MLA QuesMed mock Flashcards
The three oral antibiotics recommended for IECOPD
amoxicillin
If pen allergic: doxycycline, or clarithromycin
Blood results in adrenal crisis show:
- Hyponatraemia
- Hyperkalaemia
- hypoglycaema
What might be given to prevent a variceal rebleed?
Propranolol
- non selective beta blocker
- reduce portal pressures
Recap the hypersensitivity reactions
Type 1 - anaphylaxis (IgE antibodies), mast cell degranulation
Type 2 - IgM OR IgG –> haemolytic disease of the newborn
Type 3 - immune complexes, SLE!
Type 4 - delayed reaction by T cells: contact dermatitis
Type 5 - stimulating antibodies produced against specific receptor (GRAVES)
21 Male presents with red, painful eye: Diagnosis + Mx
HSV Keratitis
- Same day opthalmology referral!
- STOP wearing contact lenses
- Topical ABx
- quinolones = 1st line (ciprofloxacin) - Cycloplegic for pain relief
- cyclopentolate
Dendritic lesions are a typical finding in HSC keratitis
Complications
- corneal scarring
- perforation
- endophthalamitis
- visual loss
Diagnosis and management
When might you reffer:
- usually self limiting
- Topical ABx if not settling
- chloramphenicol
- fusidic acid
** Referral**
- severe persistent infection
- periorbital cellulitis
- atypical features (excess pain, visual distortion)
- pain on eye movements
Diagnosis and management
Patient presents with photophobia and an irregular pupil, cilliary flush seen
Dx: ANTERIOR UVEITIS
Mx:
1. URGENT opthal review
2. cycloplegics: atropine / cyclopentolate
3. Steroid eye drops
Cycloplegics dilate pupil to help relieve eye pain and photophobia
47 Female: SOB 2/7 days post ABDOMINAL surgery. Reduced air entry bilaterally lung bases. Elevated RR. Normal sats, calves SNT
What is likely diagnosis and management:
ATELECTASIS
Mx: chest physio and optimise pain control
Small areas of collapse. Due to pain on deep breathing and coughing leading to incomplete clearing of secretions. Managed conservatively at first.
57 Male: DRY COUGH
PMH: IHD, renal transplant
OE: chest clear, saturations drop after walking around the room. No medication allergies.
What is likely diagnosis and what would you give:
PNEUMOCYSTIS JIROVECCI
- suspect in immunocompromised patients with dry cough and exercise induced desaturations
Initially treated
- CO-TRIMOXAZOLE
Criteria used to grade flares of ulcerative colitis
TRULOVE and Witts
Ulcerative colitis: inducing remission
Inducing Remission
- Mild to moderate disease
- FIRST LINE: aminosalicylate (e.g. mesalazine oral or rectal)
- SECOND LINE: corticosteroids (e.g. prednisolone)
-
Severe
- FIRST LINE: IV corticosteroids (e.g. hydrocortisone)
- SECOND LINE: IV ciclosporin
Maintaining Remission
- Aminosalicylate(e.g.mesalazineoral or rectal)
- Azathioprine
- Mercaptopurine
Surgery: panproctocolectomy (pt left w/ permanent ileostomy or ileo-anal anastomosis (J-pouch))
43 Female: sudden onset painless visual loss.
PMH: RA, poorly controlled T2DM
Diagnosis and treatment:
Diagnosis: VIRTRIAL HAEMORRHAGE
TX: vitrectomy
Patients with poorly controlled diabetes often develop proliferative diabetic retinopathy
–> fragile blood vessels which are prone to bleeding
40 year old female has presented with pain and tenderness over the temporal arteries along with systemic upset: diagnosis and management
GIANT CELL ARTERITIS
MX:
1. 60mg OD prednislone
2. If visual symptoms/blindness: IV METHYLPREDNISOLONE
3. PPI and bisphophonates
–> prevent osteoporosis and gastric ulcers
Definitive IX
- temporal artery biopsy
- 3-5cm of artery due to skip lesions
Erectile dysfunction Mx:
Cause of ED: organic?
- Intracavernosal prostaglandins
- Sildenafil
Beware concurrent use of nitrates and sildenafil –> prodound HYPOtension
According to NICE guidelines, the first line treatment for acute attacks of migraine include
Ibuprofen 400mg, Aspirin 900mg or Paracetamol 1g.
43 Male
PC: loin to groin pain
HPC: severe, intermittent pain in left going radiating to testicle, 9/10 severity w/ associated nausea. no significant PMH.
Likely diagnosis and management:
Renal colic.
Mx: IM/PR diclofenac
75 Male: 7 kg weight loss over 3/12, tender palpable swelling in left arm. noticed few similar swellings in left arm. appears jaundiced.
Likely diagnosis and investigation:
CT ABDOMEN
pancreatic cancer??
Trousseau sign of maligancy
- migratory thrombophlebitis which presents as a tender nodule under the skin
40 MALE: Diarrhoea + Flushing 1/12. Dizzy when stands up, BP 100/60, pansystolic murmur heard loudest over 4th ICS.
Likely diagnosis and management:
Carinoid syndrome
- serotonin production from tumour
- diarrhoea, flushing, hypotension, predominantly right sided heart murmurs
TX –> OCTREOTIDE
Ix: 24 hour urine 5HIAA (breakdown product of serotonin)
56 Male
PC: breathlessness, increased thirst and urination
OE: peripheral oedema + tanned complexion
Important blood test to request and why:
Haemochromatosis: transferrin saturation
Mx:
- venesection (weekly)
- monitor serum ferritin
- monitoring and treating complications
Haemochromatosis has a long list of complications:
- Pancreas –> secondary diabetes
- Liver cirrhosis
- Endocrine –> hypogonadism, erectile dysfunction, amenorrhoea, reduced fertility
- Cardiomyopathy
- Hepatocellular carcinoma
- Hypothyroidism (iron deposits in thyroid)
- chondrocalcinosis (calcium pyrophosphate deposits in joints)
Patient presents with yellowing of skin without any other symptoms: likely diagnosis
Gilberts syndrome
- hyperbilirubinaemia occurs in absence of liver disease
Ix = check LFTs! isolated rise in unconjugated bilirubin
A 35 year old man comes to the GP with widespread raised papules with a central umbilication on his trunk, face, hands, legs and feet. He reports they have been present for the last 2 years without improvement and he is worried about them. What is the most appropriate course of action?
MOLLUSCUM CONTAGIOSUM - caused by pox virus
In adults if they persist may indicate underlying immunocompromise –> HIV testing indicated
Elderly patient admitted to ICU following diagnosis of severe UTI –> urosepsis. Pt has AKI and is catheterised.
Nurses concerned about fluctuations in mood.
Has had periods of being withdrawn, disorientated, apathetic and periods of agitation, hallucinations and delusions:
What is the likely cause of patients symptoms:
Delerium
- may be triggered by infection, change in environment or due to pain
Acute psychosis:
Although the patient describes hallucinations and delusions, the mixed picture and acuity following a physical health illness, especially in elderly patients is more suggestive of a delirium.
Pt presents w/ severe abdominal pain and swelling. Bloody diarrhoea, fever and vomiting. He has undergone triple therapy for the last two weeks for H pylori infciton.
AXR performed:
What is the most likely cause of this presentation:
Clostridium Difficile
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