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Misc Flashcards

1
Q

What is the analgesic ladder?

A

1 - paracetamol +/- NSAID
2- + weak opioid for mil to mod pain (codeine, tramadol, dihydrocodeine)
3- change to strong opioid - for mod - severe pain

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2
Q

Pain management for vertebral metastasis

A

Vertebral mets - from breast, prostate
Severe pain
All steps might be consumed

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3
Q

Mod-severe pain in vertebral mets after initial pain meds prescribed what can be added?

A

Radiotherapy as adjuvant if there is still mod-severe pain

Radio fails or inappropriate - use Bisphosphonates

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4
Q

What should you use if pain is neuropathic in nature?

A

Gabapentin or amitriptyline

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5
Q

Simple analgesics

A

NSAIDs (diclofenac)
Aspirin
Paracetamol

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6
Q

Weak opioids

A

Codeine

Tramadol

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7
Q

Strong opioids

A

Morphine
Fentanyl
Oxycodone

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8
Q

Bone pain due to mets

A

Radiotherapy

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9
Q

Neuropathic pain

A

Gabaoentin
Pregabalin
Amitriptyline

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10
Q

After open surgery - what pain meds are given?

A

Patient controlled morphine (weaned off later)

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11
Q

Visceral pain

A

Antispasmodic - Mebeverine

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12
Q

Capsular pain (liver)

A

NSAIDS - ibuprofen/Naproxen

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13
Q

Muscle spasm

A

Baclofen

Diazepam

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14
Q

Trigeminal neuralgia

A

Carbamazepine

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15
Q

Tx for intractable hiccups due to liver mets

A

Metaclorpromide

Peripheral causes of hiccups -

Liver mets - peripheral cause of hiccups due to gastric stasis and dilation - irritation of the vagus nerve.

Diaphragmatic irritation in liver mets - phrenic nerves irritated

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16
Q

Central causes of intractable hiccups

Tx-

A

Cerebral lesion

Tx - chlorpromazine/haloperidol/midazolam

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17
Q

Tx of constipation secondary to opioids

A

Senna - stimulant laxative

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18
Q

Vomiting secondary to opioids

A

Metoclopramide

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19
Q

Vomiting secondary to increased intracranial pressure or due to bowel obstruction

A

Cyclizine

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20
Q

Itching due to jaundice

A

Cholestyramine

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21
Q

What antiemetic should be used in
renal failure
Hypercalcemia (metaobolic cause)
Drug/toxin induced vomiting

A

Haloperidol

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22
Q

When can haloperidol not be used?

In that case what is the second line?

A

Parkinson’s - haloperidol is contraindicated
Metoclopramide can’t be used either

2nd line - levomepromazine

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23
Q

Antiemetic used in chemo/radio - therapy

A

Ondansetron

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24
Q

Post op intractable nause and vomiting

A

IV ondansetron

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25
Q

Antiemetics in hyperemesis gravidarum

A

1- cyclizine, promethazine
2- IV metoclopramide, ondansetron
3- steroids

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26
Q

Medication to shrink peri-lesional oedema and and alleviate ICP symptoms

A

Dexamethasone - preferred glucocorticoid in intracerebral oedema
Symptoms improve within several hours
Usual does = 4mg, 4x a day PO or IV

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27
Q

What is SVC obstruction commonly associate with?

A

Lung cancer

Another cause is lymphoma

SVC obstruction is an oncological emergency

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28
Q

Features of SVC syndrome

A

Dyspnoea
Swelling of face neck and arms - conjunctival and peri orbital oedema
Distension of veins of upper neck and chest

Facial plethora
Headache
Visual disturbance
Pulseless jugular venous distension

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29
Q

Causes of SVC obstruction

A

Common malignancies - non small cell lung ca, lymphoma

Other malignancies - metastatic Seminoma, kaposi’s sarcoma, breast ca

Aortic aneurysm
Mediastinal fibrosis
Goitre
SVC thrombosis

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30
Q

Management of SVC obstruction

A

Dexamethasone - most appropriate immediate management
Endovascular stenting - treatment of choice

Treat the cause.

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31
Q

Most appropriate investigation of SVC obstructions

A

CT Chest w/ contrast

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32
Q

What is Charcots triad ?

A

Acute ascending cholangitis

Triad - FRJ - fever, Right upper quadrant pain, Jaundice

+- leukocytosis and Hypotension

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33
Q

Investigations for ascending cholangitis

A

Abdominal US

Blood cultures

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34
Q

Patient with history of myeloma presents with back pain and urinary incontinence as well as lower limb weakness.

What diagnosis do you suspect?
What is your next step?

A

Malignant spinal cord compression
Urgent MRI of the whole spine

MSCC - history of ca - breast prostate myeloma + back pain_ neurologic sx

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35
Q

Most appropriate investigation for lipoma

What is the management?

A

US

Reassure

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36
Q

Management of lipoma

A

Typical not growing or interfering with life - reassure

Doubts of liposarcoma - >5cm, increasing in size, painful, deep anatomical location —— perform US - if suspicious - MRI referral +- surgical removal

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37
Q

Diagnosis of osteoporosis

A

T score

  • 1 or higher - normal
  • 1 - -2.5 - osteopenia
  • 2.5 or lower - osteoporosis
38
Q

Management of osteoporosis

Follow up

A

1st line - bisphosphonates
Alendronate, risedronate, zoledronic acid
70mg once weekly OR 10mg once daily.

F/U
Already on BIS - DEXA every 3-5 years
Stopped taking BIS - DEXA after 2 years

39
Q

Side effects of HRT

A

VTE
Stroke
Breast ca
Coronary disease

40
Q

Prescribing oral bisphosphonate

Explain the following to patient -

A

Dyspepsia and reflux are common in 1st month, improves with use

To reduce severity of sx - take bis in upright position and stay until 30 mins after

41
Q

What is C8

A

Nerve root that emerges below C7

There is no C8 vertebra

42
Q

Nerve root of Median nerve

A

C5-T1

43
Q

Nerve root of Ulnar nerve

A

C8 - T1

44
Q

What nerves are responsible for weakness of the hands?

A

Median and ulnar

45
Q

What is the lowest level needed to be seen after a neck in injury on a lateral neck X-ray ?

A

C7 - T1

46
Q

In a suspected cervical fracture what cervical vertebrae should be present in X-ray ?

A

C1-C7

47
Q

What junction sometimes does not appear on AP lateral and Peg view X-rays?

What view can be used to view it?

A

C7 -T1
Use Swimmer’s lateral view
If still unable to view — CT scan

48
Q

40 year old woman with menorrhagia, unable to conceive the past 2 years. TVUS drones showed thick-walled unilocular cyst with acoustic enhancement and diffuse homogenous ground glass opacities on the left ovary

What is the likely diagnosis?

A

Ovarian endometrioma

49
Q

Snowstorm appearance with mixed echogenicity
Bilateral cystic masses

What is your dx?

A

Hydatidiform mole

Bilateral cystic masses = large theca lutein cysts

50
Q

What is the US finding in PCOS

A

Multiple follicles, cysts

51
Q

Features of dermoid cyst on US

A

Iceberg tip sign
Flat-fluid level
Mostly unilocular
Dermoid mesh

52
Q

US shows ground glass appearance of ovary, thick wall uniloculat cyst, chocolate cyst
Dx?

A

Ovarian endometrioma

53
Q

Echogenic tubercle projecting into cyst lumen seen on US of ovary, what is you diagnosis?

A

Ovarian teratoma

54
Q

How does a tubo-ovarian abscess appear on US?

A

Multilocular
Separations
Irregular thick walls
Echogenic debris in pelvis

55
Q

ECG features of TCA overdose?

A

Widened QRS,PR,QT

Broad complex tachycardia

56
Q

What metabolic abnormality is seen in TCA overdose?

Treatment

A

Metabolic acidosis - severe
Tx - IV fluid bolus = .9% NaCl + IV sodium bicarbonate 50ml of 8.4%**
Aim for pH 7.5-7.55

57
Q

Electrolyte disturbances seen in refeeding syndrome?

A

Hypophosphatemia
HypoK+
HypoMg+

Cardiac + pulmonaary+neurological symptoms - can be severe if fatal

58
Q

Unilateral flank pain/loin pain + HCG +ve / amenorrhoeic

What should you suspect?

A

Ectopic pregnancy

59
Q

What tests should be done before commencing lithium ?

A

Thyroid function test **

Kidney function test

60
Q

What tests should be done before prescribing amiodarone?

A

Serum electrolytes

Urea

61
Q

What is useful thyroid cancer marker?
What does it indicate?
When is it used?

A

Thyroglobulin (Tg)
Recurrent or metastasis of thyroid cancer after successful removal of thyroid
Used after thyroidectomy

*not useful in diagnosis of thyroid cancer

62
Q

Patient with his of metastasis colorectal ca , presents with persistent vomiting of fecal content and has colicky abdominal pain
O/E - abdomen distended + high pitched sounds
What is the initial step in management?
What is the most palliative (definitive) step?
How would you manage the fecal vomiting?

A

Initial step - NGT decompression
Definitive/ most palliative step - stoma
Vomiting of fecal contents -NGT

63
Q

Features of pleural effusion

A

Dullness on percussion

Absent breath sounds

64
Q

Features of consolidation

A

Inspiration crackles + dullness on percussion

65
Q

What is a teratoma?

A

Tumour made up of several different types of tissue - hair muscle teeth epithelium cartilage or bone.

Typically form in the ovary, testicle , tailbone etc

66
Q

Presentation
Complications

Of teratoma

A

Symptoms - minimal
Testicular teratoma - painless lump

Complications - ovarian torsion, testicular torsion or hydrous fetalis

*males = ALWAYS MALIGNANT
females - usually benign

67
Q

What is Capecitabine?

Side effects

A

Chemotherapy drug

Profuse diarrhoea - to avoid severe dehydration =
requires fluid replacement
Anti-diarrhoeal meds - loperamide

If the diarrhoea and dehydration continue - stop the drug.

68
Q

Electrolyte imbalance seen in prostate ca

A

Hypercalcemia

Symptoms - depression, lethargy, constipation, polyuria, polydipsia

**SERUM CA should be requested in breast and prostate ca

69
Q

Long term meds for TIA

A

Clopidogrel + atorvastatin

70
Q

Long term management - TIA

A 
Control BP
Statins  - atorvastatin 80mg 
Anti platelets/ anticoagulations - depending on presence or absence of AF
= warfarin or DOAC
DOAC - apixaban, rivaroxaban, edoxaban

If no AF - Clopidogrel 75mg

71
Q

Acute ischemia stoke management

A

Aspirin 300 mg - 2 weeks

Clopidogrel 75mg for life

72
Q

Hydropneumothorax vs pleural effusion

A

Hydropneumothorax - air fluid levels within pleural space

Fluid level well defined extends whole length of hemithorax

-4S = straight line dullness, shifting dullness, splash, sound of coin

73
Q

Cause of hydropneumothorax

Treatment

A

Iatrogenic - during pleural fluid aspiration in effusion
Presence of gas forming organism
Thoracic trauma

Treatment
Intercostal drainage

74
Q

Fatigue weight loss high ALP and Ca++

Likely diagnosis?

A

Metastatic bone ca

75
Q

What chemotherapy drugs can cause peripheral neuropathy?

A

Vincristine
Crisp Latin
Carboplatin
Taxanes

76
Q

Small vs large bowel obstruction

A

LBO- peripheral, 8cm diameter, haustration
SBO - central, 5 cm , valvular coniventae
-ileum may appear tubeless

77
Q

Appearance of bronchiectasis (imaging)

A

Bronchial dilation and wall thickening with ground glass opacities
CXR -**Tramlines “cysts/ring opacities”
However CXR is often normal

78
Q

Clinical features of bronciectasis

A

Chronic persistent cough
Copious excessive sputum
Recurrent respiratory tract infections
Clubbing. - drumstick shaped fingers - not specific

“Irreversible dilatation of small and medium sized bronchi”

79
Q

How do you confirm a dx of bronchiectasis?

A

***HIGH RESOLUTION CT SCAN (HRCT)

80
Q

What is a post dural puncture headache?

How do you treat it?

A

Headaches after spinal anaesthesia
Caused by CSF leakage - leads to decreased intracranial pressure

Observe and encourage oral hydration
Usually self limited (goes within a week)

81
Q

Management of acute exacerbation of COPD

A

Nebuliser bronchodilators - salbutamol 5 mg (consider + ipratropium .5mg)

Corticosteroids - 30mg prednisolone, OD, for 1-2 weeks OR 100mg hydrocortisone

Oxygen via Venturi mask - FiO2 24-48% maintain stats 88-92%

Antibiotics - if FEVER, purple to sputum, raised CRP, signs of pneumonia

IV aminophylline - no adequate response to nebs

***** low pH, high CO2 = NIV
Normal pH + high CO2 = fiO2 24-48% Venturi mask

82
Q

(COPD) If there’s no response to medical treatment and the pt develops respiratory acidosis what should be done?

A

NIV - CPAP BiPAP

83
Q

(COPD) when should invasive ventilation be used?

A

If NIV fails (still rising CO2)

Or if NIV is contraindicated

84
Q

Contraindications of NIV

A

Respiratory arrest
High aspiration risk
Impaired mental status

85
Q

Initial investigations of neck mass

A

US +FNAC

86
Q

Pt with chronic cough , haemoptysis.
Chronic smoker
CXR - solitary coin lesion RUL
Most likely dx?

A

Lung cancer

87
Q

Management of status epilepticus

A

1st step - 2 separate doses (10-20 in b/w)of

  • IV lorazepam (in hospital with iv access)
  • buccal midazolam or rectal diazepam - no iv access or outside hospital

2 sep doses given with no effec move to step 2

  1. IV phenytoin (preferred over phenobarbital)
  2. Refer ICU - intubate, IV phenobarbital
88
Q

Features of CO poisoning

A

Red pink or cherry red skin/mucosa
+
Altered mental status

89
Q

Management of CO poisoning

A

Conscious 0 100% O2 via FM (tight fit)

Unconscious- intubate + ventilate w/ IPPV on 100% O2

*** hypotensive SBP <100 or unconscious = INTUBATE

90
Q

What anti-hypertensive drugs need to be stopped before surgery?
When should they be stopped?

A

ACEi + ARBs
24 hours before

*they can lead to severe hypotension after induction of GA

91
Q

Pt on corticosteroids - med adjustment for surgery

A

Same dose pre-op

Double dose post op to avoid adrenal insufficiency

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