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Family Medicine > Misc > Flashcards

Misc Flashcards

1
Q

How do you work out average glucose from A1c?

A

1.59 x A1c – 2.59

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2
Q

Describe Kallman syndrome

A

GnRH deficiency – low oestrogen
Hypogonadism
Failure to produce secondary sexual characteristics
Test FSH + LH = if low; hypogonadotrophic hypogonadism

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3
Q

What is dehydroepiandrosterone sulphate used for?

A

Evaluate adrenal function

Can distinguish between adrenal or ovarian/ testes causes of androgen conditions

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4
Q

What is medroxyprogesterone used for?

A

Induces a withdrawal bleed – can be used in evaluation of secondary amenorrhea

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5
Q

What screening test is best for T2DM in asymptomatic pts?

A

Fasting glucose

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6
Q

Describe the presentation of an epidermoid cyst

A

Painless cyst, slow growing

Produces foul discharge

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7
Q

What is Favre-Racouchot syndrome?

A

Skin disease with multiple open + closed comedones in presence of actinically damaged skin. UV + smoking = risk factors

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8
Q

Management of epidermoid cysts

A

Asymptomatic – no treatment

Intralesional triamcinolone – speeds up recovery

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9
Q

What is lichenification?

A

Thickening + hardening of skin where it is constantly scratched
Causes accentuation of skin lines

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10
Q

What abx to use for dental infection?

A

Clindamycin or amox/ clavulanate

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11
Q

What is a perilymphatic fistula?

A

Between middle + inner ear; can be caused by barotrauma, trauma or straining

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12
Q

Management of endometriosis

A 
Conservative – NSAIDs 
COCP
Danozol 
GnRH analogues eg Leuprolide acetate goserelin 
Surgery
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13
Q

How to screen for gestational DM?

A

1 hour glucose challenge test

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14
Q

How does a mitral valve prolapse present + what is it associated with?

A

Palpitations, fatigue, migraine, cough
Mid-systolic click + late systolic murmur
Linked with Marfans

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15
Q

What bacteria is present in a human bite?

A

Mixed anaerobes + aerobes

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16
Q

Management of cluster headaches

A

Oxygen via face mask

Can be treated with hypothalamic stimulation if refractory to medical therapy

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17
Q

What are the RF for cluster headaches?

A 
Sleep apnea 
Fam hx 
Excess heat 
Shift work
Gasoline + oil smells
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18
Q

Management of gestational HTN

A

Alpha methyldopa

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19
Q

What is Von Recklinghausen disease?

A 
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
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20
Q

What is Mathe’s sign?

A

Kidney doesn’t move during respiration

Sign of perinephric abscess

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21
Q

What is Murphy’s sign?

A

Positive in cholecystitis

Pain during inspiration when liver edge is caught

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22
Q

What is Litten’s sign?

A

Paralysed hemidiaphragm

Loss of movement seen on inspiration

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23
Q

What is Hoover’s sign?

A

Inward movement of lower rib cage during inspiration

Means there is a flat diaphragm; associated with emphysema

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24
Q

What is Dock’s sign?

A

Bilateral rib notching due to collateral circulation of internal mammary arteries
Linked to coarctation of the aorta

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25
Q

What is Friedreich’s ataxia?

A

Most common autosomal recessive ataxia
Occurs during puberty
Progressive ataxia with loss of deep tendon reflexes
Presence of Babinski’s sign (extensor plantar responses)

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26
Q

What is thrombophlebitis migrans?

A

Pain in lower limbs that travels from one leg to another
Erythematous nodule on superficial leg vein
Can be due to malignancy

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27
Q

What is the Trousseau sign of malignancy?

A

Thrombophlebitis migrans

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28
Q

What is the Neer sign?

A

Used to test for impingement, can be positive in frozen shoulder
Arm placed in forced flexion with arm fully pronated = pain = positive

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29
Q

What is Spurling’s sign?

A

Turn head to affected side with downward pressure on top of head
Pain = impingement due to cervical radiculopathy

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30
Q

How often should barrett’s oesophagus be monitored with endoscopy?

A

3-5 years if no dysplasia present
Low grade dysplasia = 6-12 mths
High grade = 3 months

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31
Q

What do non-caseating granulomas suggest?

A

Sarcoidosis

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32
Q

What blood tests indicate sarcoidosis?

A

Hypercalcaemia
High liver enzymes
High ACE

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33
Q

What is the most common finding in patients with sarcoidosis?

A

Bilateral hilar lymphadenopathy

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34
Q

Dx of sarcoidosis

A

Biopsy of skin lesions

Biopsy of lymph nodes

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35
Q

H pylori eradication

A

Omeprazole
Amoxicillin
Metronidazole
Clarithromycin

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36
Q

Tx of urethritis due to STI

A

IM ceftriaxone + doxycycline for 10 days

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37
Q

What does a Courvoisier sign indicate?

A

Presence of enlarged gallbladder that is non-tender + jaundiced
Sign of pancreatic cancer

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38
Q

What is the triple screen for chromosomal abnormalities?

A

AFP, HCG + Ue3

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39
Q

What does a low AFP at screening suggest?

A

Trisomy 18 or 21

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40
Q

What do CD15 + CD30 positive multinucleated cells indicate?

A

Reed Sternburg cells = Hogkins lymphoma

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41
Q

What happens when amiodarone is combined with quinidine?

A

Arrhythmias due to elevated quinidine

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42
Q

What do granulocytes with multisegmented nuclei indicate?

A

Vit B12 or folate deficiency

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43
Q

When should colon cancer screening begin + what with?

A

> 50 with FOB every 2 yeasr or sigmoidoscopy every 10 years

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44
Q

What will be seen in CSF of HSV encephalitis?

A

Normal glucose
Pleocytosis
High protein

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45
Q

What is the difference in presentation between meningitis + encephalitis?

A

Encephalitis presents with altered cerebral function

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46
Q

What is pre-diabetes?

A

Plasma glucose above normal (>6)

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47
Q

What is the recommended drinking limit for men + women?

A

15 for men, 10 for women

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48
Q

What treatment should be given with no active TB but a positive PPD?

A

Isoniazid for 9 months

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49
Q

Management of gasoline poisoning

A

Supportive

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50
Q

When should a shingles vaccine be given?

A

Anyone aged >60 regardless of prior shingles infection

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51
Q

How is GBS diagnosed?

A

CSF analysis + nerve conduction/ electromyography

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52
Q

What is GBS?

A

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

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53
Q

What is the most common complication of cataract surgery?

A

Decreased vision due to cystoid macular edema

Improves with time

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54
Q

What are the contraindications to MMR?

A

Anaphylaxis to gelatine or neomycin
Immunosuppression
Pregnancy

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55
Q

What antidote is used for anticholinesterase pesticides/ organophosphates?

A

Pralidoxime

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56
Q

What is the leading cause of death in Canada + what is its pattern?

A

Lung cancer

Increasing in women, decreasing in men

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57
Q

What are people with factitious disorder at risk of?

A

Alcohol + drug abuse

Depression

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58
Q

Where will you get the strongest evidence for treatment, screening or prevention strategies?

A

Meta-analyses
RCTs
Systematic reviews

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59
Q

What is the antidote for cyanide?

A

Sodium thiosulphate

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60
Q

What is the antidotes for copper overload?

A

Penicillamine

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61
Q

What does H influenza b cause?

A

Pneumonia
Meningitis
Epiglottitis

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62
Q

What does unencapsulated H influenza cause?

A

Otitis media
Cojunctivitis
Sinusitis

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63
Q

What is the recommended therapy for schizoid personality disorder?

A

Individual visits, short, with written instructions to minimise face to face contact

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64
Q

Describe hereditary spherocytosis

A

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

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65
Q

What are the most common complications of H influenza in children?

A

OM + meningitis

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66
Q

What infections in kids lead to myocarditis?

A

Viral; commonly adenovirus or coxsackie

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67
Q

What infection is pulmonary haemorrhage a complication of?

A

Avian flu

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68
Q

How long should a mother wait before breastfeeding after drinking alcohol?

A

2-3 hours

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69
Q

What happens to TFTs during pregnancy?

A

T4 increased
FT4I normal
T3RU decreased

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70
Q

What migraine meds are contraindicated in pregnancy?

A

Ergotamines – cause vasoconstriction of uterine vessels

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71
Q

When is prophylactic cerclage carried out?

A

Between 12-14 wks gestation

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72
Q

What is the management of an asymptomatic cyst <5cm?

A

Re-assess with US in 8-12 weeks

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73
Q

What test is diagnostic for malignant hyperthermia?

A

Caffeine halothane contracture test (requires muscle biopsy)

74
Q

What blood results would you expect with malignant hyperthermia?

A

High LDH + CPK

75
Q

What neurovascular complication is most common following a proximal humerus fracture?

A

Axillary nerve damage – reduced sensation in shoulder patch over deltoid

76
Q

What part of COPD management shows a reduction in mortality?

A

Home O2 >15 hrs a day

77
Q

Management of massive PE

A 
Fibrinolytic agent (streptokinase) unless risk of bleeding 
2nd line = embolectomy
78
Q

What is a green field filter?

A

IVC filter placed when patient has recurrent DVTs or if heparin is contraindicated

79
Q

Causes of upper lobe fibrosis

A 
CHARTS
Coal workers pneumoconiosis 
Histiocytosis 
Ankylosing spondylitis 
Radiation 
TB 
Silicosis + sarcoidosis
80
Q

What bacteria cause ventilator associated pneumonia?

A

Pseudomonas, Klebsiella

81
Q

What abx are best for HAP/ ventilator associated?

A

Tazocin

82
Q

Causes of respiratory acidosis

A

Opiates, asthma, GBS, COPD

83
Q

Causes of respiratory alkalosis

A

Pain, PE, panic attack, pneumothorax

84
Q

Causes of increased anion gap metabolic acidosis

A

DKA, lactic acidosis, aspirin OD

85
Q

Causes of decreased anion gap metabolic acidosis

A

Diarrhea, Addisons, renal tubular necrosis

86
Q

Causes of metabolic alkalosis

A

D/V, diuretics, Conns syndrome

87
Q

Chest drain safe triangle borders

A

Anterior edge of lat dorsi
Lateral border of pec major
Line superior to horizontal level of nipple
Apex below the axilla

88
Q

Which lobe is most likely to be affected by aspiration pneumonia?

A

Right lower lobe

89
Q

Describe mycoplasma pneumonia presentation

A

Prolonged, gradual onset
Flu like symptoms + dry cough
Erythema multiforme

90
Q

Ix results for mycoplasma pneumonia

A

Bilateral consolidation on CXR

Thrombocytopenia, low Hb

91
Q

Management of mycoplasma pneumonia

A

Erythromycin

92
Q

When do you see coxiella burnetti?

A

Q fever (farm animals)

93
Q

Typical presentation of SCC

A

Most present as obstructive lesions of bronchus leading to infection

94
Q

What are the common causes of bronchiectasis?

A 
TB, pneumonias, flu 
Childhood infections 
HIV 
CTD
Congenital: CF, Kartageners
95
Q

Sarcoidosis presentation

A

SOB, cough
Skin lesions around nose; indurated plaques
Joint pain
Eye problems

96
Q

TB management; how long for each abx?

A

Rifampicin + isoniazid = 6 months

Pyrazinimide + ethambutol = 2 months

97
Q

What pneumonia is associated with herpes + pleuritic chest pain?

A

Strep pneumonia

98
Q

Describe what Auer rods look like, and what they are linked with.

A

Needle shaped bodies on blood smear

Associated with AML

99
Q

Types of megaloblastic anemia

A

B12 deficiency

Folate deficiency

100
Q

Types of normocytic anemia

A

Haemorrhage
Anemia of chronic disease
Aplastic anemia
Haemolytic anemia

101
Q

Which cytokine is involved in anemia of chronic disease?

A

IL-6

102
Q

Causes of aplastic anemia

A

Idiopathic
Fanconi’s
Post viral (hepatitis)
Drugs (NSAIDs, penicillamine)

103
Q

Tx of sickle cell other than supportive (+ its main SE)

A

Hydroxycarbamide – SE is WBC suppression

104
Q

What is the presentation of, and cause, of subacute degeneration of spinal cord?

A 
Due to B12 deficiency 
Triad:
Upgoing plantars 
Loss of knee jerk 
Loss of ankle jerk
105
Q

What do hypersegmented neutrophils on a blood smear indicate

A

B12 or folate deficiency

106
Q

What are tear drop cells on a blood film associated with?

A

Myelofibrosis, thalassemia + megaloblastic anemia

107
Q

When do you give cryoprecipitate?

A

When there is a low fibrinogen level

Eg in DIC or liver failure

108
Q

When is prothrombin complex used?

A

Emergency reversal of anticoagulation

109
Q

When do you give FFP?

A

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

110
Q

What is the universal donor of FFP?

A

AB blood because there are no anti-A or anti-B abs

111
Q

What does cryoprecipitate contain?

A

Factor 8, vWF, fibrinogen, factor 13 + fibronectin

112
Q

Management of multiple myeloma

A

Proteasome inhibitors (Bortezomib)

113
Q

What does pain in lymph nodes when drinking indicate?

A

Hodgkins lymphoma

114
Q

Apart from HF, what else can cause increased levels of BNP?

A

CKD

115
Q

What does this help you remember: MicroSoft is the Operating System?

A

MS has an Opening Snap

116
Q

What does this help you remember: AR you early?

A

Aortic regurg is early diastolic

117
Q

What does this help you remember: People with AS are old and SAD

A

Happens in older people (calcification)

SAD = Syncope, Angina, Dyspnoea

118
Q

What bacteria causing endocarditis is likely following a dental procedure?

A

Strep viridans

119
Q

What bacteria causing endocarditis is likely in IVDU?

A

sTAPH

120
Q

What bacteria causing endocarditis is likely with a prosthetic heart valve?

A

Staph epidermitis

121
Q

What bacteria causing endocarditis is likely in the context of an elderly patient with colon cancer/ immunocompromised?

A

Strep bovis/ gallolyticus

122
Q

What is Libman Sacks endocarditis?

A

Non bacterial endocarditis

Heart manifestation of lupus

123
Q

What ECG changes do you get with hypercalcaemia?

A

Shortening of QT interval

124
Q

What is a globular heart associated with

A

Atrial septal defect

125
Q

What is rib notching associated with?

A

Coarctation of the aorta

126
Q

What does an inferior MI + AR murmur indicate?

A

Ascending aorta dissection (proximal)

127
Q

What is multiple endocrine neoplasia 1?

A

Autosomal dominant, causes tumours in pituitary, pancreas + parathyroid
Causes hyperparathyroidism and hypercalcaemia

128
Q

What is multiple endocrine neoplasia 2?

A

Autosomal dominant, causes tumours

Medullary thyroid cancer, parathyroid cancer + phaeochromocytoma

129
Q

What does macrocytosis + a raised GGT indicate?

A

Alcohol use

130
Q

How do you calculate anion gap?

A

(sodium + potassium) 0 (bicarb + chloride)

131
Q

What is a normal anion gap?

A

8-14

132
Q

What LFT results does a paracetamol OD cause?

A

High ALT
Normal ALP
ALT/ ALP ratio high

133
Q

What are the causes of straw coloured ascetic fluid?

A

Serous effusion
Clear = transudate
Cloudy = exudate

134
Q

What are the causes of bloody ascetic fluid?

A

Trauma, malignancy, pancreatitis, perforated ulcer

135
Q

What are the causes of turbid ascetic fluid?

A

SBP, perf

136
Q

What are the causes of chylous ascetic fluid?

A

Malignancy, lymphoma, TB, parasitic

137
Q

What is the SAAG?

A

Serum ascites albumin gradient
Measures portal pressure
Serum albumin – ascetic fluid albumin

138
Q

What causes a high SAAG?

A

Portal HTN is cause of ascites

Portal vein thrombosis, cirrhosis, hepatitis, RHF, pericarditis

139
Q

What causes a low SAAG

A

Peritoneal disease: malignancy
Nephrotic syndrome, malnutrition
Pancreatitis, myxoedema

140
Q

Describe the dysphagia associated with oesophageal cancer

A

Associated with weight loss, anorexia, vomiting

PMH of Barrett’s, GORD, alcohol or smoking

141
Q

Describe the dysphagia associated with oesophagitis

A

Dysphagia but systemically well

142
Q

Describe the dysphagia associated with oesophageal candidiasis

A

Hx of HIV or steroid inhaler use

143
Q

Describe the dysphagia associated with achalasia

A

Dysphagia of solids + liquids from the starts

Regurg of food leading to cough, aspiration pneumonia

144
Q

Describe the dysphagia associated with a pharyngeal pouch

A

Regurg, aspiration, chronic cough
Typically older men
Halitosis

145
Q

Describe the dysphagia associated with systemic sclerosis

A

Other features of CREST

LES pressure is decreased

146
Q

Describe the dysphagia associated with myasthenia gravis

A

Extraocular muscle weakness
Ptosis
Dysphagia with liquids + solids

147
Q

Causes of raised ALP with low calcium

A

Osteomalacia

Renal failure

148
Q

Causes of raised ALP with high calcium

A

Bone mets

Hyperparathyroidism

149
Q

Causes of raised ALP

A

Pregnancy
Cholestasis, hepatitis, fatty liver, neoplasia
Paget’s

150
Q

How do you test for c diff?

A

Test stool for GDH – if positive, test for toxins

151
Q

Management of Wilsons disease

A

Penicillamine

152
Q

What is Peutz Jeghers syndrome?

A

Autsomal dominant
Numerous polyps in GI tract – can cause intusseception
Associated with freckles on lips, face, palms + soles

153
Q

How does Budd-Chiari syndrome present?

A

Sudden onset abdo pain, tender hepatomegaly + ascites

Raised SAAG = portal HTN is cause

154
Q

What does a raised ALP + normal LFTs indicate

A

Malignancy, particularly bone cancer/ mets

155
Q

What is achalasia?

A

Failure of oesophageal peristalsis + relaxation of sphincter due to degenerative loss of ganglia from Auerbach’s plexus
Causes dysphagia of both liquids + solids

156
Q

What is pellagra + how does it present?

A

Deficiency of B3 (niacin)

Causes dermatitis, diarrhea, demention, death

157
Q

What is Kantor’s string sign?

A

String like configuration on barium study

Indicative of Crohns

158
Q

Difference between duodenal + gastric ulcer presentation

A 
Duodenal = relieved by eating
Gastric = worse with eating
159
Q

What is the mackler triad?

A

For Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema

160
Q

What is the Truelove + Witt’s criteria?

A

Used to assess severity of UC flare up

Looks at bowel motions, rectal bleeding, systemic symptoms, bloods

161
Q

UC management

A

Topical aminosalicylates

2nd: oral aminosalicylates
3rd: oral steroids
4th: ciclosporin

162
Q

What causes toxic megacolon?

A

UC + anti-diarrhea + codeine agents

163
Q

Management of toxic megacolon

A

Decompression

Surgery if not improved in 24hrs

164
Q

Management of Crohns

A

Corticosteroids
Azathioprine
IV steroids
Infliximab

165
Q

Management of variceal bleed post endoscopy

A

Terlipressin
Ciprofloxacin
Propranolol

166
Q

Signs of hepatic failure

A 
Jaundice
Hepatic encephalopathy 
Coagulopathy 
SBP 
Hypoalbuminaemia
167
Q

What is hepatic encephalopathy caused by?

A

Build up of ammonia

168
Q

Management of hepatic encephalopathy

A

Lactulose

Rifaximin long term

169
Q

What is the lifelong management of SBP?

A

Ciprofloxacin

170
Q

What is hepatorenal syndrome + what is the management?

A

AKI in someone with liver disease

Treat with HAS + terlipressin

171
Q

What cancers is EBV associated with?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
Nasopharyngeal cancer

172
Q

Descibe typhoid fever

A

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

173
Q

Describe the presentation + background of cryptosporidium infection

A

Diarrhea, sometimes with mucus

174
Q

Abx for COPD exacerbation

A

Amoxicillin, tetracycline or clarithromycin

175
Q

Abx for pyelonephritis

A

Cephalosporin or quinolone

176
Q

HIV seroconversion S+S

A 
Flu like symptoms 
Lymphadenopathy 
Myalgia, arthralgia 
Maculopapular rash 
Mouth ulcers 
Diarrhea
177
Q

What bacteria is associated with Guillain Barre?

A

Campylobacter jejuni

178
Q

What is the most common viral infection following solid organ transplants?

A

Cytomegalovirus

179
Q

Which treatment for TB causes optic neuritis

A

Ethambutol

180
Q

What bacteria is typically found on domestic/ exotic birds?

A

Chlamydia psittaci

Causes URTI + conjunctivitis

181
Q

What are the features of a blood film post splenectomy?

A

Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes

Family Medicine (10 decks)

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