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Finals > Medicine passmed > Flashcards

Medicine passmed Flashcards

1
Q

Bradycardia (Symptomatic)+shock treatment?

A

Atropine (IV) 500mcg = 1st line (can also use this for narrow complex tachy if cause due to AF)
- Bradycardia does not normally need treatment BUT if patient is unstable then needs!
- If needs an alternative treatment= Adrenaline/isoprenaline infusion

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2
Q

Supraventricular tachycardia(narrow complex) mx?

A

IV Adenosine

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3
Q

REGULAR broad complex tachycardia Mx?

A

Amiodarone IV: if patient has no adverse features

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4
Q

Standard post- MI medication? (after discharge)

A

4 in total
1) Dual antiplatelet therapy (aspirin+ clopidogrel/ticagrelor/prasugrel)
2) Beta blocker
3) ACE-inhibitor
4) Statin

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5
Q

Pericarditis signs?

A
  • Kussmaul’s sign= JVP increases with inspiration
  • CXR: pericardial calcification
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6
Q

Rheumatic fever presentation?

A
  • Sore throat
  • rash
  • heart MURMUR
  • arthritis (ankles and wrists aching)

Develops after infection with: Strep pyogenes

Mx: Abx- Oral penicillin V, Anti-inflammatories: NSAIDs are 1st line treatment of any complications eg. heart failure.

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7
Q

ACS poor prognosis indicator?

A

Cardiogenic Shock

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8
Q

Difference between narrow and broad complexes?

A
  • Narrow: QRS complexes less than 100 ms (milliseconds)
  • Broad: QRS complexes more than 100 ms (milliseconds)
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9
Q

Mx. for narrow complex tachycardia with no adverse effects?

A
  • Try vagal manoeuvres eg. carotid sinus massage
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10
Q

A.F mx if haemodynamically UNSTABLE(if BP is unmeasurable/too low)

A

Immediate electrical (DC) cardioversion+ followed by thromboprophylaxis

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11
Q

‘Provoked PE’ caused post-op/after immobilisation, how long to keep anticoagulation for?

A

3 Months

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12
Q

Massive PE(Pulmonary Embolism)+unstable eg. hypotension?

A

Thrombolysis

NB: medical mx order:
1) DOAC eg apixaban/rivaroxaban
if neither suitable=
2)Low weight molecular heparin
3) add another DOAC

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13
Q

Ulcerative Colitis:

A

Presence of crypt abscesses, rectal bleeding. tenesmus (feeling to empty bowel but no stool passed)
- inflammatory bowel disease
- on endoscopy: pseudopolyps, loss of haustrations
-association more common: Primary Sclerosing Cholangitis

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14
Q

Crohn’s:

A

non bloody diarrhoea
-mouth to anus skip lesions
-goblet cells
-on endoscopy: skin lesions ‘cobble stone’ appearance

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15
Q

Coeliac disease patients should also receive which vaccine?

A
  • Pneumococcal: as can cause hypo-splenism
  • in Coeliac disease: bloods= Anti-tissue transglutaminase antibody is very raised.
  • Management of coeliac: is a gluten free diet
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16
Q

coeliac foods to have and avoid?

A

-CAN have: gluten free: including rice, potatoes and corn(maize)
- CAN’T have: gluten for eg. rye bread, barley, wheat, couscous

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17
Q

Appendicitis:

A
  • Abdominal pain migrated from umbilicus to right iliac fossa within last 12 hours.
  • Rovsing’s sign: palpation of left iliac fossa= results in right iliac fossa pain
    -Mx: Appendicectomy
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18
Q

What cancer does Pernicious anaemia predispose to?

A

Gastric cancer

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19
Q

Femoral hernias mx?

A
  • Need to be surgically repaired, regardless of symptoms as there is a high risk of strangulation
20
Q

Medication that is a risk factor for c. diff

A
  • PPIs eg. Omeprazole
21
Q

Management for severe flare up of Ulcerative Colitis:

A
  • Admit the patient in hospital and treat with IV corticosteroid

Mx: for long term maintenance and remission: ORAL aminosalicylate

22
Q

Complication of pancreatitis?

A

Acute Respiratory Distress Syndrome
- Pancreatitis: will have very raised serum Amylase

23
Q

coeliac disease: what Ig should you look at?

A

Ig A

24
Q

coeliac disease testing and making a diagnosis?

A
  • needs a REintroduction of gluten for at least 6 weeks before further testing otherwise the tests will come back negative even if patient has coeliac disease.
  • Gold standard for diagnosis: Endoscopic intestinal biopsy
  • 1st line test: Tissue transglutaminase antibodies
25
Q

Hypercalcaemia ECG finding:

A
  • Shortening of QT interval
26
Q

painful Diabetic neuropathy 1st line mx: (in the feet) for pain-

A
  • Duloxetine; is a SNRI= enhances pain suppression
  • Other 1st line med: Pregabalin, Gabapentin, Amytriptiline
27
Q

Medication that can be a cause of nephrogenic diabetes insipidus?

A

Lithium

28
Q

Medication that can be a cause of SIADH:

A

Fluoxetine

29
Q

Aortic dissection presenting signs:

A
  • Weak/absent pulse (either carotid, brachial or femoral)
  • Variation in arm blood pressure
30
Q

Mx. of heart failure with a reduced ejection fraction?

A
  • In addition to: ACE-i, beta blocker, furosemide, also add 2nd line) Spironolactone(mineralocorticoid receptor antagonist), NB; contraindication to spironolactone is hyperkalaemia
    3rd line) Digoxin and Ivabradine add
31
Q

Prescribing anticoagulants post-surgery:

A
  • For a PE: Prescribe DOAC for 3 months only if the PE is provoked (ie. after surgery), if is not provoked= prescribe for 6 months.
    DOACs are offered 1st line over LWMH (low weight molecular heparin)
  • 1st line= Thrombolysis
32
Q

Mx. of a single episode of paroxysmal atrial fibrillation:

A

Even if it is provoked= need to give anticoagulation: therefore give Apixaban.
2nd line) use Warfarin

33
Q

What drug can cause Heinz Body anaemia?

A
  • Sulphasalazine
  • Can cause increased reticulocytes
  • Presents with: SOB, dizziness, tiredness
34
Q

Investigation to be able to differentiate between: IBS and IBD (Irritable Bowel Syndrome and Inflammatory Bowel Disease)=

A

Faecal calprotectin test .
- Colonoscopy is also correct, but this is a more invasive procedure therefore faecal calprotectin is preferred first line.

35
Q

Pregnant woman who smoke: management?

A
  • Nicotine patch is good!
  • Buproprion and varenicline are contraindicated in pregnancy
36
Q

Meningococcal Septicaemia in children? mx.

A
  • IV fluids and Abx
  • NB Do NOT give dexamethasone
37
Q

Asthma diagnosis investigation in children?

A
  • Peak Flow
  • Spirometry and Bronchodilator reversibility: an increase of more than 12% is considired positive= to give salbutamol.
    (FeNO is not used in children like it is used in adults)
38
Q

what is a strange common feature in appendicitis in children?

A
  • Anorexia / losing appetite and not eating
39
Q

Pathogen causing: Eczema Herpeticum?

A
  • Herpes Simplex Virus
  • the way the rash can present: painful pruritic rash, with punched out lesions (monomorphic)
  • Mx: is potentially life threatening= therefore admit children for IV Aciclovir
40
Q

Patients (children) with active HSP(henoch schloein purpura) need what investigations?

A

-Need to monitor BP and urinalysis (especially in children without renal involvement)
- HSP is a type of vasculitis
- Around 1/3rd of patients have a relapse

41
Q

Paeds BLS: life support 1st line before starting chest compressions?

A
  • Give 5 rescue breaths
42
Q

Asthma management in children?

A
  • 1) SABA
    2) SABA+ ICS
    3) SABA+ICS+ LTRA(Monteluklast)- if less than 5, after this stage refer to a paeds asthma specialist
    4) SABA+ICS+LABA (instead of LTRA)
    5)then MART etc.
43
Q

Classical presentation of HSP? (same as in children)

A
  • Abdo pain
  • arthritis
  • haematuria
  • purpuric rash over buttocks and extensor surface of arms and legs
  • often follows a URTI and is most common in children.
  • NB: need to monitor BP and Urine dipstick
44
Q

Mx. of congenital inguinal hernias?

A
  • Need to immediately refer for Paeds surgery: as there is a high rate of complications
45
Q

What medication does Eczema Herpeticum require?

A

Antivirals eg. Aciclovir

46
Q

Mx. of Testicular Torsion?

A
  • Urgent BILATERAL orchidopexy (surgery involves fixing both testes to prevent torsion of the other testes)- treatment is with surgical exploration

Finals (38 decks)

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