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FINALS > My common mistakes > Flashcards

My common mistakes Flashcards

1
Q

MDMA (ecstasy) poisoning is associated with…

A

Hyponatraemia

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2
Q

N-Acetylcysteine commonly causes what type of reaction?

A

Anaphylactoid reaction (non-IgE mediated mast cell release)

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3
Q

For DMT2 when is metformin contraindicated?

A

eGFR <30

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4
Q

What is the most highly negatively inotropic CCB? (weakens heart contractions- slows HR)

A

Verapamil

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5
Q

Key investigation for suspected CO poisoning?

A

ABG- carboxyhaemoglobin

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6
Q

Liver transplantation criteria in paracetamol overdose?

A

pH <7.3 more than 24hrs after ingestion

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7
Q

Patient on amiodarone (eg for AF) develops hypothyroidism?

A

Continue amiodarone and add levothyroxine

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8
Q

Double duct sign?

A

Pancreatic cancer

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9
Q

Haemochromatosis iron study profile?

A

Raised transferrin and ferritin, low TIBC

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10
Q

Upper GI bleed or lower GI bleed if high urea?

A

Upper- blood digested (contains protein) so increase in urea

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11
Q

Acute hypophosphataemia management- severe or symptomatic

A

IV phosphate polyfusor

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12
Q

Visual hallucinations with dementia

A

Lewy body dementia

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13
Q

Blood tests that form part of the confusion screen

A

TSH, B12, Folate & Glucose

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14
Q

Memantine drug class

A

NMDA receptor antagonist

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15
Q

Complications of thyroid surgery

A
  • Recurrent laryngeal nerve damage
  • Bleeding- laryngeal oedema.
  • Damage to the parathyroid glands resulting in hypocalcaemia.
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16
Q

Ways to remember causes of nystagmus?

A

Horizontal nystagmus = peripheral cause (goes in direction of ears)
Vertical nystagmus = central cause (goes in direction of brain)

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17
Q

Difference between neuronitis and labrynthitis?

A

Neuronitis = No loss
Labrynthitis = Loss

Vestibular neuronitis = inflammation of the vestibular nerve, which deals with balance but not hearing

Labyrinthitis = inflammation of labyrinth, which deals with both balance AND hearing

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18
Q

FLUID THERAPY IN CHILDREN

A
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19
Q

FLUID THERAPY IN ADULTS

A
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20
Q

Atropine increase or decrease HR?

A

Increase, if fails then external pacing

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21
Q

Amiodarone increase or decrease HR?

A

Decreases HR (treats fast irregular HR)

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22
Q

Cause of infective endocarditis <2m post valve surgery

A

Staph epidermidis

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23
Q

Is a child is choking, why is the foreign object most likely found in right main bronchus?

A

Shorter, wider and more vertical

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24
Q

Severe anaemia is a cause of

A

high-output heart failure

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25
Q

RBBB +left anterior or posterior hemiblock + 1st-degree heart block

A

trifasicular block

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26
Q

Acute heart failure not responding to treatment

A

consider CPAP

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27
Q

Hypothermia is a cause of

A

Torsades de pointes

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28
Q

ACS: Nitrates are contraindicated in patients with

A

hypotension (< 90 mmHg)

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29
Q

‘Global’ T wave inversion (not fitting a coronary artery territory) - think

A

non-cardiac cause of abnormal ECG

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30
Q

Hypothermia causes what on ECG

A

J waves

31
Q

Mx if V tachy leads to haemodynamic instability?

A

synchronised electrical cardioversion; may be followed by an amiodarone infusion when more stable to enhance the probability of achieving sinus rhythm

32
Q

Lichen planus vs scleorsus?

A

planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common

sclerosus: itchy white spots typically seen on the vulva of elderly women

33
Q

Toxic epidermal necrolysis (TEN) vs Stevens-Johnson syndrome (SJS)?

A

Both severe skin reactions, TEN more severe end of spectrum.

SJS: Affects less than 10% of the body’s surface area
TEN: Affects more than 30% of the body’s surface area

34
Q

erythema nodosum vs erythema multiforme?

A

Erythema multiforme is typically target shaped and only slightly raised. It’s not typically painful but can be itchy. They can also be on various sites of the body

Erythema nodosum is more like a raised nodule that mainly presents on the shins. It looks a bit like a bruise and it is painful.

35
Q

most accurate way to asses the burns area

A

Lund and Browder chart

36
Q

Wallace’s Rule of Nine

A

Each of the following is 9% of the body when calculating surface area % if a burn:
Head + neck, each arm, each anterior part of leg, each posterior part of leg, anterior chest, posterior chest, anterior abdomen, posterior abdomen

37
Q

Psoriasis commonly exhibits what pgenomenon

A

Koebner phenomenon

38
Q

What clotting factors and other components does the liver make?

A

1) Clotting factors= I (fibrinogen); II (prothrombin); V; VII; IX; XII; XIII (all for blood coag)

2) Albumin (transport and maintain BP)

3) Transport proteins= ceruloplasmin (transports copper) and transferrin (iron)

4) Bile salts (fat digestion)

5) Bilirubin (from RBC breakdown)

6) Glucose (through gluconeogenesis and glycogen storage/release)

7) Lipids (cholesterol, trigly and lipoproteins)

8) Detoxification products (ammonia to urea & drug metabolism)

9) Hormones= angiotensinogen and thrombopoietin

39
Q

Role of angiotensinogen and thrombopoietin?

A

A= BP regulation

T= platelet production

40
Q

What blood tests would you do to investigate the liver?

A

1) LFTs (enzymes & proteins):
- ALT & AST
- ALP
- GGT
- Bilirubin (total & direct)= direct is conjug and indirect is unconjug
- Albumin
- Total protein

2) Clotting screen= INR or PT

3) Viral serology= hep A, B, C, E

4) Autoantibodies= AMA, ANA, Anti-SMA

5) Ceruloplasmin

6) Ferritin and transferrin

7) Paracetamol levels

8) Alpha-1 antitrypsin

9) Tissue Transglutaminase antibody

10) Ammonia levels

41
Q

Overall tests to measure kidney function?

A

1) Bloods= serum creatinine; blood urea nitrogen (BUN); eGFR; serum uric acid

2) Urine= eg. urinalysis; protein, albumin, glucose, blood, bacteria

3) Imaging= USS, CT or MRI

42
Q

What does high serum creatinine indicate about kidney function?

A

impaired.

Creatinine= waste product from muscle metabolism in blood

43
Q

What does elevated uric acid levels indicate about kidney function?

A

kidney disease or gout

44
Q

What does proteinuria indicate about kidney function?

A

damage or disease

45
Q

What does high urine albumin indicate about kidney function?

A

Damage eg. in diabetes or HTN

46
Q

Budd-Chiari Ix- way to remember?

(pt presents with abdo pain, tender hepatomegaly and ascites- basically a painful swollen liver)

A

USS with doppler.

basically a ‘liver DVT’ , being a hepatic vein thrombosis.
The ‘painful, swollen calf’ is essentially just a painful swollen liver (abdo pain, tender hepatomegaly) + ascites due to venous obstruction.

They also have exactly the same gold standard investigation in Doppler Ultrasound!

47
Q

Hepatocellular disease LFTs?

A

ALT= raised at least 2 fold
ALP= normal
ALT/ALP= 5+

48
Q

Chlestatic disease LFTs?

A

ALT= normal
ALP= raised at least 2-fold
ALT/ALP= <2

49
Q

LFTs in mixed disease (hepatocellular + cholestatic)?

A

ALT= raised at least 2-fold
ALP= raised at least 2-fold
ALT/ALP= 2-5

50
Q

ALP, AST and ALT produced by what?

A

AST & ALT produced by hepatocytes; in hepatocellular disease, hepatocytes release these enzymes into blood so get raised ALT.

ALP produced by cells lining bile duct so in obstructive disease ALP rises.

51
Q

Summary of liver enzymes in LFTs?

A

ALT = correspond to hepatocytes
AST = correspond to hepatocytes, cardiac cells, and muscle cells
ALP = correspond to biliary system (bile ducts) & various tissues in the body eg. bones

GGT= more specific version of ALP in terms of biliary system; also indicates pt drinks alcohol

52
Q

deranged LFTs combined with secondary amenorrhoea in a young female

A

autoimmune hepatitis

53
Q

C.diff Mx

A

1st: oral vancomycin
2nd: if doesn’t work then oral fidazomicin

OR IF SEVERE (eg. hypotension, shock) or doesn’t respond to above= oral vanc + IV metronidazole

54
Q

Maintain remission in UC if have had a severe relapse or >=2 exacerbations in past yr?

A

oral azathioprine or oral mercaptopurine

55
Q

Metoclopramide MOA?

A

antagonism of D2 dopamine receptors

56
Q

Electrolyte disturbances in refeeding syndrome?

A

hypophosphataemia, hypokalaemia and hypomagnesaemia

57
Q

Receding bleeding gums

A

think scurvy

58
Q

What electrolyte disturbance can PPIs cause?

A

hyponatraemia

59
Q

Primary biliary cholangitis- M rule?

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

60
Q

How long should pts not eat gluten for before they get endoscopic intestinal biopsy to diagnose coeliac?

A

6w

61
Q

Most common site affected in Crohn’s

A

ileum

62
Q

How to stop uncontrolled variceal haemorrhage?

A

Sengstaken-Blakemore tube

63
Q

1st line Ix for acute mesenteric ischaemia?

A

Lactate= raised

64
Q

Liver + neuro disease?

A

think Wilson’s

65
Q

Mneumonic to remember causes of erythema nodosum?

A

NO - idiopathic
D - drugs (penicillin sulphonamides)
O - oral contraceptive/pregnancy
S - sarcoidosis/TB
U - ulcerative colitis/Crohn’s disease/Behçet’s disease
M - microbiology (streptococcus, mycoplasma, EBV and more)

66
Q

Reversible causes for cardiac arrest?

A

H.ypothermia
H.ypovolaemia
H.ypoxia
H.yperkalaemia

T.hrombus
T.oxins
T.ension pneumothorax
T.amponade

67
Q

ALS for VF/pulseless VT?

A

single shock followed by CPR

68
Q

ALS if cardiac arrest is witnessed in monitored pt eg. coronary care unit and is in VF/pulseless VT?

A

Up to 3 quick successive shocks rather than 1, then CPR

69
Q

What is first like and should always be attempted in ALS?

A

IV access
if can’t achieve then give drugs IO

70
Q

Role of adrenaline in ALS?

A

1mg given as soon as possible for non-shockable rhythms

shockable rhythms= 1mg once restart chest compressions after the third shock

repeat adrenaline 1mg every 3-5mins whilst ALS continues

71
Q

Role of amiodarone in ALS?

A

300mg given to pt in VF/pulseless VT after 3 shocks have been given.

then further 150mg given after 5 shocks, then 7 ect.

lidocaine can be an alternative

72
Q

When should thrombolytic drugs be given in ALS and how long should CPR continue for?

A

is PE suspected.
continue CPR for extended period of 60-90mins

73
Q

A to E vs DRABC?

A

DRABC for immediate, on-scene assessments, and A to E for systematic evaluation in a clinical setting.

74
Q
A

FINALS (34 decks)

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