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MLA Content > MLA Paper 2 A > Flashcards

MLA Paper 2 A Flashcards

1
Q

first-line to manage secretions in a palliative care setting

A

Hyoscine hydrobromide

2nd line: glycopyrronium bromide

Conservative
–> avoid fluid overload
–> educate family patient not troubled by secretions

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2
Q

The typical presentation can include reduced conscious level, slow respiratory rate, myoclonic jerks, and pinpoint pupils.

What toxicity does this relate to:

A

MORPHINE

Mild-moderate renal impairment: oxycodone

Severe renal impairment: alfentanil, buprenorphine and fentanyl patch

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3
Q

Breast cancer: management

A

1. Pre-operative axillary USS
–> (-) then sentinel node biopsy
–> palpable then axillary node clearance
NOTE consequences
*lymphoedema
*functional arm impairment

**Mastectomy **
–> multifocal tumour
–> central tumour
–> large lesion in small breast
–> DCIS > 4cm
Radiotherapy
1. T3-T4 tumours
2. with 4 or more positive axillary nodes

Wide local excision
–> solitary lesion
–> peripheral tumour
–> small lesion in large breast
–> DCIS < 4cm
Radiotherapy
1. whole breast recommended!
2. reduce recurrence 2/3rd

Hormonal therapy: if tumour (+) for hormone receptors
1. PRE-menopausual –> TAMOXIFEN
2. POST-menopausal –> ANASTROZOLE

Biological therapy
1. Trastuzumab (Herceptin) (HER2 positive)
NOTE
–> cannot use if pmhx heart disorders!

Chemotherapy
–> downstage primary lesion or post surgery
–> FEC-D used

Tamoxifen: oestrogen receptor selective antagonism

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4
Q

Infantile spasms in a child are part of what syndrome

A

WEST SYNDROME

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5
Q

Low molecular weight heparin (LMWH) exerts its anticoagulant effect primarily through inhibition of

A

Factor Xa

enoXAparin, dalteparin

Bind to antithrombin III –> cause conformational change allowing it to bind to inhibit factor Xa

Prevents conversion of prothrombin to thrombin –> reducing blood clotting

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6
Q

Heparin overdose may be reversed by

A

protamine sulphate

only partially reverses the effect of LMWH

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7
Q

Peri-arrest rhythms - bradycardia management

A
  1. Atrophine (500mcg IV) up to 3mg MAX
  2. Transcutaneous pacing
  3. Isoprenaline / adrenaline infusion titrated to response

If risk of asystole then Transvenous pacing!
–> complete heart block w/ broad complex QRS
–> recent asystole
–> mobitz type II AV BLOCK
–> ventricular pause > 3 seconds

Adverse signs
–> SHOCK
–> syncope
–> myocardial ischaemia
–> heart failure

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8
Q

What criteria is used in consideration of liver transplantation for paracetamol overdose:

A

KINGS COLLEGE HOSPITAL critiera

  1. pH <7.3 (24hrs post ingestion)
    or ALL of the following:
  2. prothrombin time > 100 seconds
  3. creatinine > 300 umol/L
  4. Grade III or IV encephalopathy

HE
Grade 1: Irritability
Grade 2: Confusion, inappropriate behaviour
Grade 3: Incoherent, restless
Grade 4: Coma

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9
Q

WHAT can occur after acute mitral valve regurgitation due to myocardial infarction

A

Flash pulmonary oedema: frothy sputum, breathlessness and coarse bilateral lung crackles

Acute mitral regurgitation
–> systolic murmur
–> jets of blood directed back towards pulmonary veins
–> causes fluid congestion in lungs and flash oedeam

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10
Q

Metabolic acidosis w/ raised anion gap

CAUSES

A

MUDPILES

NOTES
–> diarrhoea = normal ion gap metabolic acidosis

M - Methanol (think moonshine)
U - Uraemia
D - DKA (or any cause of ketoacidosis e.g. alcohol, starvation)
P - Paraldehyde (if I remember correctly it’s a rectal anticonvulsant we give to babies, but I could be wrong)
I - Isoniazid (used in TB) or Iron (classically wee kids that get into their parents pills)
L - Lactic acidosis (e.g. from ischaemia)
E - Ethylene glycol (think antifreeze)
S - Salicylates (e.g. aspirin overdose, this causes a bit of a weird picture, they make you hyperventilate so you get respiratory alkalosis, but they separately increase

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11
Q

Causes of respiratory alkalosis

A

HYPERVENTILATION
–> CO2 lost

Note: COPD patients may chronically retain CO2 so metabolism will compensate –> therefore respiratory acidosis with metabolic compensation

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12
Q

The anion gap is calculated by:

A

(sodium + potassium) - (bicarbonate + chloride)

A normal anion gap is 8-14 mmol/L

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13
Q

Causes of a normal anion gap or hyperchloraemic metabolic acidosis

A
  • gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
  • renal tubular acidosis
  • drugs: e.g. acetazolamide
  • ammonium chloride injection
  • Addison’s disease
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14
Q

Which diabetic medication has been linked to Fournier’s gangrene:

A

SGLT-2 inhibitors

Mx = Early surgical debridement and ABx

Other adverse effects of SGLT-2 inhibitors
1. Normogylcaemic ketoacidosis
2. increased risk of lower limb amputation

Benefits
–> patients often lose weight

Examples: canaglifozin!

SGLT2 enhances the urinary excretion of glucose -> bacteria love the sugar you are peeing out

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15
Q

paediatric fluid requirements for non-neonates

A

100mL/24 hours for every kilogram from 0-10 kg
50 mL/24 hours for every kilogram from11-20kg
20 mL per every kilo there after

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16
Q

WHAT is recommended as empirical therapy for adults > 50 years with suspected bacterial meningitis

A

IV cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

IM benzylpenecillin in interchange (GP land)

Signs
–> headache, neck stiffness
–> positive brudzinski sign
–> (erythematous maculopapular rash OE)

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17
Q

Menginitis: management

A
  1. ABCDE (GCS, seizures, papilloedema)
  2. IV-ACCESS
  3. IV ABx
    * (3months-50 years) –> CEFOTAXIME (or ceftriaxone)
    * (>50 years) –> CEFOTAXIME (cefotriaxone) + AMOXICILLIN (or ampicillin)
  4. IV dexamethasone (before or w/i first dose of Abx but no later than 12 hours !) avoid dex in septic shock
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18
Q

SIGMOID VOLVULUS mx

What is the most appropriate first line management for this condition?

A

If unruptured:
Decompression via rigid sigmoidoscopy and flatus tube insertion

Investigation: usually diagnosed on the abdominal film
* sigmoid volvulus: large bowel obstruction (large, dilated loop of colon, often with air-fluid levels) + coffee bean sign
* caecal volvulus: small bowel obstruction may be seen

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19
Q

Frontotemporal lobar degeneration: common features and types

and other causes of memory loss!

A
  1. Behavioural-variant frontotemporal dementia
    –> social disinhibition
    –> FHx
  2. Alzheimers
    –> more severe memory loss
  3. Dementia w/ Lewy bodies (2/4 of the following)
    –> hallucinations
    –> fluctuating consciousness
    –> REM sleep behaviour disorder
    –> Parkinsonism

Semantic dementia
–> fluent progressive aphasia (speech fluent but conveys little meaning)

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20
Q

Diagnosis and management

A

LYME DISEASE : spirochaete Borrelia Burgdorferi

Management of asymptomatic:
1. remove tick w/ tweezers , wash area after

Suspected / confirmed lyme disease
1. DOXYCYCLINE
a) Amoxicillin if allergic or pregnant
2. Disseminated disease –> CEFTRIAXONE

Note: Jarish-Herxheimer reaction post tx
–> fever, rash, tachycardia after first dose

3rd degree Heart block

Features: Early w/i 30 days
1. Erythema migrans (bulls eye rash)
2. Systemic: headache, lethargy, fever, arthralgia

Late features (after 30 days)
1. CVD –> 3rd degree heart block, peri-myocarditis
2. Neurological –> facial nerve palsy, radicular pain, meningitis

IX –> ELISA

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21
Q

Disseminated gonococcal infection triad

A
  1. tenosynovitis
  2. migratory polyarthritis
  3. dermatitis

TenDer Pol

gram negative diplococci Neisseria gonorrhoeae

Mx of Gonorrhoea
1. 1g of IM CEFTRIAXONE
2. after sensitivities then single dose oral ciprofloxacin 500mg should be given
OR
- oral cefixime 400mg (single dose) and oral azithromycin 2g (single dose)

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22
Q

Bacterial vaginosis vs Trichomonas

A
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23
Q

COPD management

A

Oral ABX prophylaxis –> Azithromycin (bewate long QT)

SABA –> salbutamol
LABA –> salmetoral or formoterol
SAMA –> ipatropium
LAMA –> tiotropium

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24
Q

When would long term oxygen therapy be offered to a patient with COPD

A

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
* secondary polycythaemia
* peripheral oedema
* pulmonary hypertension

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25
Q

Diagnosis and managment

A

IMPETIGO

Caused: staph aureus or strep pyrogenes –> VERY CONTAGIOUS

Management
1. Hydrogen peroxide 1% (low risk)
2. Topical ABx
–> Fusidic acid
–> OR topical mupirocin if resistant or MRSA

Extensive disease
1. Oral Flucloxacillin
or oral erythromycin if pen allergic

School Exclusion
–> until all lesions are crusted and healed
–> OR 48hrs post Abx tx starting

26
Q

Raised intracranial pressure management

A

1. Head elevation to 30 degrees
2. IV Mannitol
3. Controlled hyperventilation
a) reduce pCO2 –> v.constriction of cerebral arteries –> reduced ICP
4. CSF removal
a) repeated LP
b) ventriculoperitoneal shunt (hydrocephalus)
c) drain from intraventricular monitor

normal ICP = (7-15mmHg suprine)
CCP = MAP - ICP

Features
- headache
- vomiting
- reduced consciousness
- papilloedema
- CUSHINGS TRIAD

27
Q

Ulcerative colitis management

A

Maintaining remission
1. Proctitis and proctosigmoiditis
–> topical aminosalicylate (daily or intermittent)
–> oral aminosalicyclate plus rectal aminosalicylate
–> oral aminosalicylate by itself

  1. Left sided and extensive ulcerative colitis
    –> low maintenance dose of oral aminosalicylate
  2. Severe relapse or > = 2 exacerbations
    –> oral azathioprine or oral mercaptopurine
28
Q

Hashimoto’s thyroiditis

A

hypothyroidism + goitre + anti-TPO

associated w/ development of MALT lymphoma

29
Q

anticoagulation for a patient with a mechanical heart valve

A

Warfarin

AF = DOACs
Anti-phospholipid syndrome = Warfarin
Prosthetic valces = Warfarin

30
Q

Minimal change disease: mx

A

75% cases are children!

Management:
1. oral corticosteroids
2. Cyclophosphamide: steroid resistant cases

31
Q

Indications for prescribing prednisolone in sarcoidosis:

A

P- Parenchymal lung disease
U- Uveitis
N- Neurological involvement
C- Cardiac involvement
H- Hypercalcaemia

32
Q

Patients with chronic kidney disease and an ACR > 30 mg/mmol should be started on

A

ACE inhibitor

33
Q

worsening flu-like symptoms and a dry cough. Erythema multiforme is noted on examination

Stereotypical history of:

A

mycoplasma pneumonia

Ix:
mycoplasma serology
positive cold agglutination test –> peripheral blood smear may show RBC agglutination

Management:
–> doxycycline or macrolide (e.g. erythromycin / clarithromycin)

34
Q

Hypertension in diabetics management

A

ACE inhibitors/A2RBs are first-line regardless of age

35
Q

Legionella pneumophilia is best diagnosed by the

A

urinary antigen test

Legionella pneumophilia
- severe pneumonia
- hyponatraemia
- deranged LFTs
- recent travel hx turkey

36
Q

The tremor seen in Parkinson’s disease is

A

unilateral tremor that improves with voluntary movement
I

cogwheel rigidity, bradykinesia, and tremor

37
Q

causes of torsades de pointes

A

METHCATS
○ M - Methadone ○ C - Chloroquine/Citalopram
○ E - Erythromycin ○ A - amiodarone
○ T - Terfenadine ○ T - tricyclics
○ H - Haloperidol ○ S - Sotalol

Patients can present with symptoms such as palpitations, tachycardia, chest pain, shortness of breath, hypotension and syncope.

38
Q

Acute angle closure glaucoma:

associated with hypermetropia or myopia?

A

Hypermetropia

Farsighted people prepare well and can only be hit by surprises, like an acute closed angle glaucoma.

Shortsighted people never plan and can be slowly hurt over time, like with open angle glaucoma

39
Q

Decreasing vision over months with metamorphopsia and central scotoma should cause high suspicion of

A

wet age-related macular degeneration

Metamorphopsia is a syndrome in which the shape of objects appears distorted.

40
Q

The initial management of acute limb ischaemia includes

A
  • analgesia (IV opioids)
  • IV heparin
  • vascular review

Features - 1 or more of the 6 P’s
* pale
* pulseless
* painful
* paralysed
* paraesthetic
* ‘perishing with cold’

Peripheral arterial disease:

  1. intermittent claudication
  2. critical limb ischaemia
  3. acute limb-threatening ischaemia
41
Q

Most common cause of endocarditis:

A
  1. Staphylococcus aureus
  2. Staphylococcus epidermidis if < 2 months post valve surgery
  3. Strep viridans (poor dental hygiene)
  4. Strep bovis (colorectal cancer)
42
Q

Tuberculosis: drug side-effects

A

Rifampicin
–> hepatitis, orange secretions
–> flu like symptoms

Isoniazid
–> peripheral neuropathy (prevent with vitamin b6, pyridoxine)
–> hepatitis, agranulocytosis

Pyrazinamide
–> hyperuricaemia causing gout
–> arthralgia, myalgia
–> hepatitis

Ethambutol
–> optic neuritis: check visual acuity before and during tx
–> dose adjust in renal impairment

43
Q

man presenting with dyspnoea, peripheral oedema and a positive Kussmaul’s sign

Features
- SOB
- R heart failure
- pericardial knock: loud s3
- kussmaul sign positive

A

constrictive pericarditis

Kussmaul’s sign (the raised JVP that doesn’t fall with inspiration)

44
Q

Management of spontaneous bacterial peritonitis

A

Features
- fever
- abdominal pain
- ascites

Diagnosis
- paracentesis
- e.coli !

Management
- IV CEFOTAXIME

Antibiotic prophylaxis is needed in patients who have had an episode of SBP –> ciprofloxacin

45
Q

What is the most appropriate blood test monitoring for a patient started on statins:

A

LFTs at baseline, 3 months and 12 months

46
Q

45 Male
pc: 2 day hx retrosternal sharp chest pain, constant, worse on inspiration.

Diagnosis and mx

A

ECG: widespread ST elevation and marked PR depression

Causes: viral (coxsackie), TB, post MI, radiotherapy, malignancy, trauma, thyroid etc

IX
- ECG
- Transthroacic echo
- Bloods: inflammatory markers, troponin

Mx
1. avoid strenuous activity until symptom resolution
2. combination NSAIDs and colcicine (taper dose)

47
Q

Poorly controlled hypertension, already taking an ACE inhibitor

A

add a calcium channel blocker or a thiazide-like diuretic

Amlodipine is the only CCB licensed for HR. Nifedipine should be avoided to risk of exacerbation.

Thiazide like diuretic = indapamide

48
Q

Pneumocystis jiroveci penumonia is treated with

A

co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole

49
Q

THIS medication should be considered for the prevention of calcium stones

A

Potassium citrate

Prevent kidney stones
–> drink 3L of water
–> add lemon juice to drinking water
–> less than 6g salt intake
–> potassium citrate

50
Q

first-line treatments for painful diabetic neuropathy

A

Duloxetine

first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin

51
Q

THIS presents with flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs

A

Hepatitis A

vaccine available

52
Q

High-dose dexamethasone suppression test with an ectopic source of ACTH

A

Cortisol: not suppressed
ACTH: not suppressed

53
Q

can be used to treat symptomatic itch in PBC

A

Cholestyramine

54
Q

Diagnosis, cause and management

Monomorphic punched out erosions (circular, depressed and ulcerated)

A

ECZEMA HERPETICUM

Herpes simplex virus 1 or 2

LIFE THREATENING

Admission for IV aciclovir

55
Q

A patient is started on finasteride for the treatment of benign prostatic hyperplasia. How long should the patient be told that treatment may take to be effective?

A

Up to 6 months

Finasteride works by inhibiting the conversion of testosterone into dihydrotestosterone which contributes prostate enlargement

56
Q

NICE recognise any of the following criteria to diagnose AKI in adults:

A
  • ↑ creatinine > 26µmol/L in 48 hours
  • ↑ creatinine > 50% in 7 days
  • ↓ urine output < 0.5ml/kg/hr for more than 6 hours
57
Q

may be used in patients with stress incontinence who don’t respond to pelvic floor muscle exercises and decline surgical intervention

A

Duloxetine

58
Q

Inducing remission in Crohns

A
  1. Glucocorticoids (oral, topical or IV)
  2. alternatively budesonide

Second line
–> 5-ASA drugs (mesalazine)
–> azathioprine (or methotrexate) or mercaptopurine may be added on (not as monotherapy)

Refractory disease and fistulating Crohn’s –> infliximab
Isolated peri-anal disease - metronisazole

59
Q

Maintaining remission in Crohn’s

A
  1. STOP SMOKING
  2. Azathioprine or mercaptopurine (1st line)
60
Q

Vitamin B12 replacement should always occur prior to folate replacement as folate replacement prior to B12, why?

A

can precipitate subacute combined degeneration of the spinal cord.

61
Q

Diabetic ketoacidosis: once blood glucose is < 14 mmol/l an infusion of what should be started

A

10% dextrose should be started at 125 mls/hr in addition to the saline regime

DKA resolution is defined as:
* pH >7.3 and
* blood ketones < 0.6 mmol/L and
* bicarbonate > 15.0mmol/L

62
Q
A

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