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Year 5/6 > Medicine: GenMed > Flashcards

Medicine: GenMed Flashcards

1
Q

SOB DDx

A

Asthma (reversible), AECOPD (irreversible), pulmonary oedema (HF), pleural effusion (malignancy), pneumonia, pneumothorax, PE, ILD, TB

Also: anaemia, anxiety, DKA

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2
Q

List common causes of HF (6)

A

IHD, valve disease, myocarditis, HTN, dilated cardiomyopathy, arrhythmias

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3
Q

Why do you get pulm oedema w HF?

A

When the pressure of venous blood > oncotic pressure

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4
Q

The acute mx of pulm oedema

A

Sit up, oxygen, diuretics, cardio review, monitor daily weights and UO

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5
Q

Furosemide: dose and route

A

40mg oral OD

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6
Q

What can you give for acute pulm oedema if furosemide fails?

A

Diamorphine

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7
Q

Which antiemetic works well w morphine?

A

Metoclopramide

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8
Q

Tx for chronic HF

A

Conserv: exercise, red alcohol, stop smoking, dietary, red salt

Medical: ACEi, beta blocker, aldosterone antag, digoxin

Surg: implantable cardioverter defib and cardiac resynchronisation therapy

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9
Q

Ramipril: dose and route

A

1.25mg oral OD

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10
Q

What are the top three causative organisms of pneumonia?

A
  1. Pneumococcus
  2. Haemophilus
  3. Mycoplasma
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11
Q

At which hb do you transfuse?

A

Usually 70 but threshold inc to 80 in ACS pts

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12
Q

When bleeding what is the order of bottles by draw?

A 
Cultures
Blue
Yellow
Purple
Pink
Grey
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13
Q

Which blood culture bottle do you take first?

A

Aerobic -> Anaerobic

NB: clean the tops w a different wipe before use and collect at least 3ml per bottle

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14
Q

What is the blue bottle for?

Mix 3-4

A

Coag, INR, D-dimer

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15
Q

What is the yellow bottle for?

Mix 5-6

A 
CRP
U+Es
LFTs
TFTs
Iron Studies
Bone Profile
Lipid Profile
Troponin
Amylase
Hormones
Toxicology
Complement
Immunoglobulins
Tumour Markers
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16
Q

What is the purple bottle for?

Mix 8-10

A 
FBC
ESR
PTH
HbA1c
Film
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17
Q

What is the pink bottle for?

Mix 8-10

A

G+S, XM, DAT

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18
Q

What is the grey bottle for?

Mix 8-10

A

Glucose + Lactate

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19
Q

What happens if you leave the tourniquet on? (3)

A

Bruising, nerve palsies, ALI

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20
Q

List the seven types of glomerulonephritis

A

Nephrotic Syndrome: minimal change, membranous, focal segmental

Nephritic Syndrome: post streptococcal, berger disease, crescentic, alport syndrome

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21
Q

What is a/w nephrotic syndrome? (3)

A

Hypercholesterolaemia, hypoalbuminaemia, peripheral oedema

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22
Q

What are the end of life PRNs? (4)

A

Analgesic
Anti-Emetic
Anti-Secretion
Relaxant

Morphine
Levomepromazine
Glycopyrronium
Haloperidol/Midazolam

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23
Q

What are the causes of crackles during insp?

A

Fine - Fibrosis + HF

Coarse - Pneumonia + Bronchiectasis

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24
Q

Resp Failure: Type 1 vs Type 2

A

Type 1 - Hypoxaemic (V/Q Mismatch): pneumonia, pulm oedema, pulm fibrosis, pulm HTN, pneumothorax, PE, ARDS, obesity

Low O2 + N CO2 = Give CPAP

Type 2 - Hypercapnic (Hypoventilation): severe asthma, COPD, drug OD, CNS injury, primary muscle disorders, NMJ disorders, chest wall deformities, Pickwickian syndrome

Low O2 + High CO2 = Give BiPAP

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25
Q

What is low PaO2 and high PaCO2?

A

PaO2 <8kPa (60mmHg)

PaCO2 >6kPa (50mmHg)

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26
Q

What is Westermark’s sign?

A

Focal area of reduced vasc markings due to oligaemia from a massive PE

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27
Q

What is COPD?

A

Chronic Bronchitis (clinical dx - productive cough for 3m/yr for two consecutive yrs) + Emphysema (histological dx - permanent airspace dilatation)

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28
Q

What are the spirometry results in COPD?

A

FEV1 <0.8, FEV1/FVC ratio <0.7, not fully reversible

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29
Q

What are the values of FEV1 for COPD severity set by NICE?

A

Mild >80%, Mod 50-80 and Sev 30-50, V Sev <30%

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30
Q

What are the causes of COPD? (3)

A

Smoking, A1AT-D, Environmental/Occupational

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31
Q

What ca are A1AT-D pts at risk of?

A

Hepatocellular Carcinoma

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32
Q

Rx of COPD

A

Bronchodilators, ICS, FLORES: FluOxygenREhabSmoking

Flu and Pneumococcal Vaccines

LTOT if PaO2 <7.3 twice at least 3wks apart in stable pts OR <8 w secondary polycythaemia, pulm HTN, cor pulmonale, nocturnal hypoxaemia

Pulmonary Rehab + Stop Smoking

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33
Q

Mx of AECOPD

A

It’s a medical emerg therefore A-E plus three main issues: RF, infection, chronic mx

RF: controlled O2 therapy w venturi, air driven bronchodilators, BiPAP to improve V/Q mismatch

Infection: steroids + abx

Chronic Mx: FLORES

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34
Q

Comps of COPD + Lung Fibrosis (4)

A

Chest infection, resp failure, cor pulmonale, cancer

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35
Q

What cardiac drug can lead to fibrotic lung disease?

A

Amiodarone

?Skin Pigmentation ?AF

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36
Q

What is ILD?

A

Umbrella term for a group of conditions related to different pathologies that all cause a restrictive defect, hypoxia and breathlessness

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37
Q

The five broad cats of ILD

A

Idiopathic, IPF, NSIP, EAA, Pneumoconiosis

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38
Q

What are the causes of APICAL fibrosis?

A

Any environmental cause except asbestosis

PLUS sarcoidosis + ank spond

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39
Q

What are the causes of BASAL fibrosis?

A

Asbestosis

PLUS idiopathic, connective tissue diseases, drugs

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40
Q

What is Hamman-Rich syndrome?

A

Rapidly progressive fibrosis w very poor prognosis

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41
Q

What can be seen on HRCT for ILD?

A

IPF - honeycombing

NSIP - ground glass appearance

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42
Q

What imaging is required for upper lobe fibrosis?

A

MRI

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43
Q

What does lymphocytosis on a BAL predict?

A

Steroid responsiveness and therefore better prognosis

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44
Q

Mx of ILD

A

C: stop smoking + look for reversible causes

M: steroids guided by a specialist + PPIs if any sx of reflux disease

S: consider if focal disease to improve V/Q mismatch

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45
Q

What can ILD pts be switched onto if steroids aren’t working? (2)

A

Azathioprine

Cyclophosphamide

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46
Q

How does RA affect the lungs?

A

Lung fibrosis directly as autoimmune or secondary to methotrexate tx

Pleural effusions usually asx, small, self remitting

Intrapulmonary nodules inc Caplan’s syndrome

Obliterative bronchiolitis presenting w breathlessness + high pitched wheeze

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47
Q

What is bronchiectasis?

A

Permanent dilatation of terminal bronchioles

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48
Q

What are the causes of bronchiectasis?

A

Bronchial obstrc - foreign body + tumour

Childhood infections - measles, pertussis, TB

Defect of mucociliary clearance - CF + ciliary dyskinesia

PLUS ig immunodeficiency + yellow nail syndrome

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49
Q

What is the chromosomal error in CF?

A

Ch7 deletion of F508

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50
Q

What tests can you perform for suspected ciliary dysfunction?

A

Saccharin test OR cilial electron microscopy

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51
Q

What immunodeficiency classically causes bronchiectasis?

A

IgA

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52
Q

What can you see on CXR in pts w bronchiectasis?

A

Tramline shadows due to bronchial thickening

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53
Q

What is pathognomonic of bronchiectasis on HRCT?

A

Signet ring sign

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54
Q

Mx of Bronchiectasis

A

C: stop smoking, chest physiotherapy, psychological support

M: oxygen, rotating abx, carbocysteine

S: consider lobectomy if sx uncontrolled

Tx w MDT approach - chest PT for mucous clearance, O2 therapy assessment, meds to aid chest clearance and prevent infections - important to immunise these pts and take serial sputum samples looking for pseudomonas colonisation

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55
Q

What abx do you give in the acute setting for bronchiectasis?

A

Standard tx for pneumonia PLUS cover for pseudomonas

NB: always check local trust guidelines

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56
Q

What are the indications for a lobectomy? (3)

A

Main Points: bronchiectasis, TB, malignancy

Small Print: CF, abscess, single pulm nodule

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57
Q

What paraneoplastic syndromes are a/w small cell lung ca? (3)

A

SIADH, Cushings, Lambert-Eaton

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58
Q

What paraneoplastic syndromes are a/w squamous cell lung ca? (2)

A

HyperCa (PTHrP) + Hyperthyroidism (TSH)

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59
Q

What paraneoplastic syndromes are a/w adeno lung ca? (3)

A

Clubbing, HPOA, Gynaecomastia

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60
Q

How does pancoast syndrome cause shoulder/ant chest wall pain, arm weakness, ipsilateral horners?

A

It invades the brachial plexus and cervical sympathetic nerves

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61
Q

Typical ABPA pt

A

Chronic asthma, new copious mucopurulent sputum, high IgE

It’s a hyperactive response to aspergillus fumigatus NOT an infection

Rx w 16wks of antifungals

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62
Q

ABG: acidosis + low CO2

A

Met Acidosis w pt breathing heavily to compensate

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63
Q

ABG: alkalosis + low CO2

A

Resp Alkalosis w pt breathing heavily due to asthma or panicking etc

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64
Q

What does a raised lactate make you worried about?

A

End organ hypoperfusion

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65
Q

How can you tell an AV fistula is working? (2)

A

A thrill can be felt and a bruit can be heard

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66
Q

Comps of AV fistula (3)

A

If it’s large enough you get elements of high output cardiac failure

PLUS thrombosis and infection

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67
Q

Indications for RRT (5)

A

Uraemia w comps, refractory hyperK/pulm oedema/met acidosis, drug OD

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68
Q

What are the different RRT options? (4)

A
  1. Haemofiltration: used for emergencies in ITU
  2. Haemodialysis: via tunnelled line or fistula
  3. Peritoneal Dialysis: via continuous ambulatory or automated
  4. Renal Transplant
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69
Q

HF vs HD

A

HF - 24hrs; uses convection; fluid volume IS replaced; prevents intravasc depletion, BP swings, dec risk of cerebral oedema

HD - 4hrs; uses diffusion; fluid is NOT replaced; haemodynamically stable but catabolic, hyperK, fluid overloaded

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70
Q

What is the risk w haemodialysis?

A

Endocarditis of the tricuspid valve

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71
Q

What are the comps of peritoneal dialysis? (2)

A

Sclerosing peritonitis and hyperglycaemia

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72
Q

Typical PBC pt

A

40+ F w liver failure and signs of autoimmune conditions complaining of itching that started BEFORE the jaundice, fatigue, xanthelasma

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73
Q

What is a/w PBC? (3)

A

RA, Sjogrens, hypothyroidism

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74
Q

Bloods for PBC (2)

A

Anti mitochondrial ab subtype M2

Raised bilirubin, alk phos, gamma gt

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75
Q

Tx for PBC (3)

A

Fat soluble vitamin supplementation, cholestyramine for the pruritis, ultimately a liver transplant

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76
Q

What are the consequences of deficiencies in the fat soluble vitamins?

A

A - night blindness

D - tiredness, bones, schizophrenia

E - generalised weakness, myopathy, dysarthria

K - elevated INR

NB: the impact on vitamin D deficiency on bones is compounded by the chronic inflammation

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77
Q

What is a/w APCKD? (3)

A

Berry aneurysms, HTN, family screening

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78
Q

What is a/w Wilsons? (2)

A

Dysarthria + Tremor

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79
Q

What are the causes of hepatomegaly? (6)

A

3C’s: cirrhosis, cancer, congestion

3I’s: infiltrative (sarcoidosis, amyloidosis, haemochromatosis), inflam (alcoholic, viral, AI hepatitis), Riedel’s lobe structural variant

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80
Q

What is pathognomonic for cirrhosis?

A

Hepatic venous hum

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81
Q

What are the neuro comps of alcohol XS? (3)

A

Wernicke encephalopathy, cerebellar syndrome, delirium tremens on withdrawal

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82
Q

Triad of Wernicke encephalopathy

A

Ophthalmoparesis w nystagmus, ataxia, confusion

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83
Q

Consequences of an impaired synthetic function of the liver

A

Coagulopathy + Hypoalbuminaemia

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84
Q

At what neutrophil count following an ascitic tap would you start abx?

A

> 250/ml

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85
Q

How much does one unit of Novorapid reduce BMs by as a rule of thumb?

A

3mmol/L

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86
Q

What should you be wary of when giving insulin to newly diagnosed type 1s?

A

Hypos as they’ll be insulin sensitive

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87
Q

What should you check if a pt has low hb post op?

A

The pre op hb + estimated blood loss

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88
Q

When would it be urgent to receive NG tube confirmation?

A

For Parkinson pts so they can have their meds on time

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89
Q

Typical PSC pt

A

Mostly men with UC presenting w obstructive jaundice

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90
Q

What does ‘beads on a string’ on ERCP indicate?

A

PSC

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91
Q

Which ca do pts w PSC get?

A

1 in 5 get cholangiocarcinoma

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92
Q

Why do pts w PSC receive ursodeoxycholic acid when it doesn’t improve sx?

A

It improves the LFTs and increases the time until a transplant is required

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93
Q

IBD: UC vs CD

A

UC: continuous mucosal inflam w main sx of urgency, tenesmus, wt loss, bloody diarrhoea

CD: non-continuous transmural inflam w cobblestoning, skip lesions, ulcers, strictures, fistulae, perforation

NB: extra-intestinal manifestations in both inc large joint arthritis, erythema nodosum, pyoderma gangrenosum, uveitis, episcleritis

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94
Q

A/w UC

A

Greater ca risk, PSC, uveitis

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95
Q

A/w CD

A

Worse in smokers, gallstones and oxalate renal stones, episcleritis

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96
Q

Can you get a terminal ileitis w UC?

A

Despite not affecting the small bowel you can get backwash ileitis, less common than w CD, but can also have B12 def w UC

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97
Q

What infective disease can also cause a terminal ileitis?

A

Yersinia Enterocolitica

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98
Q

RIF pain ddx

A

GI: appendicitis, terminal ileitis, yersinia infection, mesenteric adenitis, meckels diverticulitis

Gynae: ectopic, ovarian/testicular torsion, PID

Uro: UTI + stone

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99
Q

LIF pain ddx

A

GI: diverticulitis, IBD, IBS, constipation, hernia

Gynae: ectopic, ovarian/testicular torsion, PID

Uro: UTI + stone

100
Q

Ix for IBD (3)

A

Bloods - anaemia, B12, vit D

Stool - inc faecal calprotectin + occult blood

AXR - obstruction, UC: toxic megacolon, CD: perforation

101
Q

Ddx for increased faecal calprotectin (5)

A

IBD, coeliac disease, infective colitis, colon cancer, NSAID use

102
Q

What is a toxic megacolon?

A

Colonic diameter >6cm on clear abdominal film PLUS signs of systemic inflam: tachycardia, febrile, leukocytosis, low albumin count

103
Q

Mx for IBD

A

Medical - 5-ASA PO/PR, steroid foams PR, budesonide PO, biologics

Surgical - UC: panproctocolectomy + CD: elective terminal ileum resection

104
Q

The three types of chronic AI hepatitis

A

Type 1: ANA, anti-SM, IgG hyperglobulinaemia

Type 2: anti LKM1 + responds to interferon

Type 3: SLA + liver-pancreas antigen

105
Q

Hep B Abs/Ags

A

HBsAb - cleared or vaccinated

HBcAb - cleared

HBsAg - active or chronic

HBeAg - active

106
Q

Tx for Hep B

A

Peg-IFNα + an antiviral agent such as entecavir or tenofovir

107
Q

Hep B vs Hep C: DNA vs RNA? Which is more likely to become chronic?

A

Hep B - DNA

Hep C - RNA

NB: it’s Hep C that’s much more likely to become chronic

108
Q

Associate features of Hep C

A

Mixed cryoglobulinaemia causing a vasculitic rash and Raynaud’s phenomenon

109
Q

Ix for Hep C

A

Rheumatoid Factor + complement screen for normal C3 and low C4

110
Q

Tx for Hep C

A

Peg-IFNα + antiviral or ribavirin

111
Q

What is the most common Hep C genotype in the UK?

112
Q

What causes your ALT to go above 1000? (2)

A

Ischaemia + Paracetamol OD

113
Q

List three other non-hepatic causes of an elevated ALT

A

Addisons, coeliac, anorexia

114
Q

What comes to mind for sudden onset severe abdo pain in elderly pt w AF?

A

Mesenteric Infarction

115
Q

Outline the associated sx to ask for a neck and throat hx

A 
Voice
Dysphagia
Odynophagia
Dyspnoea
Haemoptysis
Neck Lumps
Referred Ear Pain
Thyroid Sx
FLAWS
116
Q

Outline the examination of the neck

A

Inspect: asymmetry, oral cavity, w tongue out, sipping water

Palpate: tender, lumps, temp, trachea, LNs

Percuss: thyroid borders

Auscultate: bruits + stridor

SRV: tremor, pulse, eye signs

117
Q

What does specificity equal?

A

True Neg / (True Neg + False Pos)

Therefore high specificity means the test has few false positives

118
Q

What does sensitivity equal?

A

True Pos / (True Pos + False Neg)

Therefore high sensitivity means the test has few false negatives

119
Q

Specificity vs Sensitivity

A

SPIN + SNOUT

SPecific tests are good at ruling things IN - low false pos

SeNsitive tests are good at ruling things OUT - low false neg

120
Q

What features suggest activity in Graves disease? (2)

A

Lid Lag + Tachycardia

121
Q

What features suggest activity in acromegaly? (2)

A

HTN + Glycosuria

122
Q

What features suggest activity in Cushing’s syndrome? (3)

A

HTN, Glycosuria, Proximal Myopathy

123
Q

Dx DKA

A

CBG >11mmol/L or know diabetes mellitus

Ketones >3mmol/L or significant ketonuria

Venous pH <7.3 or HCO3 <15mmol/L

124
Q

Priorities of DKA Mx

A
  1. Fluids
  2. Insulin
  3. Potassium
  4. Anticoag
125
Q

Why do you give fixed rate insulin in DKA?

A

Ketones > Glucose

126
Q

Dx HHS

A

CBG >30mmol/L w/o sig hyperketonaemia or acidosis

Hypovolaemia + OsmolaLity >320mosmol/kg

127
Q

Priorities of HHS Mx

A
  1. Fluids
  2. Potassium
  3. Anticoag
  4. Insulin
128
Q

Why might the plasma sodium show as falsely low in HHS?

A

The hyperglycaemia results in water shift from IC -> EC

129
Q

What are the precipitating factors leading to DKA/HHS?

A

The 6I’s

Infection
Ischaemia
Iatrogenic
Intoxication
Ignorance
Infant
130
Q

How would you explain DKA/HHS to the pt?

A

Check pt understanding

Explain comp of their diabetes causing high blood sugars +/- acidic blood

Tx will require admission for fluids insulin monitoring + sx control w analgesia and anti sickness

Explore ICE eg length of stay and amount of needles

131
Q

What is the calculation to work out an IV infusion drip rate?

A

Volume/Time(mls/mins) x Drop Factor

132
Q

What is acanthosis nigricans a/w?

A

Insulin resistance, obesity, GI malignancy

133
Q

HyperNa Causes

A

Hypotonic:
Dehydration
Diabetes Insipidus

Hypertonic:
Conn’s Syndrome
Inappropriate Saline
XS Salt Ingestion

134
Q

What biopsy features are suggestive of carcinoma in any site of the body?

A

Nuclear enlargement, hyperchromasia and pleomorphism

135
Q

How can you tell if the T2RF is acute or chronic?

A

If the pt is acidotic it’s acute

136
Q

HyperK ECG

A

Diminished p waves, prolonged PR, broad QRS, tall tented t waves

137
Q

Which class of meds typically causes a hyperK?

A

ACEi therefore check U+Es a wk after starting to detect those that may be affected w renal impairment or marked hyperK

138
Q

Which ix confirm the dx of ILD following a suspicious CXR?

A

Lung function tests show a restrictive picture and high res chest CT +/- biopsy

139
Q

Causes of cavitating lung mass

A

Bacterial lung abscess, SCC, GPA and pulm infarct

140
Q

Causes of lung abscess

A

Staph aureus, klebsiella, TB and anaerobic spp.

141
Q

What causes surgical emphysema?

A

Any condition which can cause pneumothorax or pneumomediastinium

142
Q

What are the five D’s of a Charcot joint?

A 
Density
Destruction
Debris
Distension
Dislocation
143
Q

What is likely to have caused extensive air in a soft tissue?

A

Infection w gas forming organism

144
Q

Tx of gas gangrene

A

IV tazocin + clindamycin and surgical debridement

145
Q

Caecal Volvulus

A

Presence of haustra

146
Q

Sigmoid Volvulus

A

Coffee bean appearance and absence of haustra

147
Q

The 3-6-9 rule

A

The normal bowel calibre: small bowel <3cm, large bowel and appendix <6cm, caecum <9cm

148
Q

Where can volvulae coniventes be found?

A

Small bowel only

149
Q

Which hepatitis can go on to cause cirrhosis?

150
Q

Acute Hep

A

A or E - spotty necrosis

151
Q

Chronic Hep

A

B or C - peicemeal necrosis

152
Q

The major causes of cirrhosis

A

Micronodular: alcoholic and biliary tract disease

Macronodular: viral, Wilsons disease, A1AT def

153
Q

Categorise anaemia w causes

A

Microcytic anaemia is associated with iron deficiency, chronic infection, lead poisoning, thalassemias, sideroblastic and haemoglobinopathies.

Normocytic anaemia is associated with malignancy, chronic disease, primary marrow disorders and haemoglobinopathies.

Macrocytic anaemia is associated with B12, folate deficiency, liver and alcohol disease, metabolic and marrow disorders and haemoglobinopathies.

154
Q

Syphilis causative organism

A

The spirochaete bacterium treponema pallidum

155
Q

Syphilis ix

A

Dark ground microscopy of ulcer samples, nontreponemal ab tests (VDRL & rapid plasma reagin), treponemal ab tests (haemagglutination assay & fluorescent ab testing)

NB: in primary syphilis where sx have only been px for a few days baseline testing may be -ve but should be +ve within 2w so repeat tests then

156
Q

Which ab do nontreponemal tests detect?

A

Cardiolipin

157
Q

Which abs are quantifiable?

A

Nontreponemal

158
Q

Which abs remain positive after tx?

A

Treponemal

159
Q

What should you always test for following a dx of syphilis?

160
Q

Syphilis tx

A

IM benzathine penicillin (oral doxycycline if penicillin allergic), full sexual health screen, hep B vac if MSM, partner notification, advise no sex regardless of protected or not until after tx

161
Q

What may occur after initiation of abx tx?

A

A Jarisch-Herxheimer reaction

162
Q

How does a Jarisch-Herxheimer reaction px?

A

Acute febrile illness w headache, myalgia, chills and rigors resolving <24 hrs

163
Q

Describe the relationship b/w a Jarisch–Herxheimer reaction and early/late syphilis

A

Early - common but usually not clinically sig

Late - uncommon but may be life-threatening

164
Q

When does neurosyphilis occur?

A

10-20yrs after primary infection

165
Q

What is tabes dorsalis?

A

The involvement of the posterior columns of the spinal cord (sensory ataxia, shooting pain, Charcot joints)

166
Q

What is the Argyll-Robertson pupil?

A

It is fixed and constricted that responds to accommodation but not to light

167
Q

How is neurosyphilis dx?

168
Q

What can neurosyphilis comprise of?

A

Psychosis, dementia, tabes dorsalis, Argyll-Robertson pupil

169
Q

When does the secondary vasculitic phase occur?

A

4-8w after primary infection

170
Q

When does cardiovascular syphilis occur?

A

10-30yrs after primary infection

171
Q

What can cardiovascular syphilis comprise of?

A

Aortitis, aneurysm of ascending aorta, aortic incompetence, heart failure

172
Q

When does gummatous syphilis occur?

A

3-12yrs after primary infection

173
Q

Where does gummatous syphilis usually affect?

A

Skin & bone

174
Q

When are syphilis pts most infectious?

A

During primary infection

175
Q

What can a widespread maculopapular rash in a pt w fever and malaise be indicative of?

A

HIV seroconversion or secondary syphilis

Ddx pityriasis rosea & guttate psoriasis

176
Q

When would you get a rash w EBV?

A

After concomitant amoxicillin administration

177
Q

What would a rash affecting the palms and soles be more indicative of?

A

Syphilis > HIV

178
Q

How long after exposure is HIV seroconversion illness likely to develop?

179
Q

How long after exposure is secondary syphilis likely to develop?

180
Q

How long is the window period for HIV post exposure prophylaxis?

181
Q

When is resp acidosis usually seen?

A

COPD or type 1 respiratory failure when they tire

182
Q

Which features suggest PCP?

A

Dry cough over mnths, SOBOE, constitutional sx

CXR - interstitial and bilateral hilar shadowing

ABG - profoundly hypoxic w type 1 respiratory failure

183
Q

Where does cryptogenic fibrosing alveolitis typically affect?

A

Basal interstitial shadowing

184
Q

Tx for PCP

A

Oxygen, 3w co-trimoxazole or clindamycin/promaquine if allergic, steroids if PO2 <8kPa

185
Q

What is another name for co-trimoxazole?

186
Q

What is the PCP prophylaxis for HIV-positive pts w CD4 <200?

A
  1. Septrin 480mg OD

2. Dapsone 100mg OD

187
Q

How do you dx PCP?

A

Bronchoscopy, BAL, staining and PCR

188
Q

RFs for HIV transmission

A

Order of prevalence: MSM, heterosexual contact in sub-Saharan Africa, IVDU, vertical transmission

189
Q

Difference b/w type 1 and type 2 respiratory failure

A

Type 1 - low/N CO2 - VQ mismatch

Type 2 - high CO2 - inadequate alveolar ventilation

190
Q

Which hormones are stored and released from the posterior pituitary?

A

Vasopressin

Oxytocin

191
Q

What are the micro/macro vascular problems w DM?

A

Micro: retinopathy, nephropathy, neuropathy

Macro: stroke, MI, limb ischaemia

192
Q

Ddx of Hypercalcaemia

A

Malignancy
1° HyperPTH
Sarcoidosis

193
Q

Tx of Hypercalcaemia

A

Correct dehydration, single dose of pamidronate, tx underlying cause

194
Q

Ddx of a Goitre

A

Diffuse: physiological, Grave’s disease, Hashimoto’s thyroiditis, subacute thyroiditis

Nodular: multinodular, adenoma, carcinoma

195
Q

What are the sx and signs of thyroid eye disease?

A

Sx: discomfort, inc/dec lacrimation, photophobia, diplopia, dec acuity

Signs: exophthalmos, proptosis, lid retraction, lagophthalmos, corneal ulceration, conjunctival scarring, chemosis, periorbital swelling, ophthalmoplegia, lid lag, loss of colour vision, papilloedema, afferent pupillary defect

196
Q

Exophthalmos vs Proprosis

A

Both is the appearance of eye protrusion however in proptosis it must go beyond the orbit

197
Q

What is the main known risk factor for thyroid eye disease?

198
Q

Which tx of thyrotoxicosis worsens thyroid eye disease?

A

Radioiodine

199
Q

Mx of Thyroid Eye Disease

A

Get specialist help, tx the sx and any thyroid disease, stop smoking, high dose steroids, surgical decompression if sight threatening

200
Q

What are the extrathyroidal features of Grave’s disease?

A

GES plus acropachy, dermopathy, pretibial myxoedema

201
Q

What are the cut offs for impaired glucose tolerance?

A

Fasting: >=6.1 but <7mmol/L

2h OGTT: >=7.8 but <11.1mmol/L

202
Q

What is the International Diabetes Federation definition of metabolic syndrome?

A

Central obesity ie BMI >30 or inc waist circ plus two of: BP >=130/85, triglycerides >=1.7, HDL <=1.03 if male and <=1.29 if female, fasting glucose >=5.6 or T2DM

203
Q

What is important to try and distinguish b/w in the diabetic foot?

A

Ischaemia vs Peripheral Neuropathy

204
Q

When would you consider dual therapy for treating T2DM?

A

If the HbA1c rises to 58mmol/mol despite monotherapy w metformin

205
Q

Why should you avoid using metformin if the pt has a low eGFR?

A

Risk of Lactic Acidosis

206
Q

What are the causes of hypoglycaemia in a non-diabetic?

A

EXPLAIN: exogenous drugs, pituitary insufficiency, liver failure, Addison’s disease, islet cell tumour and anti-insulin receptor antibody in Hodgkin’s disease, non-pancreatic neoplasm

207
Q

What are the causes of hypoglycaemia with low insulin and no excess ketones?

A

Anti-Insulin Receptor + Non-Pancreatic Neoplasm

208
Q

What are the causes of hypoglycaemia with low insulin and inc ketones?

A

Alcohol
Pituitary
Addison’s

209
Q

What is Whipple’s triad?

A

Recorded hypoglycaemia with sx that are resolved following gluocse

210
Q

What are the patterns of features in the MEN syndrome?

A
  1. Parathyroid, Pancreas, Pituitary
    2a. Thyroid, Phaeo, Parathyroid
    2b. Above + Mucosal Neuromas and Marfanoid Appearance
211
Q

What is the 10% rule of phaeochromocytomas?

A

Malignant
Extra-Adrenal
Bilateral
Familial

212
Q

What are extra-adrenal phaeochromocytomas referred to as?

A

Paragangliomas

213
Q

Sx of Pheao

214
Q

What should you exclude before a water deprivation test?

A

HyperCa due to HyperPTH

215
Q

How can you best differentiate b/w 1° and 3° hyperparathyroidism?

A

Renal Function

216
Q

What can an afferent pupillary defect in thyroid eye disease indicate?

A

It may mean optic nerve compression requiring urgent referral for decompression

217
Q

Why do you get ophthalmoplegia in thyroid eye disease?

A

Muscle Swelling + Fibrosis

218
Q

What metabolic bone disease can anticonvulsants cause?

A

Osteomalacia

219
Q

What happens to Na and K in Addison’s disease?

A

Dec Na + Inc K

220
Q

What happens to Na and K in primary hyperaldosteronism?

A

Inc Na + Dec K

221
Q

How does thyroid dysfunction affect the menstrual cycle?

A

Hyper: oligomenorrhoea +/- infertility

Hypo: menorrhagia

222
Q

What is Nelson’s syndrome?

A

A postop comp of a bilateral adrenalectomy causing inc skin pigmentation due to ACTH release from an enlarging pituitary adenoma

223
Q

What features suggest activity in Graves disease?

A

Lid Lag + Tachycardia

224
Q

What features suggest activity in acromegaly?

A

HTN + Glycosuria

225
Q

What features suggest activity in Cushing’s syndrome?

A

HTN, Glycosuria, Proximal Myopathy

226
Q

What are the precipitants to DKA?

A 
Infection
Ischaemia
Iatrogenic
Intoxication
Ignorance
Infant
227
Q

What should you think of for a fever in a returning traveller?

A 
Malaria
Dengue
Enteric
Hep A
HIV
228
Q

How do you reverse warfarin?

A

Stop Warfarin + Vit K, Prothrombin Complex, FFP

229
Q

What are the clotting results in DIC?

A

Inc APTT and PT + Dec Pl and Fibrinogen

230
Q

What clotting result correlates with severity in DIC?

A

Fibrinogen

231
Q

What cancers are a/w pernicious anaemia?

A

Gastric Carcinoid Tumours + Adenocarcinomas

232
Q

Ddx for inc temp and HR, dec BP, collapse 15mins into blood transfusion

A

Wrong blood: stop transfusion, A-E and IV fluids, repeat G+S and XM

Bacterial contamination: same as above plus culture bag and pt then start IV empirical abx

233
Q

What is febrile non-haemolytic transfusion reaction?

A

Rise in temp <=1°C w/o circulatory collapse and haematuria likely due to cytokine release during storage

If temp keeps rising and BP falls think about a more serious reaction

234
Q

Tx for FNHTR

A

Slow the transfusion and give paracetamol

235
Q

Tx for Allergic Reaction

A

Slow the transfusion and give antihistamine

236
Q

How soon do you have to give anti-D to D- mum after delivery of a D+ baby?

237
Q

What test do you do along giving the mother anti-D?

A

Kleihauer test: to see if more anti-D is required following baseline dose

Acid solution denatures HbA but not HbF - work out ratio of the two

238
Q

How do you tx a sensitised mother w a D+ baby?

A

Intrauterine transfusion /mnth

239
Q

How can we monitor baby for anaemia?

A

Doppler US of MCA

240
Q

What pathology can anti-D abs cause in the neonate?

A

Anaemia + Jaundice (since the placenta is no longer removing the bilirubin)

241
Q

How long can blood be taken out of the fridge for then safely put back?

242
Q

What temp are blood products stored at?

A

Red Cells: 4+/-2°C

Platelets: 22°C

FFP + Cryo: -30°C

243
Q

What is the maximum length of time over which you can infuse a unit of blood to a pt?

244
Q

What is the universal donor for RBCs and FFP?

A

RBCs: O-
FFP: AB+

245
Q

When are women usually given anti-D in pregnancy?

A

500IU @ 28+34wks

Year 5/6 (20 decks)

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