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Passmed finals > Medicine > Flashcards

Medicine Flashcards

1
Q

What can you do during endoscopy to help stop variceal bleeding?

A

Band ligation

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2
Q

What can you do to stop general upper GI bleeding (not varisces)

A

Adrenaline injection

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3
Q

What can you use for bleeding prophylaxis after endoscopy

A

Propanolol

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4
Q

How can you tell between hepatocellular carcinoma and pancreatic cancer?

A

ALT/AST will be raised in hepatic cancer
Just ALP and GGT in pancreatic cancer

Both can have weight loss, anorexia and jaundice

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5
Q

First line management of NAFLD

A

Lose weight

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6
Q

Most common cause of NAFLD

A

Obesity

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7
Q

What actually IS non-alcoholic fatty liver disease?

A

Fat build up in the liver
Can result in inflammation
Can progress to fibrosis and cirrhosis

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8
Q

Which is greater, ALT or AST in NAFLD?

A

ALT > AST

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9
Q

Signs of NAFLD

A

Increased liver echogenicity on USS
ALT > AST
Heptomegaly
RF such as obesity

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10
Q

Ix for NAFLD

A

Blood tests
Liver USS
ELF liver testing

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11
Q

What can induce UC flares?

A

Smoking cessation
Illness
Stress

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12
Q

AMA is linked with which disease?

A

PBC

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13
Q

AI hepatitis blood results

A

ALT/AST > ALP

AMA negative

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14
Q

Features of autoimmune hepatitis

A

Fever
Jaundice
ANA
Inflammation beyond limiting plate on liver biopsy

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15
Q

Management of AI hepatitis

A

Steroids or other immunosuppressants

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16
Q

When is a transjugular intrahepatic portosystemic shunt performed?

A

Refractory bleeding in oesophageal varices

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17
Q

Which 2 veins are joined in a TIPS procedure?

A

Hepatic vein and portal vein

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18
Q

Management of acute oesophageal variceal harmorrhage

A 
ABC 
FFP and vit K to correct clotting
Terlipressin
Prohylactic antibiotics  (typically quinolones)
ENDOSCOPY! 
TIPS
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19
Q

Prophylaxis of variceal haemorrhage

A

Propranalol

Band ligation

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20
Q

1st line management of PBC

A

Ursodeoxycholic acid (slows progression and improves symptoms)

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21
Q

Complications of PBC

A

CIRRHOSIS

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22
Q

Which antibodies in PBC

A

AMA

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23
Q

Sx of PBC

A

Itching
Jaundice
Raised ALP
Clubbing?!

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24
Q

In transudative ascites the SAAG is high or low?

A

HIGH ( >11 )

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25
Q

Causes of exudative ascites

A

Infection

Cancer

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26
Q

SAAG in exudative ascites will be >11 or <11?

A

<11!

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27
Q

How might Budd-Chiari syndrome present?

A

Sudden abdo pain
Ascites
Tender hepatomegaly

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28
Q

Risk factors of oesophageal cancer

A

GORD
Smoking
Achalasia
Alcohol

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29
Q

Squamous oesophageal cancer usually occurs in which portion of the oesophagus?

A

Upper 2/3!

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30
Q

Dx of oesophageal cancer

A

Endoscopy

Barium swallow

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31
Q

Main risks of oesophageal surgery?

A 
Bleedings
Anastomotic leaks (can result in mediastinitis = high mortality)
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32
Q

N B symptoms in CLL suggests?

A

Richter’s transformation

CLL transforming into large cell lymphoma!

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33
Q

1/3 rule of CLL

A

1/3 bleeding
1/3 infection
1/3 transform

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34
Q

Clinical features of ARDS

A

Multi organ failure
Acute dyspnea
Rising ventilatory pressures

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35
Q

Patient is acutely unwell, should you give the flu vaccine?

A

No, you should wait

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36
Q

What is a flail chest injury?

A

Segment of rib breaks off and becomes detached

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37
Q

RF of flail chest injury

A

Pneumothorax

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38
Q

Bloody diarrhoea
Painful abdomen
SNT abdomen
AF

A

Mesenteric ischaemia

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39
Q

Diagnosis of mesenteric ischaemia

A

Lactate

CT scan

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40
Q

Signs of ischaemic colitis

A

Transient, less severe than mesenteric ischaemia

See thumb printing of bowel on abdo xray

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41
Q

What is intestinal angina also known as?

A

Chronic mesenteric ischaemia

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42
Q

Triad of chronic mesenteric ischaemia

A

Severe, long term colicky post prandial abdo pain
Weight loss
ABDOMINAL BRUIT!

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43
Q

Why do patients with chronic mesenteric ischaemia get weight loss?

A

Poor blood supply to the bowel leads to poor absorption

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44
Q

Which fissure is across the right lobe and delinieates the UL and ML?

A

Horizontal fissure

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45
Q

What is aphasia

A

Inability to comprehend or formulate language

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46
Q

Major causes of aphasia

A

CVA
Head trauma
Brain tumours

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47
Q

What can infective endocarditis put you are risk of?

A

CVA because infective emboli can break off and block vessels

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48
Q

Name of primary heart tumour

A

Atrial myxoma

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49
Q

Most commonly affected valve in IE

A

Mitral valve

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50
Q

Most common cause of infective endocarditis

A

S.Aureus in IVDU

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51
Q

HIV needlestick protocol

A

Oral anti-retroviral therapy for 4 weeks

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52
Q

Cause of bacterial vaginosis

A

Overgrowth of gardenerella vaginalis

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53
Q

Symptoms of trichomonas

A

Frothy dischargeand vulvitis, vaiginitis or cervicitis

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54
Q

Type of cell seen on microscopy in bacterial vaginosis

A

Clue cells

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55
Q

Signs of bacterial vaginosis

A

Clue cells on microscopy
Raised (>4.5) pH
Clear, thin, fishy discharge

56
Q

Treatment of bacterial vaginosis

A

Oral metronidazole

57
Q

Migraine triggers

A 
CHOCOLATE 
COCP
Hangover
Orgasms 
Chocolate
58
Q

Really acidotic in a cirrhosis patient =>

A

Alcoholic ketoacidosis

59
Q

Management of alcoholic ketoacidosis

A

Infusion of saline and IV thiamine

60
Q

DKA features

A

Ketonuria

Hyperglycaemia

61
Q

HHS features

A

Hyperglycaemia
ABSENCE of ketones
Hypovolaemia
Hyperosmolarity

62
Q

Features of an Addisonian crisis

A

Hypotension
Hypoglycaemia
N+V
Drowsiness

63
Q

Exacerbating factors of Addison’s disease

A

Infection or steroid withdrawal

64
Q

Above the waist ulcers most likely which type of herpes?

A

Herpes type 1

65
Q

Below the waist herpes most likely which type?

A

Herpes type 2

66
Q

Treatment of colicky pain due to mechanical obstruction

A

Hyoscine butylbromide

67
Q

Drugs for N+V

A

Cyclizine
Haloperidol
Metoclopramide

68
Q

Antiplatelet treatment for percutaneous coronary intervention

A

Aspirin

Ticagrelor

69
Q

Investigation for PSC

A

MRCP

70
Q

Well’s score of 1 and a swollen leg, what should you do?

A

D-dimer in 4hr

It’s very sensitive for DVT!

71
Q

1st line treatment of VTE?

A

Rivoroxaban (DOAC)

72
Q

If a DVT is ‘likely’ 2< what should you do?

A

Proximal leg vein ultrasound

If positive -> anticoagulant

73
Q

If proximal leg vein ultrasound is negative, what should you do?

A

D-dimer

74
Q

What can cause thoracic outlet syndrome?

A 
Osseous structure (rib) or soft tissue growth can impair the brachial plexus or arterial system
Either going to get tingling or a pale limb
75
Q

Management of Bell’s palsy

A

Prednisolone

Artificial tears and eye taping

76
Q

Which key drug can increase WCC?

A

Steroid
Prednisolone
Glucocorticoid

77
Q

Why do steroids increase WCC initially?

A

Cause demargination of neutrophils from the endovascular lining

78
Q

Signs of idiopathic intracranial hypertension

A

Chronic, generalised headaches
Visual disturbance
Papilloedema
High opening pressure on LP

79
Q

Biggest modifiable risk factor in idiopatic intracranial hypertension

A

Weight

80
Q

Delayed puberty and absent sense of smell since birth =>

A

Kallman’s syndrome

81
Q

Hormone levels in Kallman’s syndrome

A

Low/normal FSH

LOW TESTOSTERONE

82
Q

What is varenicline used for?

A

Smoking cessation

83
Q

MSM should be offered additional immunisation for …

A

Hepatitis A

84
Q

Mid shaft humeral fractures are assocaited with injury to which nerve?

A

Radial nerve

85
Q

How can you assess the radial nerve?

A

Extend the wrist

86
Q

Cut off for acute graft rejection

A

<6mo

87
Q

How might acute graft rejection present?

A 
Symptoms of infection
LIF pain
Fever
Rigors
Renal failure
88
Q

Best initial management of acute graft rejection

A

Increase steroid dose

89
Q

What is a typical Addisonian picture?

A

Low sodium
High potassium
Low BP

90
Q

Symptoms of acute adrenal insufficiency

A

Delerious and hypotensive after surgery after being on long term corticosteroid therapy

91
Q

Mx of adrenal crisis

A

Hydrocortisone 100mg IV

1L of normal saline over 1hr

92
Q

Cellulitis with haemorrhagic bullae implies

A

Necrotising fasciitis

93
Q

Most common location of necrotising fasciitis

A

Perineum

Fournier’s gangrene

94
Q

Mx of necrotising fasciitis

A

Urgent surgical debridement

IV antibiotics

95
Q

Iron study levels in haemochromatosis

A

Raised transferrin saturation, raised ferritin, low TIBC (because left over capacity is reduced)

96
Q

First line Mx of PBC

A

Ursodeoxycholic acid

97
Q

Complication of PBC

A

Cirrhosis -> portal hypertension -> ascites -> variceal haemorrhage

98
Q

Mx of itching in PBC

A

Cholestyramine

99
Q

Which cause of pneumonia is assocaited with erythema multiforme?

A

Mycoplasma pneumoniae

100
Q

Anaemia and raised bilirubin =>

A

Haemolysis

101
Q

Mx of mycoplasma pneumoniae?

A

Doxycycline

102
Q

Mx of hypothyroidism

A

Levothyroxine

103
Q

Mx of hyperthyroidism

A

Block and replace
Carbimazole
Levothyroxine

104
Q

Long term steroid use increases risk of…

A

Fractures

105
Q

Low platelets
Petechial rash
Bleeding

A

ITP

106
Q

First line treatment of ITP

A

Oral prednisolone

107
Q

Treatment of localised impetigo

A

Hydrogen peroxide 1% cream who are systemically well (new first line)
Topical fusidic acid
Shouldn’t be in school because it’s highly contagious

108
Q

What is osteomalacia?

A

Poor bone mineralisation due to lack of vitamin D

109
Q

Long term steroid use is associated with…

A

Osteopenia
Osteoporosis (difference = T score remember)
Avascular necrosis
Cushings

110
Q

First line T1DM management

A

Basal bolus regime = 2 doses of determir

111
Q

How often should HbA1C be monitored in T1DM?

A

Every 3-6mo

112
Q

What is the target HbA1C?

A

48mmol

113
Q

Cut off BMI for considering adding metformin to T1DM management?

A

25

114
Q

Which drug can you give to reduce vasospasm in SAH?

A

Nimodipine

115
Q

What is the surgical treatment of ruptured berry aneurysm ?

A

Insertion of a coil by interventional radiologists

116
Q

Complications of SAH (after initial stuff)

A

Vasospasm
Seizures
Hydrocephalus
Rebleeding

117
Q

What is xanthachromia?

A

Blood in the CSF, detected 12hr post bleed to confirm SAH

118
Q

What is the medical management of incomplete miscarriage?

A

Vaginal misoprostol

119
Q

Treatment of leptospirosis

A

Doxycycline

120
Q

HIV patient, getting clumsy and non-compliant with medication

A

Leukoencephalopathy

Usually secondary to JC virus

121
Q

Hyperacute T waves indicate what?

A

Early myocardial ischaemia

122
Q

Investigations for pumonary oedema

A 
Bedside observations
Arterial blood gas
ECG
Troponin if concerned about a new cardiac event
Serum BNP
Chest Xray
123
Q

Mx of pulmonary oedema

A

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

124
Q

1st line management of diabetic neuropathy

A

Pregabalin

125
Q

Management of pericarditis

A

Naproxen and bed rest

126
Q

Complications of hypomagnesaemia

A 
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
127
Q

Causes of unilateral optic disc swelling

A

Vascular – Diabetes or central retinal vein occlusion
Inflammatory – Uveitis or sarcoidosis
Infective – Herpes, toxoplasmosis or viral
Multiple sclerosis
Lymphoma

128
Q

Features of tetralogy of Fallot

A

Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect

129
Q

What type of drug is octeotride?

A

Somatostatin analogue

130
Q

Extra-intestinal features of IBD

A

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).

131
Q

Hyperkalaemia ECG changes in order of severity

A 
Tall tented T-waves
Flattened P-waves
Prolonged PR interval
Widened QRS complexes
VF/asystole
132
Q

Viral causes of gastroenteritis

A

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.

133
Q

Bacterial causes of gastroenteritis

A

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

134
Q

Asymptomatic longstanding AF, first line treatment

A

Verapamil (rate control)

135
Q

Chads vasc of 1 (1 being for female sex), what do you do?

A

Nothing

No need for anticoagulation

136
Q

Splanchnic nerve damage causes

A

Impotence

Sexual dysfunction

137
Q

Causes of urinary obstruction Sx

A

BPH
Prostate cancer
Urethral stricture

Passmed finals (17 decks)

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