Mixed PT questions Flashcards
Delirium mangement in Parkinson’s
-haloperidol 0.5 mg as the first-line sedative in NON PARKINSONS PATIENTS
-antipsychotics can often worsen Parkinsonian symptoms: atypical antipsychotics quetiapine and clozapine are preferred or lorazpam
Causes of polyuria
-diuertics, alcohol, caffeine
-DM
-lithium
-heart failure
-hypercalcaemia
-hyperthyroidism
-hypokalaemia
Diabetes insipidus
-Decreased secretion of antidiuertic hormone (ADH) from pituitary (cranial) or insensitivity to ADH (nephrogenic)
-causes: idiopathic, TBI, pituitary surgery, haemochromatosis, hypercalcaemia, hypokalamia, lithium (desensitises the kidney’s ability to respond to ADH in collecting ducts)
-SX: polyuria, polydipsia
-Ix: water deprivation test (high plasma osmolality and low urine osmolality)
-Mx: central DI: desmopressin
Nephrogenic: thiazides and low salt diet
How to reverse dabigatran (direct thrombin inhibitor)
Idarucizumab
Pneumothorax mangement
minimal symptoms as ‘no significant pain or breathlessness and no physiological compromise’
no or minimal symptoms → conservative care, regardless of pneumothorax size
symptomatic → assess for high-risk characteristics
high-risk characteristics are defined as follows:
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
if no high-risk characteristics are present, and it is safe to intervene, then there is a choice of intervention:
conservative care
ambulatory device
needle aspiration
if high-risk characteristics are present, and it is safe to intervene → chest drain
Most common form of inherited cancer
hereditary non-polyposis colorectal carcinoma (HNPCC, Lynch syndrome 5%)
high risk of endometrial cancer too
Bell’s palsy mangment
Oral prednisolone 10 days + eye care (artificial tears + eye lubricants)
Oesophageal adenocarcinoma risk factors
Usually found in the lower third near gastrooesophageal junction (oppose to squamous)
GORD
Barrett’s
Smoking/obesity
Mx: surgical resection
Crohn’s maintainence of remission
1st line: azathioprine or mercaptopurine (immunosurpressants)
2nd line: methotextrate
3rd line: Infliximab
Most appropriate screening for diabetic neuropathy
Test sensation using 10g monofilament
ACEi common side effect
Cough
MI Complications
-VSD: pansystolic murmur + HF sx
-Rupture/ischaemia of pap muscle: early to mid systolic murmur acute mitral regurg
-left ventricular free wall rupture: 1-2 weeks after MI, acute HF secondary to cardiac tamponade
-Dressler’s- central pleuritic chest pain (pericarditis) 2-6 weeks post MI
Soft S2
Aortic stenosis
Blood pressure target >80
145/80
Moderate vs Severe vs Life-threatening Asthma
Moderate: PEFR 50-75% best or predicted, Speech normal, RR < 25 / min, Pulse < 110 bpm
Severe: PEFR 33 - 50% best or predicted, Can’t complete sentences, RR > 25/min, Pulse > 110 bpm
Life-threatening: PEFR < 33% best or predicted, Oxygen sats < 92%, Silent chest, cyanosis or feeble respiratory effort, Bradycardia, dysrhythmia or hypotension, Exhaustion, confusion or coma
CHA2DS2-VASc score
0 No treatment
1 Males: Consider anticoagulation
Females: No treatment (this is because their score of 1 is only reached due to their gender)
2 or more Offer anticoagulation
Warfarin or apixaban/ dabigatran
V1-6, I, aVL ischeamic changes
left anterior descending
Statin adverse effect
Myopathaties: i.e. myositis, myalgia etc
S3 and S4 causes
S3: constrictive pericarditis, left ventricular failure and mitral regurg
S4: Aortic stenosis, HOCM, HTN
Slow rising pulse vs collapsing pulse vs narrow pulse
Slow rising/plataeu or narrow: aortic stenosis
Collapsing: aortic regurg
Propanolol contraindication
concurrent verapamil use (CCB) can cause severe bradycardia
loud S1, split S2 and a diastolic murmur
Mitral stenosis
Loop diuretics SE
Ototoxicity
Long term antiplatlets
STEMI: aspirin (lifelong) + tricagrelor (12m)
TIA: clop (lifelong)
Ischaemic stroke: clop (lifelong)
Peripheral arterial disease: clop (lifelong)
Dry cough and atypical chest signs, hyponatraemia and lymphopenia
Legionella pneumophilia- erythromycin
short QT interval
Hypercalcaemia
Asthma drug contraindications
beta blockers and adenosine
theophylline MOA
phosphodiesterase competitive inhibitor preventing cAMP breakdown
digoxin toxicity
short QT interval
inverted T waves
ST depression
prolonged PR interval
AF examination finding
pulse irregularly irregular
Angina Mx
GTN
Beta blocker (CCB if contra)
3rd line : if CCB is not erliving long acting nitrate e.g. ivabradine or isosorbide mononitrate
Granulomatosis with polyangiitis
Autoimmune resp tracts + neph
Sx: sinutitus, epistaxis/haemoptysis, SOB
cANCA, cavitating lesions
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Asthma, eosinophilia, SOB
pANACA
Hepatic encephalopathy Mx
Lactulose first line with rifaximin for prophylaxsis
Rosacea
Nose, cheeks, forehead:
flushing, telangiectasia and persistent erythema with papules and pustules (sunlight may exacerbate)
papules: topical ivermectin
what is hCG secreted by
syncytiotrophoblast, detectable 8 days after conception
Boerhaave syndrome
Transmural oesophageal perforation: vomiting
severe chest pain/shock
suprasternal crepitus (subcutaneous emphysema)
Blood film: hypersegmented polymorphs
Megaloblastic anaemia- B12 deficiency, investigation: intrinsic factor
Hypercalcaemia sx
‘bones, stones (renal), groans (abdo) and psychic moans’
corneal calcification
shortened QT interval on ECG
hypertension
Common pneumonia cause after influenza infection
Staph Aureus
Mx: fluclox + amoxicillin
Alzheimer’s drugs
- 1st line: donepezil (acetylcholineesterase inhibitor)
- 2nd line: memantine (NMDA receptor antagonist)
Febrile convulsion
Seizures provoked by fever in children between 6 months - 5 years
If recurrent benzodiazepine rescue may be used i.e. rectal diazapam or buccal midazolam
Dix Hallpike/Epley manoeuvre
Dix-Hallpike: diagnostic of BPPV
Epley: treatment of BPPV
Nephrotic syndrome vs nephritic syndrom
Nephrotic: proteinuria, hypoalbuminaemia, oedema
Nephritic: haematuria (red cast cells), proteinuria, hypertension, oliguria
Hypoglycaemia Mx
Oral glucose 10-20g liquid, tablet or gel
Cerebellar stroke sites
Anterior: legs
Middle: arms
Posterior: eyes
Which vein does varicose veins predominately affect?
Long saphenous vein
