Misc Flashcards
How do you work out average glucose from A1c?
1.59 x A1c – 2.59
Describe Kallman syndrome
GnRH deficiency – low oestrogen
Hypogonadism
Failure to produce secondary sexual characteristics
Test FSH + LH = if low; hypogonadotrophic hypogonadism
What is dehydroepiandrosterone sulphate used for?
Evaluate adrenal function
Can distinguish between adrenal or ovarian/ testes causes of androgen conditions
What is medroxyprogesterone used for?
Induces a withdrawal bleed – can be used in evaluation of secondary amenorrhea
What screening test is best for T2DM in asymptomatic pts?
Fasting glucose
Describe the presentation of an epidermoid cyst
Painless cyst, slow growing
Produces foul discharge
What is Favre-Racouchot syndrome?
Skin disease with multiple open + closed comedones in presence of actinically damaged skin. UV + smoking = risk factors
Management of epidermoid cysts
Asymptomatic – no treatment
Intralesional triamcinolone – speeds up recovery
What is lichenification?
Thickening + hardening of skin where it is constantly scratched
Causes accentuation of skin lines
What abx to use for dental infection?
Clindamycin or amox/ clavulanate
What is a perilymphatic fistula?
Between middle + inner ear; can be caused by barotrauma, trauma or straining
Management of endometriosis
Conservative – NSAIDs COCP Danozol GnRH analogues eg Leuprolide acetate goserelin Surgery
How to screen for gestational DM?
1 hour glucose challenge test
How does a mitral valve prolapse present + what is it associated with?
Palpitations, fatigue, migraine, cough
Mid-systolic click + late systolic murmur
Linked with Marfans
What bacteria is present in a human bite?
Mixed anaerobes + aerobes
Management of cluster headaches
Oxygen via face mask
Can be treated with hypothalamic stimulation if refractory to medical therapy
What are the RF for cluster headaches?
Sleep apnea Fam hx Excess heat Shift work Gasoline + oil smells
Management of gestational HTN
Alpha methyldopa
What is Von Recklinghausen disease?
AKA neurofibromatosis 1 Needs 2 of 7: >6 café au lait spots Neurofibromas Lische nodules Axillary + lymph freckes Optic nerve glioma Sphenoid dysplasia First degree fam hx
What is Mathe’s sign?
Kidney doesn’t move during respiration
Sign of perinephric abscess
What is Murphy’s sign?
Positive in cholecystitis
Pain during inspiration when liver edge is caught
What is Litten’s sign?
Paralysed hemidiaphragm
Loss of movement seen on inspiration
What is Hoover’s sign?
Inward movement of lower rib cage during inspiration
Means there is a flat diaphragm; associated with emphysema
What is Dock’s sign?
Bilateral rib notching due to collateral circulation of internal mammary arteries
Linked to coarctation of the aorta
What is Friedreich’s ataxia?
Most common autosomal recessive ataxia
Occurs during puberty
Progressive ataxia with loss of deep tendon reflexes
Presence of Babinski’s sign (extensor plantar responses)
What is thrombophlebitis migrans?
Pain in lower limbs that travels from one leg to another
Erythematous nodule on superficial leg vein
Can be due to malignancy
What is the Trousseau sign of malignancy?
Thrombophlebitis migrans
What is the Neer sign?
Used to test for impingement, can be positive in frozen shoulder
Arm placed in forced flexion with arm fully pronated = pain = positive
What is Spurling’s sign?
Turn head to affected side with downward pressure on top of head
Pain = impingement due to cervical radiculopathy
How often should barrett’s oesophagus be monitored with endoscopy?
3-5 years if no dysplasia present
Low grade dysplasia = 6-12 mths
High grade = 3 months
What do non-caseating granulomas suggest?
Sarcoidosis
What blood tests indicate sarcoidosis?
Hypercalcaemia
High liver enzymes
High ACE
What is the most common finding in patients with sarcoidosis?
Bilateral hilar lymphadenopathy
Dx of sarcoidosis
Biopsy of skin lesions
Biopsy of lymph nodes
H pylori eradication
Omeprazole
Amoxicillin
Metronidazole
Clarithromycin
Tx of urethritis due to STI
IM ceftriaxone + doxycycline for 10 days
What does a Courvoisier sign indicate?
Presence of enlarged gallbladder that is non-tender + jaundiced
Sign of pancreatic cancer
What is the triple screen for chromosomal abnormalities?
AFP, HCG + Ue3
What does a low AFP at screening suggest?
Trisomy 18 or 21
What do CD15 + CD30 positive multinucleated cells indicate?
Reed Sternburg cells = Hogkins lymphoma
What happens when amiodarone is combined with quinidine?
Arrhythmias due to elevated quinidine
What do granulocytes with multisegmented nuclei indicate?
Vit B12 or folate deficiency
When should colon cancer screening begin + what with?
> 50 with FOB every 2 yeasr or sigmoidoscopy every 10 years
What will be seen in CSF of HSV encephalitis?
Normal glucose
Pleocytosis
High protein
What is the difference in presentation between meningitis + encephalitis?
Encephalitis presents with altered cerebral function
What is pre-diabetes?
Plasma glucose above normal (>6)
What is the recommended drinking limit for men + women?
15 for men, 10 for women
What treatment should be given with no active TB but a positive PPD?
Isoniazid for 9 months
Management of gasoline poisoning
Supportive
When should a shingles vaccine be given?
Anyone aged >60 regardless of prior shingles infection
How is GBS diagnosed?
CSF analysis + nerve conduction/ electromyography
What is GBS?
Rapidly progressing muscle weakness
Comes on after infection/ surgery/ vaccine
Tingling + loss of sensation in legs
What is a urethral caruncle?
Benign, urethral lesions found most commonly post-menopause
Red, fleshy appearance
What is the most common complication of cataract surgery?
Decreased vision due to cystoid macular edema
Improves with time
What are the contraindications to MMR?
Anaphylaxis to gelatine or neomycin
Immunosuppression
Pregnancy
What antidote is used for anticholinesterase pesticides/ organophosphates?
Pralidoxime
What is the leading cause of death in Canada + what is its pattern?
Lung cancer
Increasing in women, decreasing in men
What are people with factitious disorder at risk of?
Alcohol + drug abuse
Depression
Where will you get the strongest evidence for treatment, screening or prevention strategies?
Meta-analyses
RCTs
Systematic reviews
What is the antidote for cyanide?
Sodium thiosulphate
What is the antidotes for copper overload?
Penicillamine
What does H influenza b cause?
Pneumonia
Meningitis
Epiglottitis
What does unencapsulated H influenza cause?
Otitis media
Cojunctivitis
Sinusitis
What is the recommended therapy for schizoid personality disorder?
Individual visits, short, with written instructions to minimise face to face contact
Describe hereditary spherocytosis
Autosomal dominant
Presents with haemolytic anemia, jaundice, gallstones, splenomegaly
Fam hx of anemia
Due to mutation in gene for ankyrin + spectrin proteins
What is a common cause of overflow tearing?
Epiphora = commonest cause is nasolacrimal duct obstruction
What are the most common complications of H influenza in children?
OM + meningitis
What infections in kids lead to myocarditis?
Viral; commonly adenovirus or coxsackie
What infection is pulmonary haemorrhage a complication of?
Avian flu
How long should a mother wait before breastfeeding after drinking alcohol?
2-3 hours
What happens to TFTs during pregnancy?
T4 increased
FT4I normal
T3RU decreased
What migraine meds are contraindicated in pregnancy?
Ergotamines – cause vasoconstriction of uterine vessels
When is prophylactic cerclage carried out?
Between 12-14 wks gestation
What is the management of an asymptomatic cyst <5cm?
Re-assess with US in 8-12 weeks
What test is diagnostic for malignant hyperthermia?
Caffeine halothane contracture test (requires muscle biopsy)
What blood results would you expect with malignant hyperthermia?
High LDH + CPK
What neurovascular complication is most common following a proximal humerus fracture?
Axillary nerve damage – reduced sensation in shoulder patch over deltoid
What part of COPD management shows a reduction in mortality?
Home O2 >15 hrs a day
Management of massive PE
Fibrinolytic agent (streptokinase) unless risk of bleeding 2nd line = embolectomy
What is a green field filter?
IVC filter placed when patient has recurrent DVTs or if heparin is contraindicated
Causes of upper lobe fibrosis
CHARTS Coal workers pneumoconiosis Histiocytosis Ankylosing spondylitis Radiation TB Silicosis + sarcoidosis
What bacteria cause ventilator associated pneumonia?
Pseudomonas, Klebsiella
What abx are best for HAP/ ventilator associated?
Tazocin
Causes of respiratory acidosis
Opiates, asthma, GBS, COPD
Causes of respiratory alkalosis
Pain, PE, panic attack, pneumothorax
Causes of increased anion gap metabolic acidosis
DKA, lactic acidosis, aspirin OD
Causes of decreased anion gap metabolic acidosis
Diarrhea, Addisons, renal tubular necrosis
Causes of metabolic alkalosis
D/V, diuretics, Conns syndrome
Chest drain safe triangle borders
Anterior edge of lat dorsi
Lateral border of pec major
Line superior to horizontal level of nipple
Apex below the axilla
Which lobe is most likely to be affected by aspiration pneumonia?
Right lower lobe
Describe mycoplasma pneumonia presentation
Prolonged, gradual onset
Flu like symptoms + dry cough
Erythema multiforme
Ix results for mycoplasma pneumonia
Bilateral consolidation on CXR
Thrombocytopenia, low Hb
Management of mycoplasma pneumonia
Erythromycin
When do you see coxiella burnetti?
Q fever (farm animals)
Typical presentation of SCC
Most present as obstructive lesions of bronchus leading to infection
What are the common causes of bronchiectasis?
TB, pneumonias, flu Childhood infections HIV CTD Congenital: CF, Kartageners
Sarcoidosis presentation
SOB, cough
Skin lesions around nose; indurated plaques
Joint pain
Eye problems
TB management; how long for each abx?
Rifampicin + isoniazid = 6 months
Pyrazinimide + ethambutol = 2 months
What pneumonia is associated with herpes + pleuritic chest pain?
Strep pneumonia
Describe what Auer rods look like, and what they are linked with.
Needle shaped bodies on blood smear
Associated with AML
Types of megaloblastic anemia
B12 deficiency
Folate deficiency
Types of normocytic anemia
Haemorrhage
Anemia of chronic disease
Aplastic anemia
Haemolytic anemia
Which cytokine is involved in anemia of chronic disease?
IL-6
Causes of aplastic anemia
Idiopathic
Fanconi’s
Post viral (hepatitis)
Drugs (NSAIDs, penicillamine)
Tx of sickle cell other than supportive (+ its main SE)
Hydroxycarbamide – SE is WBC suppression
What is the presentation of, and cause, of subacute degeneration of spinal cord?
Due to B12 deficiency Triad: Upgoing plantars Loss of knee jerk Loss of ankle jerk
What do hypersegmented neutrophils on a blood smear indicate
B12 or folate deficiency
What are tear drop cells on a blood film associated with?
Myelofibrosis, thalassemia + megaloblastic anemia
When do you give cryoprecipitate?
When there is a low fibrinogen level
Eg in DIC or liver failure
When is prothrombin complex used?
Emergency reversal of anticoagulation
When do you give FFP?
Most suited for significant but not major bleeds
PT or APTT increased
Can be given prophylactically if there is a high risk of bleeding in surgery
What is the universal donor of FFP?
AB blood because there are no anti-A or anti-B abs
What does cryoprecipitate contain?
Factor 8, vWF, fibrinogen, factor 13 + fibronectin
Management of multiple myeloma
Proteasome inhibitors (Bortezomib)
What does pain in lymph nodes when drinking indicate?
Hodgkins lymphoma
Apart from HF, what else can cause increased levels of BNP?
CKD
What does this help you remember: MicroSoft is the Operating System?
MS has an Opening Snap
What does this help you remember: AR you early?
Aortic regurg is early diastolic
What does this help you remember: People with AS are old and SAD
Happens in older people (calcification)
SAD = Syncope, Angina, Dyspnoea
What bacteria causing endocarditis is likely following a dental procedure?
Strep viridans
What bacteria causing endocarditis is likely in IVDU?
sTAPH
What bacteria causing endocarditis is likely with a prosthetic heart valve?
Staph epidermitis
What bacteria causing endocarditis is likely in the context of an elderly patient with colon cancer/ immunocompromised?
Strep bovis/ gallolyticus
What is Libman Sacks endocarditis?
Non bacterial endocarditis
Heart manifestation of lupus
What ECG changes do you get with hypercalcaemia?
Shortening of QT interval
What is a globular heart associated with
Atrial septal defect
What is rib notching associated with?
Coarctation of the aorta
What does an inferior MI + AR murmur indicate?
Ascending aorta dissection (proximal)
What is multiple endocrine neoplasia 1?
Autosomal dominant, causes tumours in pituitary, pancreas + parathyroid
Causes hyperparathyroidism and hypercalcaemia
What is multiple endocrine neoplasia 2?
Autosomal dominant, causes tumours
Medullary thyroid cancer, parathyroid cancer + phaeochromocytoma
What does macrocytosis + a raised GGT indicate?
Alcohol use
How do you calculate anion gap?
(sodium + potassium) 0 (bicarb + chloride)
What is a normal anion gap?
8-14
What LFT results does a paracetamol OD cause?
High ALT
Normal ALP
ALT/ ALP ratio high
What are the causes of straw coloured ascetic fluid?
Serous effusion
Clear = transudate
Cloudy = exudate
What are the causes of bloody ascetic fluid?
Trauma, malignancy, pancreatitis, perforated ulcer
What are the causes of turbid ascetic fluid?
SBP, perf
What are the causes of chylous ascetic fluid?
Malignancy, lymphoma, TB, parasitic
What is the SAAG?
Serum ascites albumin gradient
Measures portal pressure
Serum albumin – ascetic fluid albumin
What causes a high SAAG?
Portal HTN is cause of ascites
Portal vein thrombosis, cirrhosis, hepatitis, RHF, pericarditis
What causes a low SAAG
Peritoneal disease: malignancy
Nephrotic syndrome, malnutrition
Pancreatitis, myxoedema
Describe the dysphagia associated with oesophageal cancer
Associated with weight loss, anorexia, vomiting
PMH of Barrett’s, GORD, alcohol or smoking
Describe the dysphagia associated with oesophagitis
Dysphagia but systemically well
Describe the dysphagia associated with oesophageal candidiasis
Hx of HIV or steroid inhaler use
Describe the dysphagia associated with achalasia
Dysphagia of solids + liquids from the starts
Regurg of food leading to cough, aspiration pneumonia
Describe the dysphagia associated with a pharyngeal pouch
Regurg, aspiration, chronic cough
Typically older men
Halitosis
Describe the dysphagia associated with systemic sclerosis
Other features of CREST
LES pressure is decreased
Describe the dysphagia associated with myasthenia gravis
Extraocular muscle weakness
Ptosis
Dysphagia with liquids + solids
Causes of raised ALP with low calcium
Osteomalacia
Renal failure
Causes of raised ALP with high calcium
Bone mets
Hyperparathyroidism
Causes of raised ALP
Pregnancy
Cholestasis, hepatitis, fatty liver, neoplasia
Paget’s
How do you test for c diff?
Test stool for GDH – if positive, test for toxins
Management of Wilsons disease
Penicillamine
What is Peutz Jeghers syndrome?
Autsomal dominant
Numerous polyps in GI tract – can cause intusseception
Associated with freckles on lips, face, palms + soles
How does Budd-Chiari syndrome present?
Sudden onset abdo pain, tender hepatomegaly + ascites
Raised SAAG = portal HTN is cause
What does a raised ALP + normal LFTs indicate
Malignancy, particularly bone cancer/ mets
What is achalasia?
Failure of oesophageal peristalsis + relaxation of sphincter due to degenerative loss of ganglia from Auerbach’s plexus
Causes dysphagia of both liquids + solids
What is pellagra + how does it present?
Deficiency of B3 (niacin)
Causes dermatitis, diarrhea, demention, death
What is Kantor’s string sign?
String like configuration on barium study
Indicative of Crohns
Difference between duodenal + gastric ulcer presentation
Duodenal = relieved by eating Gastric = worse with eating
What is the mackler triad?
For Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema
What is the Truelove + Witt’s criteria?
Used to assess severity of UC flare up
Looks at bowel motions, rectal bleeding, systemic symptoms, bloods
UC management
Topical aminosalicylates
2nd: oral aminosalicylates
3rd: oral steroids
4th: ciclosporin
What causes toxic megacolon?
UC + anti-diarrhea + codeine agents
Management of toxic megacolon
Decompression
Surgery if not improved in 24hrs
Management of Crohns
Corticosteroids
Azathioprine
IV steroids
Infliximab
Management of variceal bleed post endoscopy
Terlipressin
Ciprofloxacin
Propranolol
Signs of hepatic failure
Jaundice Hepatic encephalopathy Coagulopathy SBP Hypoalbuminaemia
What is hepatic encephalopathy caused by?
Build up of ammonia
Management of hepatic encephalopathy
Lactulose
Rifaximin long term
What is the lifelong management of SBP?
Ciprofloxacin
What is hepatorenal syndrome + what is the management?
AKI in someone with liver disease
Treat with HAS + terlipressin
What cancers is EBV associated with?
Burkitt’s lymphoma
Hodgkin’s lymphoma
Nasopharyngeal cancer
Descibe typhoid fever
Abdo pain, fever, altered mental status
Positive Widal test (blood test)
Describe the presentation + background of Entamoeba infection
Gradual onset over 1-2 weeks
Diarrhea (+/- blood), abdo pain, weight loss
Describe the presentation + background of cryptosporidium infection
Diarrhea, sometimes with mucus
Abx for COPD exacerbation
Amoxicillin, tetracycline or clarithromycin
Abx for pyelonephritis
Cephalosporin or quinolone
HIV seroconversion S+S
Flu like symptoms Lymphadenopathy Myalgia, arthralgia Maculopapular rash Mouth ulcers Diarrhea
What bacteria is associated with Guillain Barre?
Campylobacter jejuni
What is the most common viral infection following solid organ transplants?
Cytomegalovirus
Which treatment for TB causes optic neuritis
Ethambutol
What bacteria is typically found on domestic/ exotic birds?
Chlamydia psittaci
Causes URTI + conjunctivitis
What are the features of a blood film post splenectomy?
Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes