.coli 0157 (which can cause haemolytic uraemic syndrome)
Salmonella
Shigella
Asymptomatic longstanding AF, first line treatment
Verapamil (rate control)
Chads vasc of 1 (1 being for female sex), what do you do?
Nothing
No need for anticoagulation
Splanchnic nerve damage causes
Impotence
Sexual dysfunction
Causes of urinary obstruction Sx
BPH
Prostate cancer
Urethral stricture
