MSRA Miscellaneous Flashcards
how is Wells score interpreted for DVT?
2 or more = DVT likely, do proximal leg USS
1 or less = DVT unlikely, do D-dimer within 4 hours (if result not available in this time, start interim anticoagulation)
how is Wells score interpreted for PE?
More than 4 = PE likely, do CTPA
4 or less = PE unlikely, do D-dimer
what is the difference between wernicke’s and broca’s aphasia?
1) wernicke’s (receptive)
- lesion of superior temporal gyrus which usually forms speech before sending it to broca’s
- results in word salad with impaired comprehension
2) broca’s (expressive)
- lesion of inferior frontal gyrus
- non-fluent, laboured speech with normal comprehension
what is conduction aphasia?
typically due to stroke affecting arcuate fasiculus (connection between wernicke’s and broca’s area)
speech fluent but repetition poor, pt aware of errors they are making, normal comprehension
how is beta blocker overdose managed?
1) if bradycardic, atropine
2) if resistant to atropine, give glucagon
how is benzodiazepine overdose managed?
flumazenil
what is the difference between the intrinsic and extrinsic clotting cascades?
1) intrinsic = damage to vessel wall
involves factor 8, 9, 11, 12
leads to activation of factor X
2) extrinsic - damage to external tissue
involves factor 7 and TF (tissue factor)
directly activates factor X
3) Both pathways lead to a common pathway which activates factor X, leading to the formation of thrombin which converts fibrinogen to fibrin to form a stable clot!
in a patient with rhabdomyolysis, there will be raised CK and _____, with low _______.
1) High CK and phosphate (released from myocytes)
2) Low calcium (calcium binds to myoglobin)
what is the most common causative organism of meningitis in infants?
<3 months group B strep
> 3 months N. meningitidis
what are the diagnostic criteria for AKI?
either of the below:
1) absolute increase in creatinine of 26µmol/L in 48 hours
2) More than 50% increase in creatinine over 7 days
3) urine output <0.5ml/kg/hour for more than 6 hours
4) >25% decrease in eGFR over 7 days
A 65-year-old man calls an ambulance as he has central crushing chest pain that radiates to his left arm and jaw. As he arrives at the emergency department his heart rate is found to be 50/min. An ECG is performed which shows ST elevation and bradycardia with a 1st-degree heart block.
Given the history, which of the following are the leads will most likely show the ST elevation?
Leads II, III, aVF
right coronary artery infarct supplies the AV node, hence can cause arrythmias
what is minimal change disease?
glomeruli become damaged leading to nephrotic syndrome (oedema, proteinuria)
under a microscope the glomeruli look pretty normal, hence minimal change
usually idiopathic, other causes are infection, lymphoma, NSAIDs
treat with oral steroids
what are protective factors for endometrial cancer?
smoking
COCP
multiparity
what is the most common inherited bleeding disorder?
von willebrand disease
what is the triad of behcet’s disease?
1) oral ulcers
2) genital ulcers
3) uveitis
what is first line treatment for trigeminal neuralgia?
carbemazepine
what is siadh?
how do you convert oral to subcut morphine?
divide by two
in pregnancy, if a lady’s fasting blood glucose is above what level is it that you start insulin?
fasting >7mmol/L
following prostatectomy, PSA level should be what?
undetectable
if levels detected, should refer urgently to oncology
how long before endoscopy should PPI be stopped?
two weeks (otherwise can mask sinister things like gastric cancer)
what is the antibiotic treatment for C.diff?
1) oral vancomycin
2) oral fidaxomycin
3) oral vancomycin + IV metronidazole
how do you differentiate between telangiectasia vs spider naevi?
press on them
spider naevi refill from the centre (spider naevi sentre)
telangiectasia refill from the edge (telangiEDGEtasia)
tender goitre and hyperthyroidism usually suggests what?
de quervain’s thyroiditis (graves usually non-tender)
