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Finals Revision > More Concepts > Flashcards

More Concepts Flashcards

1
Q

What suggest downs syndrome on tests

A

Raised beta-HCG, low PAPP-A, thickened nuchal translucency

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2
Q

What are TSH receptor stimulating autoantibodies

A

Thyroid stimulating immunoglobulins

Almost diagnostic of Graves’ disease

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3
Q

What are the features of Graves’ disease?

A 
Exopthalmos
Opthalmoplegia
Pretibial myxoedema
thyroid acropathy
> digital clubbing
> soft tissue swelling of hands and feet
> periosteal new bone formation
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4
Q

What are PDE5 inhibitors

A

used in treatment of erectile dysfunction and pulmonary hypertension

cause vasodilatation through an increase in cGMP leading to smooth muscle relaxation in blood vessels supplying the corpus cavernosum

Sildenafil- viagra
Tadalafil
Vardenafil

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5
Q

Side effects of viagra

A

blue discolouration of visiion

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6
Q

How does infectious mononucleosis present

A

fever, lymphadenopathy

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7
Q

How does leptospirosis present

A

influenza-like pyrexial symptoms

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8
Q

How does typhoid fever present

A

headache, fever, arthralgia
>relative bradycardia
>abdominal pain, distension
>constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
>rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid

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9
Q

Fluctuating confusion/consciousness

A

Subdural haematoma

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10
Q

When should a second drug be prescribed in diabetes

A

If HbA1c is > 58

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11
Q

1st line treatment for most patients with a pituitary tumour causing acromegaly

A

Trans-sphenoidal surgery

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12
Q

2nd line for pituitary tumour causing acromegaly when surgery is not an option

A

Somatostatin analogues

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13
Q

Management of abdominal wound dehiscence

A

coverage of wound with saline impregnated gauze + IV broad spectrum antibiotics

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14
Q

When should migraine prophylaxis be offered?

A

More than 2 migraines a month

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15
Q

Migraine prophylaxis in women of child-bearing age

A

topiramate or propanolol

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16
Q

Where is aspiration pneumonia more common

A

right lung

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17
Q

visible peristalsis in stomach of neonate

A

pyloric stenosis

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18
Q

Which women need higher dose folic acid

A 
> previous child with NTD
> diabetes mellitus
> women on antiepileptic
> obese women
> HIV +ve taking co-trimoxazole
> sickle cell
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19
Q

WHen are nitrates contraindicated

A

BP under 90mmHg systolic

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20
Q

1st line management of acute pericarditis

A

Combination of NSAID and colchicine

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21
Q

What toxin is associated with c. diff

A

toxin B

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22
Q

what is prescribed for c. diff

A

bezlotoxumab

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23
Q

gram positive cocci=

A

staphylococci and streptococci

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24
Q

gram negative cocci=

A

neisseria meningitidis + neisseria gonorrhoea + morazella catarrhalis

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25
Q

pneumonic for Gram positive bacilli

A

ABCD L

> actinomyces
> bacillus anthracis
> clostridium
> diptheria: corynebacterium diptheriae
> listeria monocytogenes
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26
Q

Investigation in all patients presenting with AKI of unknown origin

A

renal ultrasound

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27
Q

Causes of metabolic acidosis with Normal anion gap

A 
> GI bicarbonate loss: diarrhoea, fistula
> renal tubular acidosis
> drugs: acetazolamide
> ammonium chloride injection 
>addisons disease
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28
Q

Causes of metabolic acidosis with raised anion gap

A

lactate: shock, hypoxia
ketones: DKA, alcohol
urate: renal failure
acid poisoning: salicylates methanol

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29
Q

causes of metabolic alkalosis

A

loss of hydrogen ions or a gain of bicarbonate. It is due mainly to problems of the kidney or gastrointestinal tract
> vomiting, cushings, primary hyperaldosteronism,

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30
Q

when is double duct sign seen?

A

pancreatic cancer

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31
Q

fever/back pain with pain on extension of hip

A

iliopsoas abscess

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32
Q

management of otitis externa

A

> topical antibiotic or a combined topical antibiotic with a steroid
if the tympanic membrane is perforated aminoglycosides are traditionally not used*
if there is canal debris then consider removal
if the canal is extensively swollen then an ear wick is sometimes inserted

33
Q

HIT is a ________ condition

A

prothrombotic

34
Q

which kind of heparin causes HIT

A

standard heparin

35
Q

what is HIT

A

Heparin-induced thrombocytopaenia (HIT)
>immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin
> antibodies bind to the PF4-heparin complexes on the platelet surface and induce platelet activation by cross-linking FcγIIA receptors
> usually does not develop until after 5-10 days of treatment
> despite being associated with low platelets HIT is actually a prothrombotic condition

36
Q

features of HIT

A

more than 50% reduction in platelets, thrombosis and skin allergy

37
Q

Management of HIT

A

address need for ongoing anticoagulation:
direct thrombin inhibitor e.g. argatroban
danaparoid

38
Q

Sodium valproate causes _______ of the P450 system

A

inhibition

39
Q

Features of B-blocker overdose

A

Bradycardia
Hypotension
Heart failure
Syncope

40
Q

Management of B-blocker overdose

A

If bradycardic= atropine

resistant cases= glucagon

41
Q

Upper quadrant bitemporal hemianopia

A

Optic chiasm
lower quadrant defect
Inferior chiasmal compression
pituatary tumour

42
Q

lower quadrant bitemporal hemianopia

A

> Optic chiasm
upper quadrant defect
superior chiasmal compression
craniopharyngioma

43
Q

When should platelet transfusion be offered

A

platelet count of < 30 x 109

with clinically significant bleeding

44
Q

what component has the highest risk of bacterial contamination

A

platelets

45
Q

What are the two forms of trypanosomiasis

A

african trypanosomiasis= sleeping sickness

american trypanosomiasis= chagas’ disease

46
Q

clinical features of sleeping sickness

A

chancre
intermittient fever
enlargement of posterior cervical nodes
CNS involvement: somnolence, headaches, mood changes, meningoencephalitis

47
Q

management of sleeping sickness

A

IV pentamidine or suramin

if CNS involvement: IV melarsoprol

48
Q

features of chagas disease

A

asymptomatic in acute phase

  • changoma (nodule at site of infection)
  • periorbital oedema
49
Q

chronic chagas disease

A
  • myocarditis- dilated cardiomyopathy (apical atrophy) and arrythmias
  • GI : megaoesophagus and megacolon causing dysphagia and constipation
50
Q

management of chagas disease

A

acute phase: azole or nitroderivatives such as benzinidazole or nifurtimox

51
Q

how does salicylate poisoning present?

A

raised anion gap metabolic acidosis

52
Q

if fetal movements have not been felt by __ weeks, referral should be made to maternal fetal medicine unit

A

24

53
Q

how does APS present on bloods

A

raised APTT
normal PT
thrombocytopenia

54
Q

anxiety level tool

A

HAD

55
Q

liver cirrhosis scoring tool

A

child-pugh classification

56
Q

hypoglycaemia with impaired GCS

A

give IV glucose if access

57
Q

recommended investigation for all patients with suspected RA

A

x-ray hands and feet

58
Q

what can be used to differentiate between true seizure and psueudoseizure

A

prolactin

59
Q

what should be offered to ALL patients on long-term steroids

A

immediate co-prescription of alendronate

60
Q

Gross motor milestones, 3 months

A

little or no head lag, lying on abdomen, good head control, held sitting, lumbar curve

61
Q

Gross motor milestones, 6 months

A

lifts and grasps feet, pulls self to sitting, held sitting, back straight, rolls front to back

62
Q

Gross motor milestones, 7-8 months

A

sits without support (refer at 12 months)

63
Q

Gross motor milestones, 12 months

A

cruises

walks with one hand held

64
Q

Gross motor milestones, 13-15 months

A

walks unsupported, refer at 18 months

65
Q

gross motor milestones 18 months

A

squats to pick up toy

66
Q

2 years

A

runs

stairs with rail

67
Q

3 years

A

tricycle

stairs without rail

68
Q

4 years

A

hops on one leg

69
Q

presentation of syringomyelia

A

cape-like loss of pain and temperature sensation due to compression of spinothalamic tract fibres decussating in anterior white commisure of spine

70
Q

causes of syringomyelia

A

a chiari malformation
trauma
tumours
idiopathic

71
Q

what are the centor criteria

A

> presence of tonsillar exudate (1)
tender anterior cervical lymphadenopathy or lymphadenitis (1)
history of fever (1)
absence of cough (1)

0,1,2 = 3 to 17% streptococci
3 or 4= 32 to 56%

72
Q

what are the FeverPain criteria

A 
> fever over 38
> purulence
> attend rapidly (3 days or less)
> severely inflamed tonsils
> no cough or coryza
73
Q

when to give antibiotics in suspected tonsilitis

A

when 3 + centor criteria are present

74
Q

codeine to morphine

A

divide by 10

75
Q

when to do CT in head injury (within 8 hours)

A

> loss of consciousness or amnesia, and who are aged over 65 years old

76
Q

when to do CT in head injury (within 1 hours)

A

> 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

77
Q

treatment of ER +ve breast cancer

A

tamoxifen in pre/peri-menopausal

aromatase inhibitors post-menopausal

78
Q

management of HAP in penicillin allergy

A 
non-severe = doxycyline
severe= co-trim + gent

Finals Revision (29 decks)

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