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Misremembered Flashcards

1
Q

Site of ANTERIOR EPISTAXIS

A

KIESSELBACK PLEXUS

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2
Q

Site of POSTERIOR EPISTAXIS

A

WOODRUFF PLEXUS

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3
Q

DISCHARGE MEDICATIONS AFTER CAUTERISATION

A

NASEPTIN (PEANUT OIL)
BACTROBAN (IF NUT ALLERGY)

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4
Q

SIGN CRITERIA FOR TONSILLECTOMY

A

o 7+ IN ONE YEAR
o 5+/YEAR FOR 2 YEARS
o 3+/YEAR FOR 3 YEARS
o 2+ PERITONSILLAR ABSCESS EVER

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5
Q

MOST COMMON TYPE OF THYROID CANCER + BUZZWORDS

A

PAPILLARY CARCINOMA (ORPHAN ANNIE NUCLEI + PSAMMOMA BODIES)

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6
Q

BERRY’S SIGN

A

LACK OF CAROTID PULSE DUE TO MALIGNANT THYROMEGALY

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7
Q
  • SWELLING AROUND SALIVARY GLAND AND FACIAL WEAKNESS
A

PLEIMORPHIC ADENOMA

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8
Q

Pott’s disease

A

vertebral bodies (Pott’s disease) - tb infection

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9
Q

If pharmacological cardioversion has been agreed on clinical and resource grounds for new-onset atrial fibrillation, offer

A
  • flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or
  • amiodarone if there is evidence of structural heart disease.’
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10
Q

MALARIA PREVENTION

A

· Anti-malarial prophylaxis with quinine
· Bite prevention – repellent and nets

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11
Q

WHEN TO ADMIT FOR MALARIA?

A

severe/complicated malaria, falciparum malaria, child, pregnant, ≥65yo

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12
Q

TREATMENT OF NON-FALCIPARUM

A

1st line = chloroquinine or ACT

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13
Q

TX OF MILD FALCIPARUM

A

(= not vomiting, parasitaemia <2% and ambulant):
* 1st line = ACT (Artemisinin Combination Therapy)
* 2nd line = atovaquone-proguanil or quinine + doxycycline

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14
Q

TX OF SEVERE FALCIPARUM

A

1st line = IV artesunate
2nd line = IV quinine

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15
Q

EXTRA TX FOR PLASMODIUM VIVAX AND OVALE

A

Primaquine (not G6PDD): hypnozoites eradication (dormant parasites in liver in vivax / ovale)

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16
Q

HOW MUCH FLUID TO GIVE SOMEONE WITH SEVERE BURNS

A

PARKLAND FORMULA – VOLUME OF FLUID = TOTAL BODY SURFACE AREA OF BURN % X WEIGHT (KG). HALF OF THIS FLUID TO BE ADMINISTERED IN FIRST 8 HOURS

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17
Q

CRITERIA FOR BURNS UNIT

A
  • Complex burns, burns involving the hand perineum and face and burns >10% in adults and >5% in children should be transferred to a burns unit.
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18
Q

ESCHAROTOMIES DEFINITION

A

circumferential full thickness burns to the torso or limbs. Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)

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19
Q

MUCOSAL INVOLVEMENT IN BULLAE SKIN

A
  • Mucosal involvement in blister: MUCOSAL INVOLVEMENT = PEMPHIGUS VULGARIS, NOT = BULLOUS PEMPHIGOID
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20
Q

WHEN TO OFFER PLT INFUSION IN SIGNIFICANT BLEEDING?

A

OFFER IF PLT COUNT < 30 X 10^9

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21
Q

WHEN TO OFFER PLT INFUSION IN SEVERE BLEEDING?

A

OFFER IF PLT COUNT < 100 X 10^9

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22
Q

PLT LEVEL AIMS IN SURGERY

A

IF BEFORE SURGERY AIM FOR > 50 X 10^9.
50-75 X 10^9 FOR HIGH RISK OF BLEEDING.
>100 x 10^9 FOR SURGERY AT CRITICAL SITE

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23
Q

WHEN TO OFFER PLT INFUSION IF NO BLEEDING? CONTRAINDICATIONS?

A

OFFER IF < 10 X 10^9 UNLESS CI: CHRONIC BM FAILURE, AI THROMBOCYTOPENIA, HEPARIN INDUCED THROMBOCYTOPENIA OR TTP.

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24
Q

LESIONS IN HORNERS SYNDROME?

A

o CENTRAL LESION (ANHYDROSIS OF FACE, LIMBS AND TRUNK)
o PRE-GANGLIONIC (ANHYDROSIS OF FACE)
o POST-GANGLIONIC (NO ANHYDROSIS)

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25
CENTRAL LESIONS LEADING TO HORNERS
 STROKE  SYRINGOMYELIA  SCLEROSIS (MS)
26
PRE-GANGLIONIC LESIONS LEADING TO HORNERS
 TRAUMA  TUMOUR (PANCOAST)  THYROIDECTOMY
27
POST-GANGLIONIC LESIONS LEADING TO HORNERS
 CLUSTER HEADACHES  CAROTID ARTERY DISSECTION  CAROTID ANEURYSM  CAVERNOUS SINUS THROMBOSIS
28
MOST COMMON CAUSE OF CELLULITIS
o STREP PYOGENES MOST COMMONLY BUT ALSO STAPH AUREUS
29
MOST COMMON CAUSE OF RHEUMATIC FEVER
STEP PYOGENES
30
- CAUSES OF INFECTIVE ENDOCARDITIS
o MOST COMMONLY (SPECIALLY IVDU) – STAPH AUREUS o OTHER : STEP VIRIDANS (USED TO BE MOST COMMON, NOW ONLY DEVELOPING COUNTRIES) o STAPH EPIDERMIDIS – PROSTHETIC VALVE SURGERY o STREP BOVIS – COLORECTAL CANCER
31
- ERON CLASSIFICATION
FOR CELLULITIS o I – NO SIGN OF SYSTEMIC TOXICITY o II – EITHER SYSTEMICALLY UNWELL OR SYSTEMICALLY WELL BUT HAS A COMORBIDITY THAT COULD PUT HIM AT RISK OF LENGTHENED RESOLUTION OF INFECTION (PAD, CHRONIC VENOUS INSUFFICIENCY, MORBIDY OBESITY) o III – SIGNIFICANT SYSTEMIC UPSET (E.G. ACUTE CONFUSION, TACHYCARDIA, TACHYPNOEA, HYPOTENSION) OR UNSTABLE COMORBIDITIES THAT MAY INTERFERENCE WITH REPONSE TO TX. o IV – SEPTIC OR SEVERE LIFE-THREATENING INFECTION (NECROTIZING FASCIITIS)
32
WHEN TO ADMIT FOR IV ABX FOR CELLULITIS?
 CLASS III AND IV  FRAIL OR VERY YOUNG(<1YR)  IMMUNOCOMPROMISED  RECENT LYMPHOEDEMA  RAPIDLY DETERIORATING CELLULITIS  FACIAL OR PERIORBITAL
33
MX OF CLASS I CELLULITIS
ORAL ABS (FLUCLOXACILLIN) IF ALLERGIC TO PENICILLIN: CLARITHROMYCIN OR DOXY
34
MX OF CLASS II CELLULITIS
NO NEED FOR ADMISSION IF IV ABX CAN BE GIVEN IN COMMUNITY AND MONITORING
35
AAA TYPES AND MANAGEMENT
- AAA 3-4.4 cm = another USS in a year - AAA 4.5-5.4 = follow up in 3 months and conservative/medical management (statins, aspirin, HTN management. Stop smoking, WL) - AAA >5.5 =Surgical – open aortic surgery or EVAR (endovascular aortic repair)
36
INDICATIONS FOR SURGERY AAA
Ruptured, symptomatic, >5.5 cm and > 4cm and grown more than >1 cm in 1 year.
37
MEDICAL MX FOR ACUTE LIMB ISCHAEMIA
o PROLONGED COURSE OF HEPARIN o IV HEPARIN (REPEATED APTT) o 02
38
SURGICAL MX FOR ACUTE LIMB ISCHAEMIA
o EMBOLUS  EMBOLECTOMY  THROMBOLYSIS  BYPASS o THROMBUS  THROMBOLYSIS  ANGIOPLASTY  BYPASS
39
VARICOSE VEIN MX
40
MX OF GANGRENE
o ABX, SURGICAL DEBRIDEMENT, MAGGOT DEBRIDMENET, HYPERBARIC OXYGEN, VASCULAR SURGERY
41
MEDICAL MX OF PAD
o TREAT COMORBIDITIES – HTN, DM, OBESITY o STATIN AND CLOPIDOGREL.
42
OTOSCLEROSIS DEFINITION
REPLACEMENT OF NORMAL BONE BY VASCULAR SPONGY BONE  PROGRESSIVE CONDUCTIVE DEAFNESS. AUTOSOMAL DOMINANT
43
ALZHEIMERS PATHOHYSIOLOGY
MACROSOPICALLY – CORTICAL + HIPPOCAMPAL ATROPHY. MICROSCOPICALLY – TAU PROTEIN AND TYPE A BETA AMYLOID
44
ALZHEIMERS MX
o NON PHARM: ACTIVITIES TO PROMOTE WELLBEING, COGNITIVE STIMULATION THERAPY, GROUP REMINISCENCE THERAPY o PHARM: MILD – MOD – ACH ESTERASE INHIBITOR – DONEPEZIL, GALANTAMINE, RIVASTIGMINE. SEV – NMDA RECEPTOR ANTAGONIST (MEMANTINE) – ALSO USED IF FIRST ONE CI’ED OR CAN BE ADDED ON TO ACH INHIBITOR
45
- CI AND AE OF DONEPEZIL:
CI – BRADYCARDIA. AE – INSOMNIA.
46
S/S OF REACTIVE ARTHRITIS
- REACTIVE ARTHRITIS – “CANT SEE PEE OR CLIMB A TREE” o WITHIN 4 WEEKS OF INFECTIONS – SYMPTOMS ONSET o OLIGOARTHRITIS o URETHRITIS o CONJUCTIVITIS OR ANTERIOR UVEITIS o SKIN – KERATODERMA BLENORRHAGICA
47
CAUSES OF REA
POST-STI (CHLAMYDIA) OR POST DYSENTERIC (SHIFELLA, SALMONELLA, YERSINIA, CAMPYLOBACTER)
48
MX OF REA
SYMPTOMATIC: ANALAGESIA, NSAIDS, INTRARTICULAR STEROIDS. SULFASALAZINE OR MTX FOR PERISTENT DISEASE. CAN LAST FOR 4-6 MONTHS
49
CAUSES OF URETHRITIS IN MALES
GONORRHOEA, CHLAMYDIA, MYOCPLASMA GENITALUM
50
MX OF INTRADUCTAL PAPILLOMA
microdochectomy
51
PHYLLODES TUMOUR BIOPSY
enlarging mass, mixed epithelial and connective tissue elements
52
mammogram shows an area of focal microcalcification
DCIS
53
Biopsy demonstrates a biphasic lesion characterised by stromal and epithelial elements.
FIBROADENOMA
54
DUCT ECTASIA SX
dilation of the duct  tender lump around areola +/- green/cheesy nipple discharge +/- periductal mastitis
55
DUCT ECTASIA MX
Young  microdochectomy. Old  total duct excision
56
NOTTINGAM PROGNOSTIC SCORE
tumour size x 0.2 + LN score + grade score
57
OSTEOMYELITIS TYPES
o Heamatogenous – from bacteraemia, most common in children, vertebral osteromyelitis in adults, RF: IV drug use, SCA, immunosuppression, infective endocarditis o Non-haematogenous – from adjacent tissue or from direct injurt to the bone, most common form in adult, RFs: DM, diabetic foot ulcers/pressure sores, PAD.
58
CAUSATIVE ORGANISM OF OSTEOMYELITIS
staph aureus but SCA – salmonella
59
IX FOR OSTEOMYELITIS
MRI
60
MX OSTEOMYELITIS
Flucloxacillin for 6 weeks. Clindamycin if allergy
61
KLEBSIELLA PNEUMO MX
cephalosporin (e.g. cefotaxime)
62
- Legionella pneumo mx
: clarithromycin
63
APML
fusion of PML and RAR-alpha genese. Aier rods. Dic or thrombocytopenia at presentation.
64
AML TX
- supportive (RBC, Plts, FFP/croprecipitate, Abx) Chemo, targeted molecular therapy (APML = all-trans-retinoic acid/ATRA and A203), transplantation – allogenic SCT
65
ALL TX
supportive, Chemo, Molecular therapy (imatinib for Ph+ve cases. Rituximab mAb against CD20)
66
CML
associated with Philadelphia chromosome (9+22), splenomegaly, hepatomegaly
67
CML TX
associated with Philadelphia chromosome (9+22), splenomegaly, hepatomegaly
68
COMMONEST LEUKAEMIA IN WESTERN
CLL
69
SX OF LEUKAEMIA
often none. Can have WL, anorexia, bleeding, infections. Smear cells
70
BIGNET
CLL STAGING  A – high WCC, <3 groups of enlarge LNs  no tx required  B - >3 groups of enlarged LNs  C – Anaemia and thrombocytopenia
71
RICHTER TRANSFORMATION
o Leukemia cells enter LNs and change into high grade NHL o Sx: LN swelling, fever, WL, Night sweats, Nause, abdo pain
72
CLL TX
o Supportive – vaccination, infective prophylaxis, IVIG o No chemo-incurable by chemo  Chemi immunotherapy  Rituximab, cyclophosphamide, ibrutinib, venetoclav, Car-T o Young patient – allogeneic stem cell transplantation.
73
- T2DM tx licensed in CKD
– DPP4i
74
- Cataplexy
classically presents with loss of skeletal muscle tone with strong (usually postive) emotions
75
- Effect of Bendroflumethiazide on sodium
Lowers it
76
- Common STI causing proctitis and lymphadenopathy
Lymphogranuloma venereum.
77
Mx of genital warts
Topical podophyllum or cryotherapy - 1st line - multiple, non-keratinised warts warts --> topical agents - solitary, keratinised warts --> cryptherapy - 2nd line - imiquimod
78
STAGE I Hypertensive retinopathy
Silver wiring - increased light reflex Arteriolar narrowing and tortuosity
79
STAGE II Hypertensive retinopathy
Development of areas of focal narrowing, and compression of venules at sites of arteriovenous crossing (AV nipping).
80
STAGE III Hypertensive retinopathy
- Cotton wool exudates - Flame and blot haemorrhages --> may collect around fovea --> macular star
81
STAGE IV Hypertensive retinopathy
Papilloedema optic disc swelling.
82
Stages of diabetic retinopathy
- non-proliferative -proliferative -maculopathy
83
Types of non proliferative
mild - 1 or more microaneurysms moderate - Microaneurysms + blot haemorrhages + hard exudates + soft exudates severe (pre-proliferative) - blot haemorrhages. microaneurysms in a 4 quads. venous beading in at least 2. intraretinal microvascular abnormalities in 1 quad.
84
Proliferative diabetic retinopathy
Neovascularisation. More typical in Type I
85
Maculopathy
More common in type II. Hard exudates and changes on macula.
86
Tx of proliferative diabetic retinopathy
Pan-retinal photocoagulation is the primary treatment
87
Central retinal artery occlusion presents with sudden, profound loss of vision.
88
Central retinal vein occlusion occurs secondary to atherosclerotic thickening of the central retinal artery compressing the central retinal vein at a common crossing point.
89
cocaine overdose management
benzodiazepines then nitrates
90
blood supply to legs, buttocks and both.
legs - external ileac buttocks -internal ileac both - common iliac
91
Gullain Barre mx
intravenous immunoglobulin and plasmapheresis

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