Misc Knowledge Flashcards
Primary pneumothorax over 2cm or with symptoms should be treated with
Aspiration
Secondary pneumothorax over 2cm should be treated with
Chest drain
Tension pneumothorax should be treated with
Needle decompression
Patient that has received adequate fluid resuscitation and antibiotics for sepsis but still extremely hypotensive. What should be given to the patient?
Patient needs some inotropic support
- adrenaline infusion
- adrenaline would vasoconstrict vessels
Common location for venous ulcer?
Medial malleolus
haemosyderin pigmentation
- artial ulcer
- venous ulcer
Venous ulcer
- it is a sign of venous insufficiency
Which investigation do you do to give you the definitive diagnosis of hodgkins lymphoma
Excisional biopsy of lump
Patient with longstanding (several years) deep hoarse voice. No other symptoms. What is the likely diagnosis?
Renkie’s oedema
IF patient taking ICS inhaler for asthma gets oral thrush, what should you change about management?
Get patient to use spacer device
35 year old woman with painless axillary lump. Should she be referred via 2 week wait pathway to breast clinic?
Yes
- any woman over 30 with painless axillary lump
Post partum thyroiditis will show
- hypothyroid
- hyperthyroid
What is the initial treatment?
Hyperthyroid
Initial treatment is propranolol for symptomatic relief
Endoscopic biopsy of oesophagus shows “granulation tissue with a layer of necrotic debri on surface” this makes you think
- tumour invasion
- candidiasis
- oesophageal varices
- oesophageal ulceration
Oesophageal ulceration
- granulation tissue is characteristic of the base of a peptic ulcer
MODY ahs what inheritance pattern
Autosomal dominant
Patients with bronchiectasis often have a nonproductive/productive cough?
Productive
If an anti depressant is started in a patient who is suicidal, when should the patient be followed up?
- 1 week
- 1 month
1 week
Exudative pleural effusion
- protein is high/low
High
Exudative pleural effusion causes
Caused by inflammation which makes protein leak out
- lung cancer
- pneumonia
- tuberculosis
Transudative pleural effusion causes
Causes of fluid shifting
- heart failure
- hypoalbuminaemia (nephrotic syndrome, liver disease)
- hypothyroidism
Primary pneumothorax, completely asymptomatic and under 2cm. what is the management?
Conservative - send home
repeat CXR in 1 month
First line treatment of tonic clonic seizure in woman of child bearing age
Lamotrigine
What is the first line treatment for absence seizure
Ethosuximide and sodium valproate
What is the first line treatment for focal seizure
Lamotrigine, carbamazepine
Cervical myelopathy has UMN / LMN signs?
UMN
Which imaging is best for cervical myelopathy?
MRI
Lumbar puncture findings BACTERIAL meningitis
Neutrophils
High protein
Low glucose (bacteria eats glucose)
Lumbar puncture findings VIRAL meningitis
Lymphocytes
High protein
Normal glucose (viruses don’t eat glucose)
Headache + fever + seizure + rash
+ NO NECK STIFFNESS
makes you think
Encephalitis
extradural haematoma
- clinical feature
- where is the bleed
- which vessel involved
Clinical feature: lucid interval
Bleed: between dura and skull
Vessel: middle meningeal artery
Subdural haematoma
- clinical feature
- where is the bleed
- which vessel is involved
Clinical feature: gradual decline, elderly
Bleed: between dura and arachnoid matter
Vessel: bridging veins
Someone with a GCS less than 8, what is the first thing you should think of
Intubate
Posterior communicating artery aneurysm causes CN? palsy?
CN 3
Cavernous sinus thrombosis causes CN? palsy
CN 6
GBS
- CNS or PNS
- which type of cells
- UMN / LMN
PNS
Schwann cells
LMN signs
MS
- CNS or PNS
- which type of cells
- UMN / LMN
CNS
Oligodendrocytes
UMN
Diagnostic test for myaesthenia gravis
Repetitive muscle stimulation test
- muscles are fatiguable
Name 2 eye pathologies that can occur with MS
Optic neuritis
Internuclear ophthalmaplaegia
Patient has a stroke that affects legs. Which is likely artery
Anterior cerebral artery
Patient has a stroke that affects arms and face. Which is the likely artery
Midddle cerebral artery
What is the treatment of haemorrhagic stroke
Good BP control
- control the bleeding
What is the treatment of ischeamic stroke
Aspirin
Thrombolysis within 4.5 hours
CN3 palsy - dilated/constricted pupils
DILATED
On ophthalmoscopy you see flame shaped haemorrhages in all 4 quadrants. What does this make you think?
CRVO
Conjunctival injection
DIlated pupil
hazy cornea
these make yu think of which diagnosis
Acute angle closure glaucoma
Which acute angle closure glaucoma treatment reduces aqueous production
TImolol
elderly patient with unilateral ptosis and miosis. They also have cough, weight loss and change in voice. What is the most likely cause of this pateint’s horners syndrome?
Pancoast tumour
Young male with unilateral ptosis and miosis. He has a severe headache and neck pain. What is the most likely cause of this patient’s horners syndrome?
Carotid dissection
Bilateral dilated pupils
Holmes adie pupil
Bilateral constricted pupils
Argyll Robertson pupil
Patient with CKD needs IV contrast for an investigation. What is the most appropriate treatment to be given before the IV contrast?
0.9% sodium chloride infusion
Patient with rhabdomyolysis and hypovolaemia after long lie on floor. Which is most likely to cause an AKI?
Hypovolaemia
Best investigation for a ?C spine fracture
CT neck
nuclear enlargement, hyperchromasia and pleomorphism are features that suggest
cancer
Investigations for infective endocarditis
TOE
Blood cultures
Who tends to get primary hyperparathyroidism
- elderly / young
- female / male
Elderly female patients
Hypercalcaemia, High PTH, hypercalciuria, abnormal renal function. What is most likely
- primary hyperparathyroidism
- secondary hyperparathyroidism
- tertiary hyperparathyroidism
Tertiary hyperparathyroidism
If someone post op develops paralytic ileus, what should you do?
NG tube
painful swelling in groin and pain when opening bowels. Unprotected anal sex with a new male partner 4 weeks ago. perianal ulcer and tender inguinal lymphadenopathy. What is the likely diagnosis? Genital herpes HIV seroconversion Lymphogranuloma venereum Secondary syphilis
Lymphogranuloma venereum
WHich artery may be a source of major haemorrhage in peptic ulcer disease
gastroduodenal artery
Management of spinal cord compression in a frail elderly patient
External beam radiotherapy
Which condition characteristically causes haematuria A FEW DAYS after URTI
- post infectious glomerulonephritis
- IgA nephropathy
IgA nephropathy
At which time period after URTI does post infectious glomerulonephritis happen
A few weeks after URTI
Tend to put weight on / lose weight in duodenal ulcer
Put on weight
- as it is associated with releif with eating
In which part of the brain are changes most likely to be found in early alzheimers disease?
Temporal lobe - this is where the hippocampus is located
Tri-cyclic antidepressant overdose. Which drugs is used to reverse?
Sodium bicarbonate
If patient receiving blood transfusion has a TACO, how is this managed?
IV furosemide
56 year old diabetic patient with hypertension. What is first line management
ACE inhibitor
Which investigation is used to diagnose idiopathic pulmonary fibrosis?
High resolution CT scan
confusion, visual hallucinations, tachycardia and pyrexia on the background of heavy alcohol use.
- wernickes encephalopathy
- korsakoff syndrome
- delerium tremens
Delerium tremens
Which nerve is affected here:
Sensation lost below the knee, except for the medial leg.
Sciatic nerve
Painful red swelling on face with characteristically well defined edge. What is the likely diagnosis and management?
Diagnosis: erysipelas
Management: IV antibiotics
What is the recommended treatment for asystole
Adrenaline
- defibrillation wont work as it is non shockable rhythm
patient with an unprovoked DVT, which investigation should they be offered?
CT abdo pelvis
- look for malignancy
All patient with mechanical heart valves require treatment with which 2 medications
Aspirin
Warfarin
If blood tests and urine/serum osmolality suggests cranial diabetes insipidus….what is the next investigation?
MRI pituitary
Which airway device provides protection for the lungs from regurgitated stomach contents? A. Guedel (oral) airway B. i-gel (supraglottic) airway C. Laryngeal mask airway D. Nasopharyngeal airway E. Tracheal tube
E - tracheal tube
What is the screening test for haemochromatosis?
Transferrin saturatin
Hx suggestive of PE.
Which is the most appropriate next investigation?
A. Chest X-ray
B. CT pulmonary angiography
C. D dimers
D. Echocardiography
E. Ventilation/perfusion isotope lung scan
A - chest X ray
- If a patient presents with signs or symptoms of pulmonary embolism (PE), carry out an assessment of their general medical history, a physical examination and a chest X ray to exclude other causes before definitive investigations
Calculate wells score and this is low. Which investigation is done
B. CT pulmonary angiography
C. D dimers
D. Echocardiography
E. Ventilation/perfusion isotope lung scan
C - d-dimers
Calculate wells score and this is high, which investigation is done
A. Chest X-ray
B. CT pulmonary angiography
C. D dimers
D. Echocardiography
E. Ventilation/perfusion isotope lung scan
B. CT pulmonary angiography
well-defined, non-tender spherical 1 cm mass on the right side of the scrotum. It is superior to the testis and transilluminates.
Is this
- A - epididymal cyst
- B - hydrocele
Epididymal cyst
- Separate and can get above mass which is cystic is an epididymal cyst (spermatocele) which is benign and usually asymptomatic and managed conservatively. Although a hydrocele trans illuminates it would surround the testis.
Aside from staph aureus, what is the most common organism causing cellulitis in the leg?
Strep pyogenes
What is the first line treatment for superficial thrombophlebitis?
NSAID
Patient with T2DM. Due to go to surgery.
Which is the most appropriate plan for managing her diabetic medication?
A. Continue both drugs and start a variable-rate insulin infusion
B. No change to usual medication
C. Omit both drugs and start a variable-rate insulin infusion
D. Omit gliclazide and continue metformin
E. Omit metformin and continue gliclazide
D - omit gliclazide and continue metformin
- no need for insulin since patient can take metformin after op at lunch
Patient with SVC obstruction. What is the initial management
IV Dexamethasone
- this reduces tumour swelling
Nephrotic syndrome in adults requires which investigation?
Renal biopsy
If someone has malrotation, will vomit be bilous or not?
Bilous
Investigation for pyloric stenosis
US
Short duration acute low back pain in fit person.
Which is the most appropriate advice?
A. Avoid work until the pain has completely settled
B. Back strengthening exercises
C. Bed rest until pain improves, then gradual mobilisation
D. Continue usual activity
E. Self referral for physiotherapy
D
What is the first line medication for neuropathic pain
Amitryptiline
- also pregablin, gabapentin, duloxetine
If a patient has had a massive PE and is also at risk of acute haemorrhage, which medication should be adminitered initially? A. Insertion of vena cava filter B. Intravenous alteplase C. Intravenous heparin D. Apixaban
C
What is the recommended first line investigation for renal stones
CT KUB
Patient with painful swollen wrist. Joint aspiration carried out and reveals - no organisms on gram stain - no crystals - very high WCC What is the management? A. Inject steroid into the joint B. No further treatment pending culture results C. Start IV fluclox D. Start oral colchicine E. Start oral prednisolone
C
- The gram stain is positive in about 50% of cases, so a negative gram stain does not mean there is no infection. Intravenous antibiotics should be started pending culture results.
SOB 2 hours after removal of chest drain. Which is the most likely diagnosis? A. Aspiration pneumonia B. Pneumothorax C. Pulmonary embolism D. Pulmonary oedema E. Recurrence of effusion
B
What is the best investigation of an acute abdoment following surgery?
CT scan (with contrast)
A 27 year old male with polycystic kidney disease presents with sudden onset headache and collapse. On admission to emergency department his blood pressure 190/105 mmHg, tachycardic with a Glasgow Coma Score of 7/15. He is intubated and transferred for a CT scan. The scan reveals a subarachnoid haemorrhage. He is transferred to the critical care unit for monitoring.
Which medication should be prescribed to reduce the chance of any acute complications?
A. Labetalol B. Mannitol C. Ramipril D. Furosemide E. Nimodipine
E - nimodipine
- this is used to prevent vasospasm
