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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
pneumonic for Gram positive bacilli
ABCD L ``` > actinomyces > bacillus anthracis > clostridium > diptheria: corynebacterium diptheriae > listeria monocytogenes ```
26
Investigation in all patients presenting with AKI of unknown origin
renal ultrasound
27
Causes of metabolic acidosis with Normal anion gap
``` > GI bicarbonate loss: diarrhoea, fistula > renal tubular acidosis > drugs: acetazolamide > ammonium chloride injection >addisons disease ```
28
Causes of metabolic acidosis with raised anion gap
lactate: shock, hypoxia ketones: DKA, alcohol urate: renal failure acid poisoning: salicylates methanol
29
causes of metabolic alkalosis
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,
30
when is double duct sign seen?
pancreatic cancer
31
fever/back pain with pain on extension of hip
iliopsoas abscess
32
management of otitis externa
>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
HIT is a ________ condition
prothrombotic
34
which kind of heparin causes HIT
standard heparin
35
what is HIT
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
features of HIT
more than 50% reduction in platelets, thrombosis and skin allergy
37
Management of HIT
address need for ongoing anticoagulation: direct thrombin inhibitor e.g. argatroban danaparoid
38
Sodium valproate causes _______ of the P450 system
inhibition
39
Features of B-blocker overdose
Bradycardia Hypotension Heart failure Syncope
40
Management of B-blocker overdose
If bradycardic= atropine | resistant cases= glucagon
41
Upper quadrant bitemporal hemianopia
Optic chiasm lower quadrant defect Inferior chiasmal compression pituatary tumour
42
lower quadrant bitemporal hemianopia
> Optic chiasm > upper quadrant defect > superior chiasmal compression > craniopharyngioma
43
When should platelet transfusion be offered
platelet count of < 30 x 109 | with clinically significant bleeding
44
what component has the highest risk of bacterial contamination
platelets
45
What are the two forms of trypanosomiasis
african trypanosomiasis= sleeping sickness american trypanosomiasis= chagas' disease
46
clinical features of sleeping sickness
chancre intermittient fever enlargement of posterior cervical nodes CNS involvement: somnolence, headaches, mood changes, meningoencephalitis
47
management of sleeping sickness
IV pentamidine or suramin | if CNS involvement: IV melarsoprol
48
features of chagas disease
asymptomatic in acute phase - changoma (nodule at site of infection) - periorbital oedema
49
chronic chagas disease
- myocarditis- dilated cardiomyopathy (apical atrophy) and arrythmias - GI : megaoesophagus and megacolon causing dysphagia and constipation
50
management of chagas disease
acute phase: azole or nitroderivatives such as benzinidazole or nifurtimox
51
how does salicylate poisoning present?
raised anion gap metabolic acidosis
52
if fetal movements have not been felt by __ weeks, referral should be made to maternal fetal medicine unit
24
53
how does APS present on bloods
raised APTT normal PT thrombocytopenia
54
anxiety level tool
HAD
55
liver cirrhosis scoring tool
child-pugh classification
56
hypoglycaemia with impaired GCS
give IV glucose if access
57
recommended investigation for all patients with suspected RA
x-ray hands and feet
58
what can be used to differentiate between true seizure and psueudoseizure
prolactin
59
what should be offered to ALL patients on long-term steroids
immediate co-prescription of alendronate
60
Gross motor milestones, 3 months
little or no head lag, lying on abdomen, good head control, held sitting, lumbar curve
61
Gross motor milestones, 6 months
lifts and grasps feet, pulls self to sitting, held sitting, back straight, rolls front to back
62
Gross motor milestones, 7-8 months
sits without support (refer at 12 months)
63
Gross motor milestones, 12 months
cruises | walks with one hand held
64
Gross motor milestones, 13-15 months
walks unsupported, refer at 18 months
65
gross motor milestones 18 months
squats to pick up toy
66
2 years
runs | stairs with rail
67
3 years
tricycle | stairs without rail
68
4 years
hops on one leg
69
presentation of syringomyelia
cape-like loss of pain and temperature sensation due to compression of spinothalamic tract fibres decussating in anterior white commisure of spine
70
causes of syringomyelia
a chiari malformation trauma tumours idiopathic
71
what are the centor criteria
> 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
what are the FeverPain criteria
``` > fever over 38 > purulence > attend rapidly (3 days or less) > severely inflamed tonsils > no cough or coryza ```
73
when to give antibiotics in suspected tonsilitis
when 3 + centor criteria are present
74
codeine to morphine
divide by 10
75
when to do CT in head injury (within 8 hours)
> loss of consciousness or amnesia, and who are aged over 65 years old
76
when to do CT in head injury (within 1 hours)
> 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
treatment of ER +ve breast cancer
tamoxifen in pre/peri-menopausal aromatase inhibitors post-menopausal
78
management of HAP in penicillin allergy
``` non-severe = doxycyline severe= co-trim + gent ```

Finals Revision (29 decks)

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