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Liverpool (Year 3) > Medicine > Flashcards

Medicine Flashcards

1
Q

What are the common gram positive infections?

A

Staphylococcus aureus
Group B strep
Streptococcus pneumoniae

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2
Q

What are the common gram negative bacteria?

A

E.Coli (UTI/Biliary tract)
Klebsiella
Pseudomonas aeruginosa

Nesseiria meningitidis
Haemophilus influenza

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3
Q

Which family inherited syndrome predisposes patient to gastric/duodenal ulcers?

A

Zollinger-Ellison Syndrome. Tumours which cause the stomach to produce more acid leading gastric and duodenal ulcers.

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4
Q

List the extra-intestinal manifestations of Ulcerative Colitis?

A

Axial Spondylarthritis
Primary Sclerosing cholangitis

Due to activity of colitis:
Erythema Nodosum
Anterior Uveitis
Episcleritis
Acute arthropathy
Aphthous ulcers

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5
Q

List differentials for haematemesis?

A

Most likely to least likely :

Oesophagitis/gastritis/duodenitis
Bleeding peptic ulcer (gastric / duodenal)
Oesophageal varices
Mallory-Weiss Tear (tear of lower oesophagus caused by coughing/vomiting/endoscopy)
Oesophageal or Gastric Cancer
GIST (gastrointestinal stromal tumour)
Arteriovenous malformations
Angiodysplasia (Small vascular malformation - NB - Does not cause pain)
Haemobilia (fistula between splanchnic blood vessels and biliary tree)
Trauma to oesophagus or stomach

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6
Q

Risk factors for oesophageal variceal haemorrhage. (i.e not risk factors for varices)

A

Large Varices
High venous portal pressure (>12mmHg)
Abnormal variceal wall (haematocystic spots)
High Child-Pugh score (>8)

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7
Q

Name the 5 factors that the Child-Pugh score uses to assess the risk of oesophageal varices haemorrhage?

A

Serum Bilirubin
Serum Albumin
Prothrombin Time
Presence of Ascites
Presence of Encephalopathy

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8
Q

List the clinical signs of liver cirrhosis

A

Finger clubbing
Palmer Erythema
Parotid enlargement
Gynaecomastia
Spider Naevi
Testicular atrophy

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9
Q

Autoimmune hepatitis is associated with which other pathology?

A

Hypo and hyperthyroidism

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10
Q

Serum Ascites Albumin Gradient (SAAG) is used to determine whether ascites is transudative or exudative. Explain the difference between transudative and exudative and list the causes of each type of ascites.

A

A SAAG > 1.1g/dL is considered transudative and is 97% accurate in detecting venous portal hypertension.

Transudative is caused by high hydrostatic pressure (i.e blood pressure/intravascular volume) and thus is commonly caused by:

Venous Portal hypertension (secondary to alcoholic hepatitis/Liver cirrhosis)
Portal vein thrombosis
Heart Failure (Increased circulating volume due to reduced kidney perfusion etc

**There will be a high protein difference in transudative ascites**

A SAAG < 1.1 g/dL is considered exudative.

Exudative refers to an increased vascular permeability often caused by inflammation. It is often an indication of peritonitis (secondary to previous pathology - obstruction/perforation/pancreatitis)

Malignancy
TB
Nephrotic syndrome
Serositis (lymphoma)

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11
Q

Which seven markers are commonly sent for to assess ascitic tap / SAAG

A

Total Protein
Albumin
LDH
Glucose
Cell Count
Cytology
Culture and sensitivity

*Amylase/Bilirubin (perforation)/Triglycerides (chylous ascites) can also be sent for*

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12
Q

Name the different classes of insulin regimes, their duration of action, and examples of each.

A

Rapid-acting: 4hrs

  • Novorapid
  • FIASP (starts working within 2 mins)
  • Humalog
  • Apidra

Short-acting : 8hrs

  • Humulin-S
  • Insuman RAPID

Intermediate-acting: 16hrs

  • Insuman BASAL
  • Insulatard
  • Humulin - I

Long Acting: 24+ hrs

  • Levemir (24hrs)
  • Toujeo (36hrs)
  • Tresiba (>42 hrs)
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13
Q

Name the 4 classes of drugs used in treating IBD and examples of each.

A

(1) Steroids (e.g Oral Prednisolone or Budenoside (works well in crohns) /IV hydrocortisone)
(2) Immunomodulators (e.g Azathioprine is a prodrug of 5- Mercaptopurine/ Methotrexate)

**In patients with a deficiency in the enzyme thiopurine methyltransferase (TPMT), azathioprine is not suitable as patients cannot metabolize the drug and it can lead to life-threatening bone marrow toxicity** - Allopurinol can be used as a substitute in these instances.

(3) Aminosalicylates (5-ASA) (e.g Mesalazine better safety profile to sulfasalazine)
(4) Biologics (predominantly Anti-TNF adalmimumab and infliximab and cylcosporin

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14
Q

What are the major and minor DUKE criteria for the diagnosis of endocarditis?

A

Remember mnemonic: BE FIVR P

Major:

Blood culture for endocarditis causing organism (twice and 12 hrs apart) or if culture grows Coxiella Burneti once.

Echo shows Vegetation/abscess

Minor:
Fever
Immunological phenomena
Vascular/thrombotic phenomena
Risk factor - CVD/IVDU

Persistent bacteremia

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15
Q

What is the name of the parasite that causes the most dangerous form of malaria? And what treatments are critical in the management of this severe malaria?

A

Plasmodium Falciparum

IV Artesunate
Quinine Dihydrochloride

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16
Q

Name the 3 drugs that are commonly used as malaria prophylaxis?

A

Proguanil and atovaquone
Mefloquine
Doxycycline

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17
Q

What are the possible complications of severe malaria?

A

Cerebral Malaria
Seizures
Reduced Consciousness
Pulmonary Oedema
AKI
DIC
Severe Haemolytic Anaemia
Multi-organ failure and Death

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18
Q

Name 2 antibiotics that can be used to treat MRSA?

A

Teicoplanin and Vancomycin

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19
Q

What is the classic 3 symptom presentation of a hypercalcaemic crisis?

A

Intermittent confusion / Non-specific abdominal pain / Constipation

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20
Q

What acute management steps would you take in a patient with Hypercalcaemia of malignancy?

A

(1) IV fluids (if dehydrated)
(2) IV Biphosphonates (increased osteoclast activity is likely cause of hypercalcaemia)
(3) Refer to oncology

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21
Q

What are the treatment options for hyperthyroidism?

A

1st line: Carbimazole
(Titration-block / block and replace)

2nd line: Propylthiouracil (small risk of severe hepatic reaction and death) also preferred option for thyroid storm.

Radioactive iodine also an option (avoid pregnancy for 3 months - avoid children and pregnant women for 3 weeks).

Surgery

Both the latter options require lifelong levothyroxine replacement.

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22
Q

What are the features of SLE?

A

SOAP BRAIN MD

Serositis - pleuritis/endocarditis (libbmann-sacks - vegetation on mitral valve)
Oral Ulcers
Arthralgia (>2 joints)

Blood disorders (haemolytic anaemia)
Renal dysfunction (ex. glomerular nephritis / IgA nephropathy)
Auto - antibodies (ANA)
Immunological (anti-dsDNA)
Neurological Dysfunction (Seizures/Psychosis)
Malar Rash
Discoid Rash

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23
Q

List the 3 common gram positive cocci?

A

Staphylococcus (staph means group)
Streptococcus (strep means chain)
Enterococcus (diplococci)

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24
Q

List the Gram positive but rod shaped (bacilli) bacteriae?

A

“Corney Mike’s List of Basic Cars”

Corneybacteria
Mycobacteria
Listeria (dangerous in pregnancy)
Bacillus
NoCardia

*Remember Rice looks like rods”

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25
List the Gram Positive anaerobes?
"CLAP" Clostridium Lactobacillus Actinomyces Propionibacterium
26
Differentials for Bilateral Hemianopia?
Neoplastic: Pituitary Adenoma Meningioma Craniopharyngioma Glioma (chiasmatic) Non-Neoplastic: Aneurysm Cyst Sarcoid
27
What are the different treatment options of acromegaly?
Surgical (definitive): Transphenoidectomy / Trans-sphenoidal resection Medical: - GH antagonist – Pegvisomant - Somatostatin (known as the “growth hormone inhibiting hormone” Analogue – Ocreotide - Dopamine agonist – Bromocriptine / Cabergoline (also used for prolactinoma) Radiation: - Older people not suitable for surgery can have external beam irradiation.
28
What are the classic unique signs of graves disease?
Diffuse Goitre Graves Exophthalmos (proptosis of the eye due to inflammation/swelling and hypertrophy of the tissue behind the eye) Pretibial Myxodema (Waxy discoloured oedematous appearance to the shin due to deposits of mucin as a response to TSH receptor simulation) Acropachy (Soft tissue swelling of the hands and feet)
29
What antibodies can be tested for Autoimmune hepatitis?
Anti-Mitochondrial Anti-Smooth Muscle (Anti- SMA)
30
What is the initial and secondary management of Acute Coronary Syndrome (ACS) ?
**MONA/BASH** * *M**orphine (Give metoclopramide beforehand) * *O**xygen (if \<94%) * *N**itrates (GTN sublingually) * *A**nticoagulant (STAT Aspirin 300 mg and Ticagrelor/Clopidogrel) 2nd prevention _if not going for PPCI_: **B**eta Blocker **A**CE Inhibitor (unless CKD - Nephrotoxic) and Aspirin 80mg Statin (Atorvastatin) **H**eparin (LMWH - Fondeparinox/ Enoxaparin) or Ticagrelor/Clopidogrel. \*Remember A's are X2\*
31
What are the Post-MI complications?
DARTH VADER Death Arryythmias Rupture of the heart septum / Papillary muscles (mitral valve regurgitation) Tamponade Heart Failure Valve disease Aneurysm Dressler's syndrome Embolism Reinfarction Heart Failure DREAD Death Rupture of the Heart Septum / Papillary Muscles (most commonly mitral valve - regurgitation) Edema (Secondary to Heart Failure/cardiogenic shock) Arrythmias and Aneurysm Dressler's Syndrome (Autoimmune Pericarditis occurring anywhere from 2-10 weeks post-MI)
32
What is the medical management of Heart Failure?
Remember \*\*ABAL\*\* ``` Ace Inhibitor (ex. Ramipril) Beta Blocker (ex. Bisoprolol) ``` If this doesn't control symptoms consider: ``` Aldosterone Antagonist (Eplerenone / Spironolactone - improves cardiac mortality) Loop Diuretic (Furosemide - symptomatic relief only benefit) ```
33
What 3 pathological features can sometimes be seen on an ECG in an NSTEMI?
Pathological Q waves or ST depression or Inverted T wave
34
What are the causes of recurrent miscarriage?
Anti-Phospholipid syndrome Thrombophilia PCOS Cervical Incompetence
35
What clinical features are sometimes seen in mitral regurgitation?
Dyspnoea Atrial Fibrillation Pan Systolic Murmur Displaced/Hyperdynamic apex \*Pink Cheeks --\> Mitral Stenosis.
36
What are the causes of a raised JVP?
PQRST Pulmonary hypertension/PE/Pericardial Effusion Quantity of fluid (i.e overload) RVF SVC obstruction Tamponade
37
List the complications of lnfective Endocarditis?
Heart Block TIA AKI Heart Failure Vertebral Osteomyelitis
38
What is the name of the risk stratification system used to determine whether NSTEMI patients are suitable for PCI/Angioplasty or not. What are the components/variables of this score.
GRACE score (those at high risk should have primary angioplasty within \<72 hrs of admission). Age Heart Rate Systolic Blood Pressure Creatinine Congestive Heart Failure Cardiac Arrest at admission ST segment deviation Cardiac enzymes
39
Boerrhave's Oesophagus leads to what complications. What is the immediate investigation and management of this condition.
Pleural Effusion Pneumomediastinum Pneumothorax Mediastinitus and Sepsis Antibiotics and Surgical repair (\<30% mortality if surgery within 24 hrs/ 50-60% mortality if surgery initiated after this).
40
List 4 drugs that can cause a hypersensitivity pneumonitis? (similar symptoms as IPF)
Nitrofurantoin Amiodarone Methotrexate Bleomycin
41
List the causes of Atrial Fibrillation
Mitral Stenosis/Regurgitation Sepsis Hypertension Thyrotoxicosis (NB - often the only presentation of hyperthyroidism in the elderly) IHD
42
What are the causes of Hypertension?
R.O.P.E Renal pathology Obesity Pregnancy Endocrine
43
What is the criteria for hospital acquired pneumonia?
Acquired \>48 hrs after admission
44
What are the contents of the Curb-65? (used to measure severity of pneumonia and whether patients need admission to primary care)
Confusion Urea \> 7 Resp rate \> 30 Blood pressure \<90/60 Age \> 65
45
Atypical cause of pneumonia with: Hyponatraemia Farmer Parrot keeper Erythema Multiforme Chronic Wheezy child
Hyponatraemia - Legionella Pneumoniae Farmer - Coxiella Burnetii Parrot Keeper - Chlamydia Psittaci Erythema Multiforme - Mycoplasma Chronic Wheezy Child - Chlamydophilia
46
Most common bacterial cause of pneumonia?
Streptococcus Pneumoniae
47
What are the first line investigations in asthma?
Spirometry with reversibility Fractional Exhaled Corticosteroids (FeNO)
48
What are the two licenced biologics can be used to slow disease progression in IPF?
Nintedanib Pirfenidone
49
Electrolyte imbalance in sarcoidosis?
Hypercalcaemia
50
Screening blood test for sarcoidosis?
Serum ACE
51
What is the 1st line treatment of sarcoidosis?
Steroids
52
Gold standard Investigation for sarcoidosis?
Histology (bronchoscopy)
53
What are the screening tools used for harmful alcohol use?
CAGE and Audit Questionnaire Cut down (have you ever felt) Annoyed at your friends commenting on your drinking Guilty about your drinking? Eye opener (ever drunk in the morning to ease hangover/nerves?)
54
Medical Emergency caused by alcohol withdrawal?
Delirium Tremens (rapid onset of confusion/tremor and auditory and visual hallucinations)
55
Medication used for treatment of alcohol withdrawal?
Chlordiazepoxide (Librium) IV B - Vitamins (Pabrinex)
56
What are the differentials for a purpuric rash?
Menigo-coccal septicaemia Henoch - Schonlein Purpura Idiopathic Thrombocytopenia Purpura Haemolytic Uraemic Syndrome (Thrombocytopenia/Haemolytic anaemia/AKI)
57
Erythema Nodosum causes?
IBD Group A Strep Malignancy Sarcoidosis Pregnancy TB Drug (sulphonamide) Chlamydia
58
Erythema Multiforme Causes?
HSV (main precipitating factor) Mycoplasma Pneumoniae Infection Drugs
59
Complications of Erythroderma?
Secondary Infection Hypotension Hypothermia Electrolyte Imbalance Rarer: High Output Heart Failure Capillary leak syndrome (severe)
60
Causes of Erythroderma?
Eczema Psoriasis Drugs Lymphoma
61
Causes of Pyoderma Gangrenosum?
Myeloproliferative disease (myeloma) IBD Autoimmune (e.g RA) Diabetes
62
Skin Lesions associated with diabetes?
Necrobiosis Lipoidica Granulosum Annulare Pseudo-Acanthosis Nigricans
63
What are the most common causes of Community Acquired Pneumonia?
``` Strep Pneumoniae (39%) Viral Pneumonia and Chlamydia Pneumonia (13%) Mycoplasma Pneumonia (11%) Haemophilus Influenza (5%) ``` \*Pseudomonas Aeruginosa - Difficult to treat but often difficult to treat\*.
64
Most common type of Lung Cancers?
Adenocarcinoma (40%) Squamous Cell (25%) Small Cell Lung Cancer (15%)
65
Side effects of glucocorticoids?
Remember Mnemonic \*Cushinghoid Map\* Cushings Ulcers (Give PPI to reduce chance of GI bleed) Striae Hypertension Infection Necrosis (avascular) Growth Restriction Osteoporosis (give Vit. D supplementation) Increased intracranial pressure Diabetes Myopathy Adipose tissue hypertrophy Pancreatitis
66
Name 4 common sites of lung cancer metastases?
Brain Liver Bone Adrenals
67
Asthma is a type ___ Hypersensitivity reaction.
Type 1 IgE mediated Onset within 1 hr Mast cell Degranulation
68
List the stages of severity of COPD that are used in FVC1 spirometry.
Stage 1 (Mild): FVC1 \> 80% of predicted Stage 2 (Moderate): FVC1 50-79% of predicted Stage 3 (Severe): FVC1 30-49% of predicted Stage 4 (Very Severe): FVC1 \< 30% predicted
69
The _____ Scale is used to assess shortness of breath in COPD? List the 5 stages
The MRC Dyspnoea Scale Stage 1: Breathlessness on strenuous exercise Stage 2: Breathlessness walking up a hill Stage 3: Breathlessness eased by walking on the flat Stage 4: Breathlessness walking 100 metres - need to stop and catch their breath. Stage 5: Too breathless to leave house
70
What are the pharmacological options available for smoking cessation?
Nicotine Replacement Therapy (NRC) (ex.gum/inhaler/lozenges/patches/nasal spray) - patch and another option is often useful for chronic smokers or who have failed single NRT therapy in the past. Varenicline Bupropion
71
ECG signs of a PE?
Sinus Tachycardia Right Bundle Branch Block Right Axis Deviation S1Q3T3 Pattern First degree AV block Atrial Fibrillation
72
List the Exudative and Transudative causes of pleural effusion and the protein content to determine each.
Transudative (protein count . 3g/L) Heart failure Hypoalbuminaemia Hypothryroidsim Meig's syndrome (unilateral pleural effusion secondary to ovarian malignancy) Exudative (protein count \<3g/L) Malignancy TB Pneumonia Rheumatoid Arthritis
73
What is the mnemonic used to describe a murmur?
Assessing a Murmur (SCRIPT mnemonic) Site: where is the murmur loudest on auscultation? Characteristic: is it crescendo (getting louder) or decrescendo (getting quieter) or crescendo-decrescendo (louder then quieter)? Radiation: can you hear the murmur over the carotids (AS) or left axilla (MR)? Intensity: what grade is the murmur? Pitch: is it high pitched or low and grumbling? Pitch indicates velocity. Timing: is it systolic or diastolic? Think of the radiation of murmurs to occur in the direction of the blood flow (i.e. aortic stenosis the blood flows towards the carotids – therefore radiates there. In mitral regurgitation the blood flows backwards towards the left axilla – therefore radiates there.)
74
List the classical three clinical features of Lofgren's syndrome? (Sarcoidosis)
Erythema Nodosum Bilateral Hilar Lymphadenopathy (On Xray) Polyarthralgia
75
What are the components and scores given for the Wells Criteria when assessing likelihood of a VTE?
Remember mnemonic \*EAT CHIPS\* Edema or any leg signs of DVT (i.e pain/tenderness/redness/hot) - 3 points Alternative diagnosis less likely - 3 points Tachycardia (\>100) - 1.5 points Cancer - 1 point Haemoptysis - 1 point Immobilised (post surgery/ long flight haul) - 1.5 point Previous DVT/PE Surgery (major surgery in the past month) Remember a score \<4 with a negative d-dimer is unlikely to be a VTE - 92% sensitivity. However a score of \> 4 needs a CTPA Interpretation: Score \>6.0 — High (probability 59% based on pooled data) Score 2.0 to 6.0 — Moderate (probability 29% based on pooled data) Score \<2.0 — Low (probability 15% based on pooled data)
76
What are the respiratory causes of finger clubbing?
Remember the mnemonic: \*ABCDE\* Asbestosis Bronchiectasis Cancer (lung) Do not say \*\*COPD\*\* Empyema (There are some more respiratory causes such as interstitial lung disease) COPD/Asthma/Pneumonia do not cause finger clubbing.
77
Which associated disease in SLE increases the patients likelihood of having a VTE? (i.e DVT/PE)
Anti-phospholipid syndrome
78
Hypertensive retinopathy is graded using which classification?
The Keith-Wagener classification is used to stage hypertensive retinopathy: Stage 1 - mild narrowing of the arterioles Stage 2 - focal constriction of blood vessels and AV nicking Stage 3 - cotton-wool patches, exudates, and haemorrhages Stage 4 - papilloedema
79
Name shockable rhythms and non-shockable rhythms and their management.
Shockable rhythms include ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT). In the context of a shockable rhythm, Adrenaline and Amiodarone are administered only after the third shock from defibrillator has been delivered. Non-shockable rhythms include pulseless electrical activity (PEA) and asystole. In the scenario of a non-shockable rhythm, the most appropriate next step would have been the administration of adrenaline.
80
A 25-year-old male presents to his GP with a three-month history of fatigue, weight loss, intermittent palpitations and a new diastolic murmur. The GP requests an echocardiogram. In which cardiac chamber would a myxoma most likely originate?
Left Atrium
81
What are the ECG changes most commonly associated with acute Pericarditis?
Widespread PR depression and concave ST elevation
82
What scoring criteria is used to assess the risk of a stroke or thromboembolic event following the diagnosis of AF?
CHA2DS2 VASc Congestive Heart Failure Hypertension Age 65-74 - 1 point 75+ - 2 points Diabetes Stroke (previous stroke/TIA) - 2 points Vascular Disease Sex - Female - 1 point Score 2 indicates anticoagulant therapy. Score of 1 in a male can be considered for anticoagulant. NOAC or Warfarin \*NB - Needs to be balanced with risk of bleeding HAS-BLED score\*
83
What are the two main complications of permanent pacemaker (PPM) insertions?
Pneumothorax and lead dislodgement PPM insertions are relatively minor and uncomplicated procedures; the main acute complications are pneumothorax and lead dislodgement. Patients with PPM insertion are often admitted for telemetry monitoring overnight. They need a PPM check to assess device function and a CXR prior to discharge to assess lead positioning and rule out any pneumothorax. Pneumothorax is a recognised complication after PPM insertion due to the proximity of the subclavian vein to the pleura, which can be inadvertently punctured, leading to a pneumothorax.
84
What are the 4 principle drugs used in the treatment of TB?
Remember Mnemonic RIPE 2 months - Rifampicin (hepatic toxicity) Isoniazid (peripheral neuropathy) Pyrazinamide (gout) Ethambutol (optic neuritis) Then 4 months - Rifampicin Isoniazid
85
Secondary prevention of CVS disease can be remembered as the 4 A's.
``` Aspirin (plus a second antiplatelet such as clopidogrel for 12 months) Atorvastatin (80mg) Atenolol (ex. bisoprolol titrated to maximum possible dose) ACE inhibitor (max tolerable dose) ```
86
Name 3 side effects of statins
Myopathy (check Creatine Kinase in patients with muscle pain or weakness - rhabdomyolysis) Type 2 diabetes Haemorrhagic strokes Raised LFTs (often subsides)
87
Four principles to managing angina
Remember RAMP Refer to cardiology Advise about diagnosis, management and when to call an ambulance Medical management Procedural or surgical interventions
88
What are the 3 Indications for CABG? (i.e instead of PCI)
LCA \> 50% stenosed LAD or Circumflex \> 70% stenosed Significant 3 vessel stenosis
89
\_\_-\_\_% is a normal ejection fraction
60-65%
90
What are the 3 classical features of Beck's triad indicating cardiac tamponade?
Raised JVP Muffled Heart sounds Hypertension

Liverpool (Year 3) (3 decks)

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