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RW FY1 > Misc. > Flashcards

Misc. Flashcards

1
Q

Stress incontinence - Tx?

A

(1) Pelvic floor exercises
(2) Duloxetine
(3) Colposuspension
(4) Intramural bulking agents
(5) nerve stimulation

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2
Q

Urge incontinence - Tx?

A

(1) Bladder re-training
(2) Anti-muscarinics
- Oxybutynin (IR)
- Tolterodine
- Solifenacin
- Darifenacin
(3) - If frail/elderly –> Mirabegron (B3-agonist)
(4) Botox into bladder
(5) Nerve stimulation

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3
Q

High QRISK 2 score. Started on Atorvastatin 20mg ON. 3 month follow up target?

A

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%

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4
Q

Ethylene glycol overdose - Tx?

A
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5
Q

Bisoprolol overdose - Tx?

A

(1) IV Atropine
(2) IV Glucagon

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6
Q

DHx Warfarin. Started new TB drug. Now raised INR.

What drug?

A

Isoniazid

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7
Q

DHx Warfarin. Started new TB drug. Now decreased INR.

What drug?

A

Rifampicin

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8
Q

Which organelle does catabolism of long chain fatty acids?

A

Peroxisome

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9
Q

Dermatitis herpetiformis

Which HLA?

A

HLA-DR3

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10
Q

TCA overdose - Tx?

A

IV Bicarbonate

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11
Q

Conversion ratios

S/C morphine –> PO Morphine

PO Oxycodone –> PO Morphine

PO Codeine –> PO Morphine

PO Tramadol –> PO Morphine

A
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12
Q

Which opioid in renal impairment can you use

A
  • If eGFR 30-60
    • Oxycodone
  • If eGFR < 30
    • Buprenorphine patch
    • Fentanyl parch
    • Alfentanil (under specialist advice)
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13
Q

Bony metastases pain - Tx?

A

Tx: NSIADs

+/- Opiates

+/- Bisphosphonates (pain improves within 4 weeks)

+/- Radiotherapy (pain improves within 6 weeks)

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14
Q

How to titrate morphine

A

Starting dose

  • PO Morphine sulphate 5mg every 4 hours (30mg/day)
    • PRN Oromoprh IR 5mg for breakthrough pain

Up-titrating if pain is not > 90% relieved

  • Method 1
    • Increase dose by 30-50%
  • Method 2
    • Calculate total daily dose (including PRN doses)
    • Divide into 2x 12 hourly doses as BD modified release
  • Calculate new PRN dose (1/6 total daily dose)
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15
Q

Breakthrough pain

Tx?

A

Immediate release morphine sulphate (e.g. Oromorph)

Dose = 1/6 TOTAL daily dose

PRN every 4-6 hours

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16
Q

Palliative medications

Agitation + Anxiety

Agitation + Delirium

SOB

Secretions

Diffuse oral pain

Hiccups

A

Agitation + Anxiety –> Midazolam

Angitation + Delirium –> Haloperidol or Levomepromazine or Chlorpormazine

SOB –> Morphine

Secretions –> Hyoscine butylbromide or Glycopyrronium bromide

Diffuse oral pain –> Benzydamine mouthwash

Hiccups –> Chlorpromazine

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17
Q

Alcohol abstinence maintainence therapy

A
  • Disulfiram (unpleasant symptoms after drinking)
    • MOA: Inhibits acetaldehyde dehydrogenase –> ↑ acetaldehyde –> ↑ N&V, mimics flush reaction
  • Acamprosate (↓ cravings)
    • MOA: unknown –> ↑ GABA –> ↓ craving
    • ↓ pleasurable effects of alcohol
  • Naltrexone
    • MOA: µ-opiate receptor antagonist –> ↑ GABA –> ↓ DA
    • ↓ pleasurable effects of alcohol
    • Can safely drink
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18
Q

Aspirin overdose - Tx

A

IV sodium bicarbonate

If within 12 hours –> Oral activated charcoal

+/- Haemodialysis

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19
Q

Aspirin overdose - ABG

A

Mixed respiratory alkalosis + metabolic acidosis

hyperventilation –> respiratory alkalosis

salicylate –> metabolic acidosis

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20
Q

CO poisoning - Tx

A

Hyperbaric oxygen

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21
Q

“Brick-red skin”

Smell of “bitter almonds”

Headache

Confusion

Ataxia

Diagnosis? MOA? Tx?

A

Cyanide poisoning

Cyanide inhibits Cytochrome C

Tx: IV Hydroxocobalamin

or Combination of Amyl nitrite (inhaled) + IV Sodium nitrite + IV Sodium thiosulfate

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22
Q

Basophilic stippling

Abdominal pain

Confusion

Diagnosis? Treatment?

A

Lead poisoning

Tx: Dimercaprol

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23
Q

Benzodiazepine overdose - Tx

A

Flumazenil

S/E: Seizures

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24
Q

Methanol overdose & Ethylene glycol vose

Tx?

A

Fomepizole

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25
Q

Heparin overdose - Tx

A

Protamine sulphate

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26
Q

Iron overdose - Tx

A

Desferrioxamine

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27
Q

Lithium overdose - Tx

A

IV 0.9% saline

Haemodialysis

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28
Q

Local anaesthetic toxicity

Tx?

A

IV Lipid Emulsion 20%

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29
Q

Aflatoxin

Aniline

Risk factors for what cancer

A

Aflatoxin -> alpha fetoprotein -> liver cancer

Aniline -> urine -> bladder cancer

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30
Q

Bladder cancer

Most common type

Most common type associated with Schistosomiasis

A

Bladder cancer

  • Transitional cell carcinoma (90%)
  • Squamous cell carcinoma - associated with Schistosomiasis
  • Adenocarcinoma (rare)
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31
Q

Once lung cancer is diagnosed, what Ix to assess suitability for surgical resection

A

PET scan:

to look for extent of primary tumour and any mets

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32
Q

Small cell + Squamous cell lung cancer

Paraneoplastic syndromes

A
33
Q

Tx for neutropenic sepsis

A

Tazocin + Gentamicin

34
Q

VIPoma presentation

A

Most arise from Pancreas

WDHA syndrome

  • WD = Watery diarrhoea
  • H = Hypokalaemia
  • A = achlorhydia (absence of hydrochloric acid secretion)
35
Q

Factors affecting PSA levels

A
36
Q

Medical Tx for prostate cancer

A

GnRH agonist (Goserelin)

+ Anti-androgen (Cryproterone acetate)

  • co-presecribed to prevent initial increase Testosterone
37
Q

Thyroid cancer

Most common types

Most aggressive type

Most slow growing

Associated with MEN2A/2B

Associated with Hashimoto’s thyroiditis

A

Thyroid cancer

Most common types –> Papillary

Most aggressive type –> Anaplastic

Slow growing –> Follicular

Associated with MEN2A/2B –> Medullary (Parafollicular C cells)

Associated with Hashimoto’s thyroiditis –> MALT lymphoma

38
Q

Unilateral sensorineural hearing los

Tinnitus

Facial palsy

Absent corneal reflex

Diagnosis?

Associations?

Most common location

A

Acoutstic neuroma = vestibular schwannoma

Associated with NF2

Most commonly located at the cerebellopontine angle

39
Q

BPPV

Dix-Hallpike vs Epley

A

Dix-Hallpike manoeuvre is diagnostic

Epley manoeuvre is for treatment

40
Q

Recurrent vertigo

Caused by movement

Diagnosis?

A

BPPV

41
Q

Episodic vertigo

Sensorineural hearing loss

Tinnitus

Sensation of fullness (in affected ear)

Horizontal nystagmus

Diagnosis

A

Meniere’s disease

42
Q

Recent viral illness

Vertigo (room spinning)

Horizontal nystagmus

+ve head impulse

Normal hearing

Single episode

DDx from BPPV and Vestibular migraine

which require recurrent episodes for diagnosis

A

Vestibular neuritis

Single episode –> DDx from BPPV and Vestibular migraine

which require recurrent episodes for diagnosis

43
Q

Recent URTI

Sensorineural hearing loss

Vertigo

Diagnosis?

A

Labyrinthitis

44
Q
A
45
Q

Von Hippel Lindau

aetiology

presentation

A

Von Hippel Lindau

Autosomal dominant mutation in VHL gene

  • Café au lait macules
  • Haemangiomas
    • CNS haemangiomas –> subarachnoid haemorrhage
    • Retinal haemangiomas –> Vitreous haemorrhage [often 1st sign]
46
Q

Alports syndrome

Aetiology

Presentation

A

Alports syndrome

X linked dominant

  • Triad
    • Haematuria –> Renal failure
    • Sensorineural deafness
    • Ocular pathology
      • Lens dislocation
      • Retinitis pigmentosa
  • Renal biospy: “baseket weave appearance” of GBM
47
Q

Achondroplasia

Aetiology

Features

A

Achondroplasia

Autosomal dominant mutation in FGFR3 gene

  • Short stature
  • Long bone shortening
  • Trident hands
  • Flat nasal bridge with frontal bossing
  • Narrow foramen magnum
48
Q

Bartter vs Gitelman vs Liddle syndrome

A

Bartter (Barffer = Furosemide = Loop diuretic)

  • Defect in Na-K-Cl co-transporter in LoH (similar to Furosemide)
  • Hypokalaemia + Normotension

Gitelman (GiTelman = Thiazide = Na Cl in DCT)

  • Defect in NaCl co-transporter in DCT (similar to Thiazides)
  • Hypokalaemia + Normotension

Liddle (Liddle Conn / Little Kong)

  • Defect in Na channels in DCT –> increase Na absorption (similar to Conn’s)
  • Hypokalaemia + Hypertension
49
Q

Pseudomembranes on the tonsils

Diagnosis?

A

Diphtheria

50
Q

HIV and opportunistic infections

A
51
Q

HHV 1-8

A
52
Q

Itchy, maculopapular rash

Classicaly AFTER administration of Amoxicillin or Cephalosporin

Diagnosis?

Cause?

Investigations?

A

Infectious mononucleosis

EBV

Monospot test for Heterophile antibodies

Anti-EBV antibodies

Atypical lymphocytosis

53
Q

HPV types and causes

A

Genital warts –> HPV 6 / HPV 11

Cervical cancer –> HPV 16 / HPV 18

54
Q

Patches of hypopigmented skin + sensory loss

Diagnosis?

Cause?

A

Leprosy

Mycobacterium leprae

55
Q

Painful genital ulcer

Ragged undermined border

Painful inguinal lymphadenopathy

Diagnosis?

A

Chancroid

Haemophilus ducreyi

56
Q

MSM (Anal sex)

Painless genital ulcer

Balanitis / Proctitis / Cervicitis

Painful inguinal lympadenopathy

Diagnosis?

Cause?

A

Lymphogranuloma venerum (LGV)

Chlamydia

57
Q

Diarrhoea

Weight loss, Arthralgia, Lymphadenopathy

Ophthalmoplegia

Jejunal biopsy shows Macrophages with Periodic acid schiff granlues

Diagnosis? Cause?

A

Whipple’s disease

Tropheryma whippelii

58
Q

Tx for schistosomiasis

A

Praziquantel

59
Q

Quadrantanopia

A

Tip: PITS (Parietal-Inferior, Temporal-Superior) for Pie in the Sky

Superior quadrantanopia ==> Lesion of Temporal lobe

Inferior quadrantanopia ==> Lesion of Parietal lobe

60
Q

Homonymous hemianopia with macular sparing

Lesion?

A

Occipital cortex

61
Q

Gradual reduce visual acuity

Glare + Halos

Loss of red reflex

Diagnosis

A

Cataract

62
Q

Acute onset, painful red eye

Haloes

Fixed dilated pupil

Diagnosis?

A

Closed angle glaucoma

63
Q

Asymptomatic

Peripheral visual field loss / Tunnel vision

Scotoma

Diagnosis?

A

Open angle glaucoma

64
Q

Diabetic

Sudden, painless visual loss

New floaters

Blood on retina

Diagnosis?

A

Vitreous haemorrhage

65
Q

Drusen

A

Dry AMD

66
Q

Choroidal neovascularisation

A

Wet AMD

67
Q

Painless deterioration of central vision

A

AMD

68
Q

Sudden onset, painless vision loss

Pale retina

Cherry red spot

Diagnosis? Causes?

A

Central retinal arterial occlusion

Caused by Embolism or Giant Cell Arteritis

69
Q

Sudden onset, painless loss of vision

Retinal haemorrhages

Diagnosis?

A

Central retinal vein occlusion

70
Q

Floaters + Flashing lights

Normal vision

Diagnosis?

A

Posterior vitreous detachment

71
Q

Floaters + Flashing lights

Visual field loss

Diagnosis?

A

Retinal detachment

72
Q

Vertical diplopia

Patients head tilted to contralateral side

Diagnosis? Cause?

A

4th nerve palsy

Trauma

73
Q

Horizontal diplopia

Diagnosis? Cause?

A

6th nerve palsy

Raised ICP

74
Q

Horizontal diplopia

Failure of adduction (ipsilateral)

Abducting nystagmus (contralateral)

Diagnosis? Lesion? Cause?

A

Internuclear ophthalmoplegia (INO)

Lesion in medial longitudinal fasciculus (midbrain/pons)

Caused by MS

75
Q

Causes of red eye

A
76
Q

Holmes-Adie pupil

Features

A

Holmes-Adie pupil

  • Reecent infection –> damage to parasympathetic to eye
  • Dilated pupil
  • Slowly reactive to light
    • Once constricted, it remains abnormally small for a long period of time
  • +/- Absent knee or ankle jerks
77
Q

Marcus Gunn pupil

A

Marcus Gunn pupil = RAPD

  • MS
  • Ischaemic optic disease
  • Glaucoma
78
Q

Hutchinson’s pupil

A

Hutchinson’s pupil

Compression of CN III by SOL

  • Unilaterally dilated pupil
  • Unresponsive to light

In contrast, Holmes-Adie is dilated + slowly constricts to light

79
Q

Argyll-Robertson pupil

Features? Cause?

A

Argyll-Robertson pupil

Neurosyphilis = “prostitute’s pupil” –> “accommodates but doesn’t react”

  • Bilaterally, small pupils
  • Do NOT react to bright light
  • Normal accommodation

RW FY1 (15 decks)

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