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Misremembered 2 Flashcards

1
Q

Management of hydrocephalus

A
  1. External Ventricular Drain
  2. Ventriculoperitoneal shunt
    If obstructive - treat the cause
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2
Q

What are the adverse effects of hydroxychloroquine? What should be monitored?

A

Bull’s eye retinopathy - Severe and permanent visual loss.

Baseline ophthalmological examination and annual screening is generally recommened

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3
Q

Complications of RhA.

A

Respiratory - pulmonary fibrosis, pleural effusion, pleurisy, methotrexate pneumonitis,
Ocular - keratoconjunctivitis sicca, episcleritis, scleritis, corneal ulceration
Osteoporosis
IHD
Infections
Depression

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4
Q

Sulfasalazine cautions

A

G6PD deficiency
allergy to aspirin or sulphonamides (cross-sensitivity)

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5
Q

What should we do with calcium and vitamin D when giving bisphosphonates?

A

Hypocalcemia/vitamin D deficiency should be corrected before giving bisphosphonates.

When starting bisphosphonate treatment for osteoporosis, calcium should only be prescribed if dietary intake is inadequate.

Vitamin D supplements are normally given.

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6
Q

The most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease

A

Thrombocytopenia (platelet count <150,000 mm^3)

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7
Q

Period of hypotension followed by renal impairment with urinary casts

A

acute tubular necrosis

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8
Q

Main causes of Acute tubular necrosis

A

Ischaemia:
shock
sepsis

Nephrotoxins:
aminoglycosides
myoglobin secondary to rhabdomyolysis
radiocontrast agents
lead

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9
Q

Rosacea management

A
  • mild-to-moderate papules and/or pustules CKS
    topical ivermectin is first-line
    alternatives include: topical metronidazole or topical azelaic acid
  • moderate-to-severe papules and/or pustules CKS
    combination of topical ivermectin + oral doxycycline
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10
Q

Campylobacter mx

A
  • usually self-limiting
  • the BNF advises treatment if severe or the patient is immunocompromised
  • the first-line antibiotic is clarithromycin
  • ciprofloxacin is an alternative although the BNF states that ‘Strains with decreased sensitivity to ciprofloxacin isolated frequently’
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11
Q

Campylobacter mx

A
  • usually self-limiting
  • the BNF advises treatment if severe or the patient is immunocompromised
  • the first-line antibiotic is clarithromycin
  • ciprofloxacin is an alternative although the BNF states that ‘Strains with decreased sensitivity to ciprofloxacin isolated frequently’
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12
Q

What is severe campylobacter infection?

A

(high fever, bloody diarrhoea, or more than eight stools per day) or symptoms have last more than one week

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13
Q

Anti-emetic for reduced gastric motility

A

Involves H2 and D2 receptors:
metoclopramide and domperidone

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14
Q

Anti-emetic for Chemically mediated

A

If possible, the chemical disturbance should be corrected first
ondansetron, haloperidol and levomepromazine

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15
Q

Anti-emetic for Visceral/serosal causes

A

Cyclizine and levomepromazine are first-line

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16
Q

Anti-emetic for Raised intra-cranial pressure

A

The NICE CKS guidelines recommend using cyclizine for nausea and vomiting due to intracranial disease
Dexamethasone can also be used

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17
Q

Anti-emetic for Vestibular

A

Opioid related
cyclizine

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18
Q

Anti-emetic for Cortical

A

Lorazepam (associated with anxiety)

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19
Q

Autoimmune hepatitis Abs

A

Anti-smooth muscle antibody, Anti-liver kidney microsomal-1 (anti-LKM-1). Anti soluble liver antigen (anti-SLA)

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20
Q

Autoimmune haemolytic anaemia Ab

A

Anti-Rh Blood Group Antigen

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21
Q

Autoimmune thombocytopenic purpura Ab

A

Anti-Glycoprotein IIb-IIIa or Ib-IX Antibody

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22
Q

Eosinophilic Granulomatosis with polyangiitis Ab

A

p-ANCA

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23
Q

Dermatitis Herpetiformis Ab

A

Anti-endomysial antibody

24
Q

Dermatomyositis Ab

A

Anti-Jo-1

25
Q

Diffuse cutaneous scleroderma Ab

A

Anti Scl79

26
Q

CREST Ab

A

Anti-centromere antibody

27
Q

Microscopic polyangiitis

A

p-ANCA

28
Q

Polymyositis Ab

A

Anti-Jo-1

29
Q

PBC Ab

A

AMA

30
Q

Rheumatoid arthritis Abs

A

Anti-CCP, RF

31
Q

Sjogrens syndrome Abs

A

Anti-Ro, Anti-La, RF

32
Q

SLE Abs

A

Anti-ds DNA (also Ro, La, Sm, U1RNP)

33
Q

Granulomatosis with polynangitis

A

c-ANCA

34
Q

Otitis externa in diabetes

A

Ciprofloxacin to cover for pseudomonas

35
Q

How can we differentiate central and peripheral causes of vertigo?

A

The HiNTS exam is composed of 3 tests which include the head impulse test, the test of skew and assessing nystagmus. Peripheral vertigo will display an abnormal head impulse test, either no nystagmus or unidirectional nystagmus and no vertical skew. Central vertigo will have a normal head impulse test, vertical or saccadic nystagmus and will display a vertical skew.

36
Q

Non-bloody diarrhoea with a prolonged incubation period and apyrexia tx

A

Giardia - Metronidazole

37
Q

Supraspinatus function

A

Abduction

38
Q

Infraspinatus function

A

External Rotation

39
Q

Teres minor function

A

External rotation

40
Q

Subscapularis function

A

Internal rotation

41
Q

History of ACL rupture

A

An ACL tear typically occurs in an athlete with a history of twisting the flexed knee whilst weight-bearing.

42
Q

Mx of ACL tear

A

As with any acutely swollen knee, the immediate management of a suspected ACL tear is RICE (Rest, Ice, Compression and Elevation).

The specific treatment of an ACL rupture can be either conservative or surgical, dependent on the suitability of the patient for surgery and their current levels of activity

43
Q

History of a MCL tear

A

A medial collateral ligament tear will typically occurs after trauma to the lateral aspect of the knee.

In isolated medial collateral ligament tears, this is usually a direct blow in a valgus stress direction. Non-contact MCL injuries occur less commonly, and often arise from a valgus stress with external rotation force, such as in skiing.

44
Q

Mx of MCL tear

A

Grade I Injury: Rest, Ice, Compression, and Elevation (RICE) with analgesia (typically NSAIDs) as the mainstay. Strength training as tolerated should be incorporated, with an aim to return to full exercise within around 6 weeks.

Grade II Injury: Analgesia with a knee brace and weight-bearing/strength training as tolerated. Patients should aim to be able to return to full exercise within around 10 weeks

Grade III Injury: Analgesia with a knee brace and crutches, however any associated distal avulsion then surgery is considered. Patients should aim to be able to return to full exercise within around 12 weeks.

45
Q

History of meniscal tear

A

Patients often report a ‘tearing’ sensation in their knee, associated with an intense sudden-onset pain. The knee invariably swells slowly subsequently over a period of 6-12 hours.

In cases where the meniscal tear results in a free body within the knee (typically the bucket-handle type), it may be locked in flexion and unable to extend.

46
Q

Mx of meniscal tear

A

The immediate management of an acutely swollen knee is for rest and elevation with compression and ice. Most small (<1cm) meniscal tears will initially swell however the pain will subside over the next few days as the tear heals.

For larger tears or those remaining symptomatic, arthroscopic surgery is indicated

47
Q

History of patellar fracture

A

They typically occur as a result of direct trauma to the patella, however less commonly can occur as a result of rapid eccentric contraction of the quadriceps muscle.

48
Q

Mx of patellar fracture

A

Conservative management is often used in cases of non-displaced or minimally displaced patella fractures, or with vertical fractures providing that the extensor mechanism remains functional.

Patients are placed in a brace or cylinder cast, ensuring early weight bearing in extension with initial minimal displacement and articular step-off, before increasing flexion incrementally.

Operative intervention is indicated in cases of significant displacement or compromise to the extensor mechanism. The aim of surgery is to obtain anatomical reduction, adequate fixation, and restoration of the extensor mechanism.

49
Q

Tibial fracture management

A
  1. Realignement as soon as possible
  2. Following reduction, an above knee backslab (in slight flexion at the knee and neutral dorsiflexion at the ankle) should be applied to control rotation. The limb must be elevated immediately and closely monitored for signs of compartment syndrome.
  3. Post-manipulation plain radiographs should be performed and the neurovascular status of the limb re-assessed and documented.
  4. Most tibial shaft fractures are managed surgically. - Intramedullary nailing –> should be able to weight-bear immediately

Non-operative management with a Sarmiento cast

50
Q

Tibial Plateau Fracture hx

A

The tibial plateau most commonly fractures following high-energy trauma, such as a fall from height or a road traffic accident, from the impaction of the femoral condyle onto the tibial plateau. Less commonly they can occur in elderly patients following a fall, especially those with osteoporosis.

51
Q

Tibial Plateau Fracture Mx

A

Non-operative management can be trialled in uncomplicated tibial plateau fractures (including no evidence of ligamentous damage, tibial subluxation, or articular step <2mm)

These can typically be treated with a hinged knee brace and non- or partial-weight bearing for around 8-12 weeks, alongside ongoing physiotherapy and suitable analgesia

Operative management is typically warranted in complicated tibial plateau fractures*, or any evidence of open fracture or compartment syndrome.
Open reduction and internal fixation (ORIF) is the mainstay of most tibial plateau fractures, with the aim to restore the joint surface congruence and ensure joint stability. Any metaphyseal gaps can be filled with bone graft or bone substitute.

Postoperatively, a hinged knee brace is fitted with early passive range of movement but limited or non-weight bearing for around 8-12 weeks months is typically required.

52
Q

Tx of malignant hyperthermia

A

dantrolene - prevents Ca2+ release from the sarcoplasmic reticulum

53
Q

Decreased perfusion to left colon. Which artery most likely affected?

A

Inferior mesenteric artery

54
Q

Bleed from caecal carcinoma. Which artery needs to be accessed for embolisation?

A

Superior mesenteric artery

55
Q

What electrolyte abnormalities contribute to paralytic ileus?

A

K+, Mg, PO4

56
Q

Recreational drug that causes hypokalaemia and hyponatraemia

A

MDMA/ecstasy

57
Q

Pain at 80-120 degrees abduction.

A

Subacromial bursitis/supraspinatus tendonitis

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