MLA Flashcards

1
Q

MI complications, left ventricular aneurysm

A

Persistent ST elevation
LV failure - pulm oedema
S3 sounds - LV larger
S4 sounds - LV stiffer
Anticoag as risk of thrombus

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2
Q

Left ventricular free wall rupture

A

1-2 weeks after
Acute HF 2ndry to cardiac tamponade, raised JVP, pulses paradox, HS muffled
Hypotension

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3
Q

Acute mitral regurg

A

More common in infero post infarction
Papillary muscle rupture
Acute hypotension, flash pulmonary oedema
Early to mid systolic murmur
Vasodilator therapy, surgery

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4
Q

MI complication, Ventricular septal defect

A

occur in 1st wk
new pan systolic murmur
Raised JVP
SOB, bibasal crackles

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5
Q

Dressler’s syndrome post MI

A

pleuritic pain, left, pericardia effusion
Saddle shape st elev on ecg
After MI 2-6wks
Tx - nsaids

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6
Q

MI complic, bradyarrhythmia

A
  • AV block common after inferior MI -> HB
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7
Q

Drugs causing drug induced liver disease

A

Paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin

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8
Q

drug induced cholestasis

A

COCP
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates

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9
Q

P450 enzyme inducers (inc other drugs metabolism, reduce therapeutic conc)

A

Antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking

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10
Q

P450 enzyme inhibitors, inc therapeutic concentration

A

Ciprofloxacin, erythromycin
isoniazid
cimetidine, omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake

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11
Q

Palliative med, what medication is started with

A

modified release morphine or standard release
laxative co prescribed

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12
Q

what is the breakthrough dose for morphine

A

1/6 of total dose

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13
Q

What is used for metastatic bone pain

A

opioids
bisphosphonates
radiotherapy

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14
Q

what is the drug conversion of oral codeine/tramadol to oral morphine

A

divide by 10

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15
Q

drug conversion oral morphine to oral oxycodone

A

divide by 1.5

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16
Q

what opioid is used in mild moderate renal impairment

A

oxycodone

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17
Q

what opioid is used in severe renal impairment

A

alfentanil,
buprenorphine,
fentanyl

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18
Q

conversion for oral morphine to s/c morphine

A

divide by 2

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19
Q

oral morphine -> subcut diamorphine

A

divide by 3

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20
Q

oral oxycodone -> subcut diamorphone

A

divide by 1.5

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21
Q

Mechanism of action metformin

A

Biguanide

Inc insulin sensitivity
Dec hepatic gluconeogenesis

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22
Q

DDP-4 inhibitor

A

Increase active incretin levels
Reduce peripheral breakdowns of incretins

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23
Q

Pioglitazone

A

inc insulin sensitivity

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24
Q

Sulfonyurea

A

Inc insulin release from pancreas

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25
GLP-1 analogues
Inc insulin release inhibit glucagon secretion
26
Mx of open angle glaucoma
360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg NICE Prostaglandin analogue (PGA) eyedrops should be used next-line, Latanoprost beta-blocker eye drops carbonic anhydrase inhibitor eye drops sympathomimetic eye drops
27
Latanoprost action and SE
Prostaglandin analogue increasing uveoscleral outflow Brown pigmentation of the iris, increased eyelash length
28
Beta blocker timolol action
Reduces aqueous production
29
Carbonic anhydrase inhibitors (e.g. Dorzolamide) action
Reduces aqueous production
30
Miotics (e.g. pilocarpine, a muscarinic receptor agonist) action
Increases uveoscleral outflow
31
Causes of gynaecomastia
syndromes with androgen deficiency: Kallman's, Klinefelter's testicular failure: e.g. mumps liver disease testicular cancer e.g. seminoma secreting hCG ectopic tumour secretion hyperthyroidism haemodialysis drugs: spironolactone (most common drug cause) cimetidine digoxin cannabis finasteride GnRH agonists e.g. goserelin, buserelin oestrogens, anabolic steroids
32
what drug most commonly causes gynaecomastia
spironolactone
33
Thiazide diuretics side effects
hypokalaemia hyponatraemia hypercalcaemia impaired glc tolerance gout sexual dysfunction Dehydration Postural hypo digoxin toxicity
34
What are the features of dengue fever
viral infection - fever - retro orbital headache - facial flushing - myalgia, bone pain - rash - haemorrhagic - thrombocytopenia, raised AST - travelling - 7 day incubation period
35
Features of typhoid fever
salmonella typhi initially, headache, fever, arthralgia relative bradycardia constipation, abd pain rose spots - trunk
36
X-ray features of rheumatoid
- loss of joint space - peri articular erosions - juxta articular osteoporosis - soft tissue swelling - subluxation
37
X-ray fts of osteoarthritis
-osteophytes -loss of joint space -cyst formation -subchondral sclerosis
38
Indications for urgent CT head (within 1 hour) in head injuries
GCS < 13 on initial assessment GCS < 15 at 2 hours post-injury suspected open or depressed skull fracture any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign). post-traumatic seizure. focal neurological deficit. More than 1 episode of vomiting
39
When should you send a urine culture for UTI in non pregnant women
visible or non visible haematuria over 65
40
Pleural effusion exudative causes
Protein >30 Infection -pneumonia (most common exudate cause), -tuberculosis -subphrenic abscess Connective tissue disease -rheumatoid arthritis -systemic lupus erythematosus Neoplasia -lung cancer -mesothelioma -metastases pancreatitis pulmonary embolism Dressler's syndrome yellow nail syndrome
41
Pleural effusion transudative cause
Protein <30 heart failure (most common transudate cause) hypoalbuminaemia liver disease nephrotic syndrome malabsorption hypothyroidism Meigs' syndrome
42
Empyema ph, glucose and LDH levels
pH <7.2 low glc high LDH
43
features of limited systemic sclerosis
scleroderma of face and distal limbs (tightening and fibrosis of skin) CREST Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia anti centromere antibody
44
Diffuse cutaneous systemic sclerosis fts
anti scl-70 antibodies resp involvement - interstitial lung disease renal disease - use ACEI hypertension
45
Metformin side effects
GI upset Reduced vit b12 asso Lactic acidosis w severe liver disease or renal failure
46
Sulphonyurea side effects
weight gain hypoglycaemia (siadh
47
DDP-4 inhibitor side effects
weight neutral pancreatitis nausea nasopharyngitis
48
Thiazidolines side effects
weight gain fluid retention - contraind HF inc risk bladder cancer inc risk fractures
49
GLP-1 analogues side effects
weight loss nausea pancreatitis
50
SGLT2-inhib side effect
inc risk UTI weight loss Inc risk lower limb amputation Contraind in active foot disease - skin ulcer Necrotising fasciitis of genitalia
51
what does 4AT include
Alertness - name and address 4AMT - age, date of birth, place, current year Attention - state months of year backward Acute change or fluctuating course
52
What is the treatment for focal seizures
lamotrigine, levetiractam 2nd line - carbemazepine
53
What drug is used to treat myoclonic seizures in females
Levetiracetam
54
What anti epileptics are contraindicated in pregnancy
sodium valproate - neural tube defect phenytoin - cleft palate
55
Causes of interstitial nephritis
penicillin rifampicin NSAIDs allopurinol furosemide SLE, sarcoid staph, hanta virus
56
What defines an exudate in pleural effusion
protein >30 pleural fluid protein divided by serum protein >0.5 pleural fluid LDH divided by serum LDH >0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
57
what defines a transudate pleural effusion
protein <30
58
Causes of exudative pleural effusion
malignancy pneumonia Pulmonary embolism Infection Mesothelioma
59
causes of transudate pleural effusion
Heart failure liver cirrhosis Hypoalbuminaemia Malabsorption hypothyroidism Meigs' syndrome
60
Investigations for premature rupture of membranes?
sterile speculum exam for fluid, if no pooling of fluid PAMG-1 test
61
Management of preterm rupture of membranes
Admit, observe for chorioamniotiis oral erythromycin 10 days antenatal steroids, reduce risk of respiratory distress
62
Management of post partum haemorrhage
ABCDE - crystalloid infusion - empty bladder catheterise - masssage umbilicus - IV oxytocin - ergometrine (not if hypertension) - IM carboprost (not if asthma) - misoprostal sublingual surgical - intrauterine balloon tamponade
63
carcinoid syndrome fts
flushing (earliest symptom) Abd pain D+ Bronchospasm Hypotension Cushings syndrome Right heart valve stenosis
64
carcinoid syndrome ix and mx
urinary 5-HIAA ocreotide
65
Osteoarthritis x-ray features
LOSS loss of joint space osteophytes at joint margins subchondral sclerosis subchondral cysts
66
signs of vitamin C deficiency
Follicular hyperkeratosis and perifollicular haemorrhage Ecchymosis, easy bruising Poor wound healing Gingivitis with bleeding and receding gums Sjogren's syndrome Arthralgia Oedema Impaired wound healing Generalised symptoms such as weakness, malaise, anorexia and depression
67
Amiodarone side effects
thyroid dysfunction corneal deposits pulmonary fibrosis/pneumonitis liver fibrosis/hepatitis peripheral neuropathy, myopathy photosensitivity 'slate-grey' appearance thrombophlebitis and injection site reactions bradycardia lengths QT interval
68
beta blocker side effects
bronchospasms cold peripheries fatigue sleep disturbances, including nightmares erectile dysfunction
69
ECG changes in trifasicular block
RBBB LAD 1st degree HB
70
Causes od G6PD exacerbation
anti malarials - primaquine ciproflox sulphonamides sulfonureas infection fava beans
71
drugs causing erythema multiforme
penicillin sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
72
causes of erythema multiforme
HSV idiopathic bacteria: Mycoplasma, Streptococcus drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine connective tissue disease e.g. Systemic lupus erythematosus sarcoidosis malignancy
73
physiological abnormalities of anorexia nervosa
G's and C's raised growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia hypokalaemia low FSH, LH, oestrogens and testosterone
74
Hypercalcaemia ecg changes
short QT interval
75
Hypocalcaemia ecg
prolonged QT interval
76
What measurement is prolonged QT interval
>450
77
Normal PR interval
120-200 (3-5 small squares)
78
Hypokalaemia ecg changes
widened P waves Prolonged PR interval Long QT U waves (after T wave in V2/3) T wave inversion, small or absent
79
Wolf parkinson white syndrome ecg changes
Broad complex tachycardia short PR interval wide QRS complexes with a slurred upstroke - 'delta wave' usually LAD - affecting right accessory pathway
80
Hyperkalaemia ecg changes
Tall tented t waves Loss of p waves Broad QRS
81
Neuroleptic malignant syndrome features
Muscle rigidity confusion hypotension hyperthermia
82
Causes of warm haemolytic anaemic
CLL, lymphoma SLE methyldopa idiopathic
83
Causes of cold haemolytic anaemia
mycoplasma EBV lymphoma neoplasia
84
Most common cause of D+ in HIV
cryptosporidium parvum
85
What is the post exposure prophylaxis in HIV
up to 72hrs after exposure, 4 weeks antiretrovirals
86
How should asymptomatic patients be tested for HIV
test 4wks after exposure if negative repeat at 12wks
87
How is HIV diagnosed
- HIV p24 antigen 1-4wks - HIV ab 4wks-3mths 4th generation if positive, repeat test
88
How is HIV disease progress monitored
using CD4+ cell count and viral load
89
HIV complications CD4 200-500
-oral thrush -shingles -hairy leucoplakia (EBV) - kaposi sarcoma (HHV-8)
90
HIV complications CD4 100-200
- PJP pneumocystitis - cryptosporidiosis (D+) - cerebral toxoplasmosis - progressive leukoencephalopathy (JC virus) - HIV dementia
91
HIV complications CD4 50-100
- aspergillosis - oesophageal candidiasis - Cryptococcal meningitis - fungal, low glc, high protein, india ink staining - primary CNS lymphoma (EBV)
92
HIV complications CD4 <50
- CMV retinitis - mycobac avium intracellulare
93
Features of PJP pneumocystitis in HIV and CD4 count
100-200 pneumothorax common - exercise induced desat - cxr bilat interstitial pulm infiltrates - mx oral co-trimox IV pentamidine in severe
94
what should be given to HIV patients w CD4 count <200
prophylactic co-trimoxazole
95
Fts of cerebral toxoplasmosis and CD4 count
100-200 headaches, double vision CT - mult ring enhancing lesions negative thallium spect scan - tx sulfadiazine, pyrimethamine
96
Fts of cerebral progressive multifocal lekoencephalopathy and CD4 count
100-200 - neuro symptoms, demyelination on MRI - JC virus
97
Fts of CNS Lymphoma and CD4 count
50-100 EBV - CT single enhancing lesions, SPECT positive - tx steroids, chemo
98
Fts of cyptococcal meningitis and CD4 count
50-100 fungal, low glc, high protein, india ink staining
99
When is the combined test for downs syndrome and what does it include
11 - 13+6 weeks nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A) thickened nuchal inc bcg dec papp
100
When is the quadruple test done
15-20wks quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
101
quadruple test positive results for downs
afp down oestriol down bhcg up inhibin a up
102
renal cell carcinoma triad of fts
Flank pain, Palpable abdominal mass, Haematuria
103
Henoch Schloein Purpura or IgA vasculitis fts
palpable non blanching purpura on buttocks, lower limbs abd pain renal involvement haematuria polyarthritis
104
Alpha 1 antitrypsin deficiency fts
young p's non smokers panacinar emphysema, lower lobes obstructive spirometry
105
Cerebral palsy dyskinetic fts
athetoid movements and oro-motor problems - damage to basal ganglia and substantia nigra
106
Cerebral palsy spastic fts
most common - damage to upper motor neurons in periventricular white matter, hemiplegia, hypertonia
107
cerebral palsy ataxic fts
nystagmus, ataxia
108
Newborn screening hearing test
Otoacoustic emission test
109
newborn hearing test 2nd line
Auditory Brainstem Response test
110
hearing test at >3years old
Pure tone audiometry
111
features of posterior hip dislocation
90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated.
112
fts of anterior hip dislocation
abducted and externally rotated. No leg shortening.
113
Alport syndrome fts
X linked dominant microscropic haematuria sensorineural deafness occular defects progressive CKD retinitis pigementosa
114
Causes of raised prolactin
prolactinoma pregnancy oestrogens physiological: stress, exercise, sleep acromegaly: 1/3 of patients polycystic ovarian syndrome primary hypothyroidism metoclopramide, domperidone phenothiazines haloperidol
115
myxedema coma fts
- undiagnosed hypothy or poor compliance hypothermia Hypotension Bradycardia Confusion
116
myxedema coma management
IV thyroxine and hydrocortisone
117
Thyrotoxic storm management
IV propanolol, anti thyroid drugs, methimazole, hydrocortisone
118
Edward syndrome fts
trisomy 18 dysmorphic fts rocker bottom feet overlapping fingers low set ears microgathnia - small jaw
119
Patau syndrome fts
trisomy 13 microcephalic, small eyes polydactyly cleft lip/palate
120
Noonan syndrome features
autosomal dominant short stature broad forehead downward sloping eyes webbed neck pectus excavatum low set ears pulmonary stenosis wide set eyes
121
Prader willi syndrome fts
deletion of 15q11-q13 infantile hypotonia/ feeding problems hyperphagia/ obesity short stature hypogonadism developmental delay
122
Fragile X fts
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
123
Klinefelter syndrome fts
Males XXY low testosterine High FSH and LH tall, infertility, gynaecomastia
124
lateral stemi ecg changes and artery affected
I, aVL +/- V5-6 left circumflex
125
Medications for focal seizure
Lamotrigine Leviteraciteam Carbemazepine
126
Medication for myoclonic seizure in females
Levitiracetam
127
Antiphospholipid syndrome antibody and blood results
anti-cardiolipin AB prolonged APTT thrombocytopaenia
127
Antiphospholipid syndrome fts
Clots, venous arterial thrombosis Livedo reticularis (mottled skin) Obstetric loss
128
primary thromboprophylaxis in antiphospholipid syndrome
low dose aspirin
129
Behcet's triad
oral ulcers genital ulcers anterior uveitis
130
Rheumatic fever organism
strep pyogenes
131
Rheumatic fever
erythema marginatum Sydenham's chorea: this is often a late feature polyarthritis carditis and valvulitis subcut nodules
132
what is Sydenham's chorea
late complication of rheumatic fever abrupt involuntary movements, muscle weakness
133
drug induced lupus antibodies and causes
procainamide - hydralazine - isoniazid - phenytoin - anti-histone antibodies - ANA
134
Vitamin B12 deficiency, subacute degen of spinal cord symptoms
hyperreflexia loss of proprioception, vibration
135
ankylosing spondylitis features, A's
Reduced lateral and forward flexion of spine Limitations of chest expansion morning stiffness back pain Bilateral sacroiliitis Apical fibrosis (lungs) Anterior Uveitis Aortic regurg Achilles tendonitis AV node block Amyloidosis Arthritis peripheral And cauda equina
136
Type 1 hypersensitivity reaction
Anaphylactic - IgE - anaphylaxis - atopy
136
Type 2 hypersensitivity reaction
Cell Bound - IgG or IgM to antigen on cell surface - autoimmune haemolytic anaemia - ITP - good pastures - Pernicious - Rheumatic fever
137
Type 3 hypersensitivity reaction
Immune complex - free antigen and antibody combine IgG or IgA - SLE - post strep glomerulonephritis
138
Type 4 hypersensitivity reaction
Type 4 Delayed - t cell mediated - TB - graft vs host disease - allergic contact derm - MS - GBS
139
Post splenectomy infectious organisms
strep pneumoniae haem influenza meningococci Capnocytophaga (dog bite)
140
Rivaroxaban + apixiban reversal agent
Andecanet alfa
141
Heparin reversal agent
protamine sulphate
142
How do u monitor unfractioned heparin
APTT
143
Lithium side effects
benign leucocytosis - hyperparathyroidism -> hypercalc - fine tremor - N, V+ - nephrotoxicity - polyuria - IIH - weight gain - thyroid enlarge, hypothyroidism
144
Lithium toxicity precipitants
dehydration, renal failure, diuretics esp thiazides, ACEI, NSAIDs, metronidazole
145
Lithium toxicity mx if >3.5
haemodialysis
146
Palliative med for visceral/serosal (constipation) N+ and V+
cyclizine, levomeprozine
147
Palliative med for chemically mediated N+ and V+
- ondanestron - haloperidol
148
Typical antipsychotics
haloperidol chlorpromazine
149
Side effects of atypical antipsychotics
weight gain (most common) hyperprolactinaemia DM dyslipidaemia
150
reed sternberg cells description
large B cells, multinucleated. large cells with a bilobed nucleus and prominent eosinophilic inclusion-like nucleoli.
151
Acute myeloid leukaemia fts
anaemia, pallor, breathlessness - thrombocytopenia, bruising, petechiae purpura and mucosal membrane bleeding -recurrent infection because of neutropenia hepatomegaly splenomegaly gum hyperplasia myeloid blast cells Aur rods
152
Chronic myeloid leukaemia fts
Philadelphia chromosome 9:22 thrombocytosis inc granulocytes at dif stages of maturation high WCC massive splenomegaly anemia weight loss sweating hyperleukocytosis - fundal haemorrhage and venous congestion tx - imatinib
153
Acute lymphoblastic leukaemia fts
75% cases occur in children <6years B-cell lineage 2-3 week history of bone marrow failure +/- rasied wcc bone/joint pain infection night sweats neutropenia anaemia, soft systolic murmur and SOB thrombocytopenia, easy bruising, petechiae lead to DIC splenomegaly hepatomegaly Blast cells
154
Chronic Lymphocytic Leukaemia fts on blood film
smudge cells
155
CLL fts
asymptomatic at presentation - bone marrow failure - anaemia, thrombocytopenia - lymphadenopathy - splenomegaly - fever and sweats warm haemolytic anaemia inc wbc inc lymphocytes
156
PRV gene and pathophysiology
JAK2 V617F gene too many red cells, blood thick, raised haematocrit, red cell count and Hb conc
157
PRV presentation
fatigue headache itch ruddy complexion gout vas occlussion TIA, stroke splenomegaly Raised Hb and haematocrit
158
PRV mx
venesection aspirin
159
Idiopathic thrombocytosis presentation
raised platelet count - asymp - burning hands - arterial venous thromboses - bleeding - digital ischaemia - gout - headache - mild splenomegaly
160
Idiopathic thrombocytosis mx
aspirin and hydroxycarbamide or anagrelide
161
Myelofibrosis features
fatigue massive splenomegaly weight loss, night sweats tear drop poikolocytes
162
testicular cancer teratoma blood marker
AFP and BHCG non seminoma
163
Clozapine side effects
agranulocytosis, neutropenia reduce seizure threshold constipation myocarditis, do baseline ecg hypersalivation
164
Pityriasis Rosea organism and features
HHV 7 Herald patch, rash on trunk, first singular raised erythematous, oval, scaly fir-tree appearance
165
Pityriasis versicolour organism, fts, tx
Malassezia furfur trunk patches vary in colour, hyperpigmentation, pink, brown scaling sun make it more evident topical ketoconazole
166
What is Trousseau's sign
carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic wrist flexion and fingers are drawn together in hypocal
167
what is Chvostek's sign
tapping over parotid causes facial muscles to twitch in hypocal
168
Anal fissure mx if <1wk
Soften stool, dietary advice, bulk forming laxative Lubricant bfr defecation Topical anaesthetic
169
Anal fissure mx if >6wks
topical GTN If not effective >8wks, sphincterotomy or botulinum toxin
170
What is budd chiari syndrome, symptoms?
hepatic vein thrombosis - abd pain - ascites - hepatomegaly tender
171
what types of shock causes warm peripheries
Neurogenic Anaphylactic Septic
171
what types of shock causes cool peripheries
cardiogenic haemorrhagic
171
HIV toxoplasmosis tx
sulfadiazine, pyrimethamine
172
Metronidazole side effects/ interactions
disulfiram-like reaction with alcohol increases the anticoagulant effect of warfarin
173
genital wart tx if keratinised
crypotherapy
174
ascites SAAG >11 indicates? causes
portal hypertension Budd-Chiari liver cirrhosis Right HF
175
ascites SAAG <11 causes
Malignancy Hypoalbuminaemia, nephrotic syndrome Tuberculosis peritonitis Pancreatitis Biliary ascites
176
tetracyclines SE
discolouration of teeth: therefore should not be used in children < 12 years of age photosensitivity - sunburn angioedema black hairy tongue
177
tx for telangiectasia in acne rosacea
laser therapy
178
tx for flushing in rosacea
topical brimonidine
179
cause of pseudohponatraemia
hyperlipidaemia (increase in serum volume)
180
Hepatitis E
RNA virus undercooked pork Shellfish Signify mortality during pregnancy
181
Hepatitis A features
benign, self-limiting disease flu-like prodrome abdominal pain: typically right upper quadrant tender hepatomegaly jaundice deranged liver function tests
182
which hepatitis has signif mortality in preg
hep E
183
who should be vaccinated for hep A
people travelling to or going to reside in areas of high or intermediate prevalence, if aged > 1 year old people with chronic liver disease patients with haemophilia men who have sex with men injecting drug users individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
184
what is TURP syndrome
Glycine toxicity results in hyponatremia
185
Cisplatin side effects
otoxicity - hypomagnesia - peripheral neuropathy
186
Cyclophosphamide side effects
- myelosuppression - haemorrhagic cystitis - transitional cell carcinoma
187
Anthracyclines, Doxorubicin side effect
cardiomyopathy
188
Bleomycin side effect
lung fibrosis
189
Vincristine side effect
peripheral neuropathy, paralytic ileus
190
what is Brudzinski’s sign
hip and knee flex on passive flexion of neck meningitis
191
what is kernig's sign
pain on passive extension of knee meningitis
192
Organism for meningitis <3mths
- group b strep - e. coli - listeria monocytogenes
193
Down's quadruple test results
- low AFP - low oestriol - high hcg - high inhibin A
194
Edwards quadruple test results
low afp low oestriol low hcg inhibin normal
195
neural tube defect quadruple test results
high afp normal oestriol normal hcg normal inhibin A
196
cephalhaematoma description
Develop after birth and do not cross the suture lines of the skull as the blood is confined between the skull and periosteum
197
neiseria gonorrhoea tx for needle phobic p's
oral cefixime + oral azithromycin
198
Metoclopramide side effects
EPS - acute dystonia D+ hyperprolactinaemia tardive dyskinesia parkisonism avoid in bowel obstruction
199
levodopa side effects
dry mouth anorexia palpitations postural hypotension psychosis dyskinesia at peak dose, dystonia, chorea, athetosis
200
dopamine receptor agonist side effects
impulse control disorders excessive daytime somnolence
201
Amantadine side effects
ataxia, slurred speech, confusion, livedo reticularis
202
horners central lesion features and causes
anhidrosis of face, arm trunk Stroke, syringomyelia, MS, tumour, encephalitis
203
Horner's pre ganglionic lesion fts and causes
Anhidrosis of face pan coast tumour Thyroidectomy Cervical rib
204
Horner's post ganglionic lesion fts and causes
No anhidrosis Carotid artery dissection Carotid aneurysm Cavernous sinus thrombosis Cluster headache
205
Criteria for long term oxygen therapy in COPD p's
2 ABG pO2 < 7.3 or 7.3 - 8 + 2ndry polycythaemia, peripheral oedema, pulmonary hypertension
206
organs that metastasise to Brain
lung (most common) breast bowel skin kidney
207
adrenaline induced ischaemia reversal agent
phentolamine
208
safe triangle borders
Latissimus dorsi, pectoralis major, line superior to the nipple apex at the axilla
209
what conditions cause lower than expected Hba1c levels, (reduced rbc lifespan)
G6pd sickle cell hereditary spherocytosis haemodialysis
210
what conditions cause higher than expected Hba1c levels, (increased rbc lifespan)
Vitamin B12/folic acid deficiency Iron-deficiency anaemia Splenectomy
211
when doing PSA how long musy you wait after - biopsy - uti etc
6wks prostate biopsy 4wks UTI 1wk DRE 48hrs vigorous exercise or ejaculation
212
Opiate withdrawal symptoms
insomnia - yawning - dilated pupils - muscle pain and cramps - agitation - anxiety, D+
213
MDMA (ecstasy) overdose signs
neurological: agitation, anxiety, confusion, ataxia tachycardia, hypertension hyperthermia rhabdomyolysis hyponatraemia this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA
214
Cocaine side effects
hypertension n HR - euphoria - hyperthermia - seizures - coronary artery spasm
215
Ciprofloxacin side effects
QT prolong reduce seizure threshold tendon, cartilage damage
216
Renal tubular acidosis ABG effect
hyperchloraemic metabolic acidosis, normal anion gap
217
Type 1 renal tubular acidosis
distal hypokalaemia nephrocalcinosis, renal stones causes - idiopathic - RA - SLE - sjogrens
218
Type 1 renal tubular acidosis causes
- idiopathic - RA - SLE - sjogrens
219
Type 2 renal tubular acidosis
proximal hypokalaemic - osteomalacia causes - idiopathic - fanconi - wilsons disease - carbonic anhydrase inhib
220
Type 2 renal tubular acidosis causes
- idiopathic - fanconi - wilsons disease - carbonic anhydrase inhib
221
Type 4 renal tubular acidosis
hyperkalaemic causes - hypoaldosteronism, DM
222
drug causes of pancytopenia
Cytotoxics Trimethoprim, chloramphenicol Gold, penicillamine Carbimazole* Carbamazepine sulphonylureas: tolbutamide
223
Parkinson's plus syndrome Multiple system atrophy fts
autonomic CF Postural hypotension Incontinence Erectile dysfunction Cerebellar signs
224
Cortico basal degenerations fts Parkinson plus
- spontaneous activity of limb or akinetic rigidity
225
cystic fibrosis diagnosis and value
sweat chloride test >60
226
when are cleft lips repaired
first week of life to 3mths
227
when are cleft palates repaired
6-12mths
228
drugs causing IIH
combined oral contraceptive pill steroids tetracyclines retinoids (isotretinoin, tretinoin) / vitamin A lithium
229
causes of hypokalaemia w alkalosis
vomiting thiazide and loop diuretics Cushing's syndrome Conn's syndrome
230
causes of hypokalaemia w acidosis
diarrhoea renal tubular acidosis acetazolamide partially treated diabetic ketoacidosis
231
causes of hyperkalaemia
acute kidney injury drugs: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin metabolic acidosis Addison's disease rhabdomyolysis massive blood transfusion
231
causes of hypercalcaemia
primary hyperparathryoidism malignancy sarcoid vitamin D intoxication acromegaly thyrotoxicosis thiazide diuretics dehydration addisons
232
how is severe hypocalcaemia managed
IV calcium gluconate 10%
233
treatment for severe hyponatraemia <120
Hypertonic saline (typically 3% NaCl)
234
statins contraindications
pregnancy on course of macrolides
235
Levodopa side effects
dyskinesia at peak dose, dystonia, chorea, athetosis Dry mouth, end of dose wearing palpitations, N+ V+ Psychosis Postural hypotension
236
dopamine agonist side effects
impulse control disorders, gambling, hyper sexuality, shopping, binge eating Excessive daytime somnolence
237
drug treatment for N+ and V+ in parkinsons
Domperidone Doesn’t cross blood Brain barrier
238
MAO-B inhibitor drug examples
selegiline, rasagiline, safinamide
239
when should pregnant women take folic acid
until 12th week of pregnancy
240
when do pregnant women require 5mg folic acid
partner has a NTD, they have had a previous pregnancy affected by a NTD, family history of a NTD antiepileptic drugs coeliac disease, diabetes thalassaemia trait BMI >30
241
what causes false positive syphilis test
negative TPHA and positive VDRL pregnancy, HIV, SLE, TB malaria
242
MEN1 features
hypercalcaemia Parathyroid hyperplasia and adenomas Pancreatic insulinoma, gastronoma, peptic ulceration Pituitary adenoma
243
MEN 2 type 2a fts
RET oncogene Parathyroid Phaemochromocytoma Medullary thyroid carcinoma
244
MEN 2 type 2b fts
Phaemochromocytoma Marfanoid body Neuromas
245
antibiotics used in brain abscess
IV 3rd-generation cephalosporin + metronidazole
246
common causes of meningitis <3mths
Group b strep e.coli listeria
247
common causes of meningitis
Neisseria meningitidis - gram neg diploc Streptococcus pneumoniae