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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

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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

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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

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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

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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.

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35
Q

most accurate way to asses the burns area

A

Lund and Browder chart

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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

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37
Q

Psoriasis commonly exhibits what pgenomenon

A

Koebner phenomenon

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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

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39
Q

Role of angiotensinogen and thrombopoietin?

A

A= BP regulation

T= platelet production

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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

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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

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42
Q

What does high serum creatinine indicate about kidney function?

A

impaired.

Creatinine= waste product from muscle metabolism in blood

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43
Q

What does elevated uric acid levels indicate about kidney function?

A

kidney disease or gout

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44
Q

What does proteinuria indicate about kidney function?

A

damage or disease

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45
Q

What does high urine albumin indicate about kidney function?

A

Damage eg. in diabetes or HTN

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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!

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47
Q

Hepatocellular disease LFTs?

A

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

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48
Q

Cholestatic disease LFTs?

A

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

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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

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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.

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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

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52
Q

deranged LFTs combined with secondary amenorrhoea in a young female

A

autoimmune hepatitis

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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

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54
Q

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

A

oral azathioprine or oral mercaptopurine

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55
Q

Metoclopramide MOA?

A

antagonism of D2 dopamine receptors

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56
Q

Electrolyte disturbances in refeeding syndrome?

A

hypophosphataemia, hypokalaemia and hypomagnesaemia

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57
Q

Receding bleeding gums

A

think scurvy

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58
Q

What electrolyte disturbance can PPIs cause?

A

hyponatraemia

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59
Q

Primary biliary cholangitis- M rule?

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

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60
Q

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

A

6w

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61
Q

Most common site affected in Crohn’s

A

ileum

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62
Q

How to stop uncontrolled variceal haemorrhage?

A

Sengstaken-Blakemore tube

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63
Q

1st line Ix for acute mesenteric ischaemia?

A

Lactate= raised

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64
Q

Liver + neuro disease?

A

think Wilson’s

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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)

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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

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67
Q

ALS for VF/pulseless VT?

A

single shock followed by CPR

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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

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69
Q

What is first line drug administration route and should always be attempted in ALS?

A

IV access
if can’t achieve then give drugs IO

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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

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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

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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

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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.

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74
Q

What is a heart attack?

A
  • must have troponin RISE AND FALL
  • must also have typical CP, ECG changes or new scar (eg. ST depression or elevation; T wave inversion-new; CLINICAL CONTEXT)
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75
Q

Standard bloods for chest pain?

A

FBC, U+E, LFT, Clotting screen, Troponin +/- D dimer, Cholesterol, Glucose/HbA1c

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76
Q

Ix for chest pain?

A
  • vital signs
  • ECG
  • CXR
  • Bloods
  • ABG if hypoxic/PE suspected
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77
Q

Criteria for PPCI in STEMI?

A
  • ST elevation >2mm in 2 contiguous chest leads or >1mm in 2 contiguous limb leads (i.e. territorial not randomly distributed)

~Chest pain or other evidence of ischaemia

  • New or presumed new LBBB was an indication for thrombolysis and is often considered an indication for PPCI in the right clinical context
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78
Q

If morphine is given in acute Mx of STEMI, what needs to be given with it?

A

Metoclopramide as morphine can make pt feel sick (delays absorption of anti platelet drugs)

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79
Q

What if pt is already on aspirin but you need to give 300mg stat for STEMI acute Mx?

A

in theory don’t need to give but best to just give anyway as shouldn’t do any harm

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80
Q

When to measure troponin?

A
  • Depends on assay
    STH assay – hsTnT:
  • Measure ASAP
  • If raised, measure again in 3h – significant rise or fall suggests MI
  • If not raised, can r/o MI, unless pain was <6 hrs ago, in which case obtain further measurement at that point – significant rise suggests MI
  • Does NOT rule out ACS (could still be unstable angina)
  • MI is NOT always due to ACS
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81
Q

Follow up post MI?

A

Clinic 1 month – can consider device therapy if significant LVSD
Transthoracic echocardiogram if not had as inpatient
Cardiac rehabilitation programme
Smoking cessation
GP – uptitrate secondary prevention e.g. ramipril and bisoprolol towards 10 mg OD

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82
Q

Advise for pt post MI?

A

Don’t drive for 1 week if PCI, 4 weeks if no PCI (we advise all pts 4 weeks)
Gradual return to usual activity levels
Typically 6 weeks off work
Stop smoking

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83
Q

MI- what to write on the TTO?

A

Big 5

1) Aspirin 75 mg OD

2) Potent P2Y12 inhibitor – ticagrelor 90 mg BD or prasugrel 5-10 mg OD for >=1 year. Can consider a PPI alongside.

3) Cardioselective beta blocker (caution if asthmatic, bradycardic, conduction disease) e.g. bisoprolol 2.5 mg OD

4) ACE inhibitor (ARB if intolerant due to cough) (caution if hypotensive, severe CKD) e.g. ramipril 2.5 mg OD

5) High intensity statin e.g. Atorvastatin 80 mg OD

(PRN GTN)

Pretty much most pts will go home on these if tolerated

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84
Q

What drugs to consider writing on the TTO for MI?

A
  • Consider if poor LV function
    MRA – eplerenone or spironolactone 12.5 – 25 mg OD
  • Consider if pericarditic pain
    Colchicine 500 mcg BD
  • Consider if clinical heart failure
    Loop diuretic e.g. Furosemide 40 mg OD
    SGLT2 inhibitor e.g. Dapagliflozin or Empagliflozin
  • Consider if non-revascularized significant coronary artery disease
    Anti-anginals - beta blocker, nitrates, amlodipine etc.
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85
Q

Cardiac Resynchronisation Therapy (CRT)

A

Patients with LVSD + LBBB or needing a PPM or very wide
RBBB

Dual chamber PPM
- RA lead
- RV lead

  • PLUS LV lead (in the CS)
  • Bi-ventricular PPM
  • Biventricular PPM = ‘CRT-P’
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86
Q

Groups of patients with at significant risk of VT/VF

A

Severe LVSD
Previous VT/VF (but not if assoc with an acute infarct)
Inherited cardiac conditions
HCM, Brugada etc.

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87
Q

Implantable Cardioverter Defibrillator (ICD)

A

Adds a generator and shock coils to pacing function
If added to a single lead or dual chamber PPM = ‘ICD’
If added to a CRT device = ‘CRT-D’

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88
Q

What is the tumour marker for pancreatic ca?

A

CA 19-9

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89
Q

What lung ca has the strongest association with smoking?

A

squamous cell lung ca

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90
Q

What drug is used to suppress N&V with intracranial tumours?

A

dexamethasone

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91
Q

What chemo drug is associated with hypomagnesaemia?

A

cisplatin

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92
Q

What chemo drug may cause pulmonary fibrosis?

A

bleomycin

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93
Q

What should be part of the diagnostic work up in a women found to have abdo malignancy of unknown primary?

A

CA 125

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94
Q

What HPV subtypes are carcinogenic and increase risk of cervical ca?

A

16,18,33

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95
Q

What HPV subtypes are NOT carcinogenic and are associated with genital warts?

A

6, 11

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96
Q

Tumour marker in colorectal ca and has a role in monitoring disease activity?

A

CEA

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97
Q

Most common cause of SVCO?

A

small cell lung ca

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98
Q

What chemo drug may cause peripheral neuropathy?

A

vincristine

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99
Q

Tumour marker for breast ca?

A

CA 15-3

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100
Q

Women with bone mets, likely to originate where?

A

breast ca

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101
Q

Tumour marker in medullary thyroid ca?

A

calcitonin

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102
Q

PBC vs PSC?

A

PBC is middle-aged women, anti-mitochondrial antibodies, assoc with keratoconjunctivitis sicca.

PSC is young men, often with Ulcerative colitis, assoc with pruritus and fatigue, anti-mitochondrial antibodies negative.

Primary Sclerosing Cholangitis is associated with Ulcerative Colitis (i.e. both ‘itis’), which occurs in younger people.

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103
Q

Way to remember PBC?

A

PBC - M Disease - Increased IgM, AMA associated, Middle Aged Women!

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104
Q

Melanosis coli is most commonly caused by

A

prolonged laxative use

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105
Q

The oral contraceptive pill and co-amoxiclav is associated with

A

drug-induced cholestasis

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106
Q

Budd-Chiari syndrome presents with the triad of

A

sudden onset abdominal pain, ascites, and tender hepatomegaly

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107
Q

High urea levels can indicate

A

upper GI bleed versus lower GI bleed

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108
Q

Bile-acid malabsorption may be treated with

A

cholestyramine

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109
Q

Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels are characteristic of

A

autoimmune hepatitis

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110
Q

Odynophagia is a concerning symptom that may be present in patients with

A

oesophageal ca

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111
Q

first line test for diagnosis of small bowel overgrowth syndrome

A

hydrogen breath testing

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112
Q

All patients with suspected upper GI bleed require

A

endoscopy within 24 hours of admission

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113
Q

key investigation for a suspected perforated peptic ulcer

A

erect CXR

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114
Q

PPIs can increase the risk of

A

osteoporosis and fractures

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115
Q

used in the management of severe alcoholic hepatitis

A

corticosteroids

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116
Q

should be given before endoscopy in patients with suspected variceal haemorrhage

A

Both terlipressin and antibiotics

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117
Q

Autoimmune hepatitis is more likely to show predominantly raised

A

raised ALT / AST on LFTs than ALP

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118
Q

cause of hypogonadotrophic hypogonadism

A

haemochromatosis

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119
Q

generally used to induce remission of Crohn’s disease

A

Glucocorticoids (corticosteroids) (oral, topical or intravenous)

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120
Q

used to monitor treatment in haemochromatosis

A

Ferritin and transferrin saturation

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121
Q

first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis

A

A topical (rectal) aminosalicylate +/- an oral aminosalicylate

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122
Q

HBsAg negative, anti-HBs positive, IgG anti-HBc positive

A

previous infection, not a carrier

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123
Q

Diarrhoea, fatigue, osteomalacia →

A

?coeliac

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124
Q

diagnostic investigation of choice for pancreatic cancer

A

High-resolution CT scanning

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125
Q

Always examine the what in a young man with RIF pain

A

testicles

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126
Q

In an acute upper GI bleed, what can identify low risk patients who may be discharged

A

Blatchford score

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127
Q

A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects the

A

hepatic vein to portal vein

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128
Q

may be useful for diagnosing and monitoring the severity of liver cirrhosis

A

Transient elastography

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129
Q

characteristic iron study profile in haemochromatosis

A

Raised transferrin saturation and ferritin, with low TIBC

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130
Q

Jaundice following abdominal pain and pruritus during pregnancy think

A

acute fatty liver of pregnancy

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131
Q

somatostatin analogue used to treat the symptoms of carcinoid syndrome

A

Octreotide

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132
Q

develops in around 10% of primary sclerosing cholangitis patients

A

Cholangiocarcinoma

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133
Q

Obesity with abnormal LFTs

A

? non-alcoholic fatty liver disease

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134
Q

Iron defiency anaemia vs. anaemia of chronic disease

A

TIBC is high in IDA, and low/normal in anaemia of chronic disease

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135
Q

C. difficile antigen positivity only shows what?

A

exposure to the bacteria, rather than current infection

toxin=current

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136
Q

If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given what to maintain remission?

A

oral azathioprine or oral mercaptopurine

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137
Q

Small bowel obstruction (often due to intussusception) is a common presenting complaint in what syndrome?

A

Peutz-Jegher’s syndrome

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138
Q

Ongoing diarrhoea in Crohn’s patient post-resection with normal CRP

A

cholestyramine

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139
Q

Large-volume paracentesis for the treatment of ascites requires albumin ‘cover’. Evidence suggests this reduces

A

paracentesis-induced circulatory dysfunction and mortality

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140
Q

best first line management for NAFLD

A

weight loss

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141
Q

prophylaxis of oesophageal bleeding

A

non-cardioselective B-blocker (NSBB) eg. propanolol

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142
Q

Acute mesenteric ischaemia first line Ix?

A

raised lactate (causes this and is the 1st line Ix)

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143
Q

Acute hypoperfusion (e.g. low BP secondary to blood loss) may result in

A

ischaemic hepatitis

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144
Q

Most likely area to be affected by ischaemic colitis

A

splenic flexure

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145
Q

Increased goblet cells

A

Crohn’s

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146
Q

Constipation - if symptoms don’t respond to a bulk-forming laxative such as isphagula husk, try what?

A

osmotic laxative such as a macrogol

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147
Q

Bile-acid malabsorption may be treated with

A

cholestyramine

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148
Q

The definition of an Upper GI Bleed is a haemorrhage with an origin proximal to the…

A

ligament of Treitz

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149
Q

HBsAg negative, anti-HBs positive, IgG anti-HBc negative

A

previous immunisation

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150
Q

In patients with severe colitis, colonoscopy should be avoided due to the risk of perforation, so what should be used?

A

flexible sigmoidoscopy

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151
Q

Coeliac disease increases the risk of developing what ca?

A

enteropathy-associated T cell lymphoma

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152
Q

Long term proton pump inhibitor therapy can cause what electrolyte disturbances?

A

hypomagnesaemia
hyponatraemia

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153
Q

Dermatitis, diarrhoea, dementia/delusions, leading to death

A

Pellagra

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154
Q

First-line pharmacological management of acute constipation

A

bulk-forming laxative such as isphagula husk

mobility, increasing fluid intake and high fibre diet also v important

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155
Q

Induce remission in crohn’s

A

glucocorticoids (oral, topical or intravenous)

Budesonide is alternative in certain pts

metronidazole is often used for isolated peri-anal disease

156
Q

Maintaining remission in crohn’s?

A

azathioprine or mercaptopurine

and stop smoking

methotrexate is used second-line

157
Q

Useful in refractory disease and fistulating Crohn’s to induce remission?

A

infliximab
Patients typically continue on azathioprine or methotrexate.

158
Q

Induce remission in ulcerative colitis?

A

topical (rectal) aminosalicylate

if not achieved in 4w= add an oral aminosalicylate

still not achieved= add topical or oral corticosteroid

159
Q

Induce remission in ulcerative colitis in extensive disease?

A

topical (rectal) aminosalicylate and a high-dose oral aminosalicylate

if remission is not achieved within 4w= stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid

160
Q

Induce remission in ulcerative colitis in severe colitis?

A

should be treated in hospital

IV steroids first-line
IV ciclosporin may be used if steroids are contraindicated

if after 72 hours there has been no improvement, consider adding IV ciclosporin to IV corticosteroids or consider surgery

161
Q

Maintaining remission in UC if mild or moderate eg. proctitis and proctosigmoiditis?

A

topical (rectal) aminosalicylate alone (daily or intermittent) or

an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent) or

an oral aminosalicylate by itself: this may not be effective as the other two options

162
Q

Maintaining remission in UC if left-sided and extensive ulcerative colitis?

A

low maintenance dose of an oral aminosalicylate

163
Q

Maintaining remission in UC following a severe relapse or >=2 exacerbations in the past year?

A

oral azathioprine or oral mercaptopurine

164
Q

UC flare severity?

A

Mild= <4 stools a day, with or without blood

Moderate= 4-6; minimal systemic distrubance eg. slight raise in CRP

Severe= >6 a day, containing blood; systemic disturbance eg. fever, anaemia, hypoalbuminaemia, tachy, abdo tenderness

165
Q

first line test for diagnosis of small bowel overgrowth syndrome

A

Hydrogen breath testing

166
Q

You cannot interpret TTG level in coeliac disease without looking at

A

IgA level (so test this when u test TTG)

167
Q

Patients must eat gluten for at least how long before they are tested for coeliac?

A

6w

168
Q

What is used for complex perianal fistulae in patients with Crohn’s disease?

A

A draining seton

169
Q

crypt abscesses

A

UC

170
Q

Dyspepsia: there is no need to check for H. pylori eradication with urea breath test if

A

symptoms have resolved following test and treat

171
Q

treatment for achalasia

A

1st= Pneumatic dilatation (less invasive)
2nd if failed= Heller cardiomyotomy (surgery)

172
Q

If a severe flare of UC has not responded to IV steroids after 72 hours, consider adding

A

IV ciclosporin or surgery

173
Q

In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, how to Mx?

A

oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far

174
Q

Coeliac disease is associated with what deficiencys?

A

iron, folate and vitamin B12 deficiency

175
Q

What should be assessed before offering azathioprine or mercaptopurine therapy in Crohn’s disease?

A

TPMT activity

176
Q

Ascites: a high SAAG gradient (> 11g/L) indicates

A

portal hypertension

177
Q

A combination of liver and neurological disease points towards

A

Wilson’s

178
Q

During infection, ferritin is an unreliable indicator of iron stored in the body as it is an acute phase protein. What should be used instead?

A

Transferrin saturation

179
Q

Autosomal recessive vs dominant conditions typically….

A

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

180
Q

Cerebellar disease signs?

A

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’

A - Ataxia (limb, truncal)

N - Nystamus (horizontal = ipsilateral hemisphere)

I - Intention tremour

S - Slurred staccato speech, Scanning dysarthria

H - Hypotonia

181
Q

Unilateral cerebellar lesions cause…

A

ipsilateral cerebellar signs

182
Q

Ptosis + dilated pupil = ?

Ptosis + constricted pupil = ?

A

Ptosis + dilated pupil = third nerve palsy

Ptosis + constricted pupil = Horner’s

183
Q

Total anterior circulation infarcts - all 3 of the following:

A

unilateral hemiparesis and/or hemisensory loss of the face, arm & leg

homonymous hemianopia

higher cognitive dysfunction e.g. dysphasia

184
Q

left homonymous hemianopia means

A

visual field defect to the left, i.e. lesion of right optic tract

185
Q

homonymous quadrantanopias

A

PITS (Parietal-Inferior, Temporal-Superior)

186
Q

Lambert-Eaton Syndrome is a paraneoplastic myasthenic syndrome most commonly associated with

A

small cell lung cancer.

It may precede the cancer diagnosis by a number of years

187
Q

Lateral medullary syndrome - PICA lesion?

A

cerebellar signs, contralateral sensory loss & ipsilateral Horner’s

188
Q

Fever, headache, psychiatric symptoms, seizures, focal features e.g. aphasia

A

?herpes simplex encephalitis

189
Q

The radial nerve is at risk in a shaft fracture of the

A

humerus

190
Q

Raised ICP can cause what nerve palsy?

A

third nerve palsy due to herniation

191
Q

Contralateral hemiparesis and sensory loss with the upper extremity being more affected than the lower, contralateral homonymous hemianopia and aphasia

A

middle cerebral artery

192
Q

Patients who present 4.5-9 hours after symptom onset, or with ‘wake-up stroke’ should still be considered for thrombolysis if

A

they have imaging evidence of potential to salvage brain tissue

193
Q

Progressively worsening headache with higher cognitive function impaired

A

urgent imaging

194
Q

Contraindication to triptan use

A

Cardiovascular disease

195
Q

Hoover’s sign

A

differentiates between organic and non-organic lower leg weakness

196
Q

Headache linked to Valsalva manoeuvres =

A

raised ICP until proven otherwise so LP is contraindicated

197
Q

Partial anterior circulation infarcts - 2 of the following:

A

unilateral hemiparesis and/or hemisensory loss of the face, arm & leg

homonymous hemianopia

higher cognitive dysfunction e.g. dysphasia

198
Q

rapid onset dementia and myoclonus

A

Creutzfeldt-Jakob disease

199
Q

Intubate if the GCS is less than

A

8

200
Q

Common peroneal nerve lesion can cause

A

weakness of foot dorsiflexion and foot eversion

201
Q

Pt presents with a fall following a recent diagnosis of Parkinson’s, think what?

A

may be Parkinson’s Plus syndrome eg. Progressive supranuclear palsy- so test CN III, IV and VI (common CP of PSP is vertical supranuclear gaze palsy

anyone with a fall test CN III, IV and VI

202
Q

Progressive supranuclear palsy

A

postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

203
Q

Progressive supranuclear palsy vs multiple system atrophy?

A

PSP= vertical gaze impairment

MSA= autonomic dysfunction is a more significant feature such as tachycardia, fainting, erectile dysfunction

both may present like Parkinsons

204
Q

Pulmonary function test results for obstructive lung disease eg. asthma, COPD, Bronchiectasis,
Bronchiolitis obliterans?

A

FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced

transfer factor reduced or normal

205
Q

Pulmonary function test results for restrictive lung disease eg:

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity

A

FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

transfer factor reduced or normal

206
Q

Normal FEV1, FVC and FEV1/FVC ratio?

A

FEV1= >80% predicted
FVC= >80% predicted
FEV1/FVC= >70% predicted

207
Q

Clubbing may be seen in what?

A

bronchiectasis

208
Q

What is helpful in ventilated pts with ARDS?

A

prone positioning

209
Q

Pneumothorax Mx- what are the high-risk characteristics that determine the need for a chest drain?

A
  • Haemodynamic compromise (suggesting a tension pneumothorax)
  • Significant hypoxia
  • Bilateral pneumothorax
  • Underlying lung disease
  • ≥ 50 years of age with significant smoking history
  • Haemothorax
210
Q

Over rapid aspiration/drainage of pnuemothorax can result in what?

A

re-expansion pulmonary oedema

211
Q

When should oral Abx only be given in acute exacerbation of COPD?

A

presence of purulent sputum or clinical signs of pneumonia

212
Q

Neuromuscular disorders result in what pattern on pulmonary function tests?

A

restrictive pattern

213
Q

patient get admitted and you don’t know their full PMH. If someone is put on 15L of high flow O2 and suddenly go into respiratory acidosis and T2RF

A

think COPD

214
Q

Causes of upper lobe pulmonary fibrosis?

A

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

215
Q

Examples of SABA, SAMA, LABA, LAMA, ICS

A

SABA - Salbutamol or Terbutaline
SAMA - Ipratropium Bromide
LABA - Salmeterol or Formoterol
LAMA - Tiotropium
ICS - Budesonide or Fluticasone

216
Q

Characterising fractures: way to remember the Salter-Harris criteria (type of fracture)?

A

SALTEr
1 S-Straight
2 A-Above
3 L-Lower
4 T-Through (above and below)
5 Er-Everything (Crush)

217
Q

General Abx for pregnant pt allergic to penicillin?

A

erythromycin

218
Q

CO2 in asthma exacerbation?

A

pt hyperventilates so should be high O2 and low CO2

in severe= CO2 normal

near-fatal= CO2 >6 (should be low as breathing fast in exacerbations but as it is raised this is really bad)

219
Q

Pregnant women, severe asthma attack and improve with medical Tx?

A

still need hospital admission if pregnant

220
Q

What causes lower zone pulmonary fibrosis?

A

A - asbestos.
C - connective tissue diseases.
I - idiopathic pulmonary fibrosis.
D - drugs e.g. methotrexate, nitrofurantoin.

221
Q

Acute asthma Mx?

A
  1. Oxygen
  2. Salbutamol nebulisers
  3. Ipratropium bromide nebulisers
  4. Hydrocortisone IV OR Oral Prednisolone
  5. Magnesium Sulfate IV
  6. Aminophylline/ IV salbutamol
  7. ITU (intubation)

Oh
Shit,
I
Hate
My
Asthma

initially salbutamol + ipra together if severe or life-threatening

222
Q

COPD exacerbation, what to do when medical Mx fails?

A

BiPAP

if this fails then intubation and ventillation

223
Q

Target O2 sats in COPD?

A

if a known type 2 resp failure i.e hypercapnic on blood gas= 88-92%

Normal CO2 (not hypercapnic)= 94-98%

224
Q

COPD symptoms in a young person/non-smoker?

A

think alpha-1 antitrypsin (A1AT) deficiency

225
Q

Painful shin rash + cough

A

?sarcoidosis

226
Q

Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems →

A

?bronchiectasis

227
Q

Bronchiectasis vs pulmonary fibrosis

A

Bronchiectasis:

Primary Problem= Airway damage and dilation
Cough= Productive (mucus) Onset= Chronic but not necessarily progressive
Main Tx Focus= Infection control, airway clearance

Pulmonary Fibrosis:

Primary Problem= Lung tissue scarring
Cough= Dry
Onset= Progressive and worsening
Main Tx Focus= Slowing fibrosis, symptom management

228
Q

Sudden deterioration with ventilation suggests

A

tension pneumothorax

229
Q

Patients diagnosed with pneumonia who have COPD should be given what even if no evidence of the COPD being exacerbated

A

corticosteroids

230
Q

Although diagnosis is often confirmed on CT imaging, WHAT is raised in approximately 60% of sarcoid patients at diagnosis and is the most specific autoantibody used in diagnosis.

A

serum ACE raised in sarcoidosis (also hypercalcaemia)

231
Q

Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes

A

silicosis

232
Q

Hypercalcaemia + bilateral hilar lymphadenopathy

A

?sarcoidosis

233
Q

Light’s criteria state that a pleural effusion is an exudate if:

A
  • Effusion lactate dehydrogenase (LDH) level greater than 2/3 the upper limit of serum LDH
  • Pleural fluid LDH divided by serum LDH >0.6
  • Pleural fluid protein divided by serum protein >0.5
234
Q

If a pleural effusion is drained too quickly, a rare but important complication that can develop is

A

re-expansion pulmonary oedema

235
Q

Gynaecomastia - associated with what lung ca

A

adenocarcinoma

236
Q

most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics

A

Klebsiella

237
Q

A chest infection failing to improve with antibiotics followed by a deterioration in symptoms with a cough productive of foul, purulent sputum, and rigours suggests

A

an empyema or abscess

CT findings of a smooth-walled fluid collection with air-fluid levels and pleural enhancement, alongside pleural fluid analysis showing a low pH, high LDH, and low glucose, confirm this diagnosis

chest tube drainage combined with antibiotics

238
Q

Indications for corticosteroid treatment for sarcoidosis are:

A

parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement

239
Q

treatment of choice for allergic bronchopulmonary aspergillosis

A

oral glucocorticoids eg. pred

240
Q

Which of the following options confirms that the chest drain is located in the pleural cavity?

A

The water seal rises on inspiration and falls on expiration

241
Q

COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features →

A

add a LABA + LAMA

242
Q

COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features →

A

add a LABA + ICS

243
Q

contraindication for chest drain insertion

A

INR >1.3

244
Q

The treatment of extrinsic allergic alveolitis is

A

mainly avoidance of triggers

245
Q

Acute respiratory distress syndrome can only be diagnosed in the absence of

A

a cardiac cause for pulmonary oedema (i.e. the pulmonary capillary wedge pressure must not be raised)

246
Q

Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation eg. acute pancreatitis →

A

?ARDS

247
Q

Obstructive sleep apnoea can cause

A

HTN

248
Q

first-line for acute bronchitis (unless pregnant/child)

A

oral doxycycline

249
Q

Fine end-inspiratory crepitations are seen in

A

idiopathic pulmonary fibrosis

250
Q

Coal workers’ pneumoconiosis typically causes

A

upper zone fibrosis

251
Q

What is recommended in COPD pts who have frequent exacerbations?

A

Azithromycin prophylaxis

252
Q

Large bullae in COPD can mimic a

A

pneumothorax

253
Q

Squamous cell carcinoma is associated with

A

hypertrophic pulmonary osteoarthropathy (HPOA)

254
Q

Asthmatic features/features suggesting steroid responsiveness in COPD:

A

previous diagnosis of asthma or atopy

a higher blood eosinophil count

substantial variation in FEV1 over time (at least 400 ml)

substantial diurnal variation in peak expiratory flow (at least 20%)

255
Q

Causes of hypoglycaemia

A

EXPLAIN

Exogenous drugs (typically sulfonylureas or insulin)
Pituitary insufficiency
Liver failure
Addison’s disease
Islet cell tumours (insulinomas)
Non-pancreatic neoplasms

256
Q

DKA resolution is defined as:

A

pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

257
Q

What should happen to patients regular insulin if DMT1 in DKA?

A

continue long acting insulin and stop short acting

258
Q

Hyponatraemia, hyperkalaemia and weight loss

A

?Addison’s disease. Presentation of adrenal insufficiency can be very non-specific.

259
Q

Cushing’s syndrome electrolyte abnormality

A

hypokalaemic metabolic alkalosis

260
Q

Primary hyperaldosteronism can present with

A

hypertension, hypernatraemia, and hypokalemia

261
Q

High-dose dexamethasone suppression test with an ectopic source of ACTH

A

Cortisol: not suppressed
ACTH: not suppressed

262
Q

High-dose dexamethasone suppression test with Cushing’s syndrome due to other causes (e.g. adrenal adenomas)

A

Cortisol: not suppressed
ACTH: suppressed

263
Q

High-dose dexamethasone suppression test with Cushing’s disease (i.e. pituitary adenoma → ACTH secretion)

A

Cortisol: suppressed
ACTH: suppressed

264
Q

‘unrecordable’ blood sugar measurement with confusion and abdominal pain

A

DKA

‘unrecordable’ means it is too high

265
Q

High insulin, High C-peptide = Endogenous insulin production →

A

Insulinoma or sulfonylurea use/abuse

265
Q

Congenital adrenal hyperplasia has the following biochemical abnormalities

A

Increased plasma 17-hydroxyprogesterone levels
Increased plasma 21-deoxycortisol levels
Increased urinary adrenocorticosteroid metabolites

266
Q

PHaeochromocytoma - give what to manage HTN prior to surgical removal

A

PHenoxybenzamine (non-selective alpha-blocker) before beta-blockers

267
Q

Water deprivation test: primary polydipsia

A

urine osmolality after fluid deprivation: high
urine osmolality after desmopressin: high

268
Q

Endocrine parameters reduced in stress response: eg. following major surgery

A

Insulin
Testosterone
Oestrogen

269
Q

SGLT-2 inhibitors examples

A

canagliflozin, dapagliflozin and empagliflozin.

270
Q

TFTs in critically ill pt eg. ITU with pneumonia?

A

TSH normal, T3 & T4 low (Sick euthyroid syndrome)

271
Q

How to distinguish between DMT1 and DMT2?

A

C-peptide levels and diabetes-specific autoantibodies (anti-GAD)

normally in type 1= c-peptide low and antibodies present

272
Q

normal stroke - Mx

normal TIA - Mx

AF causing stroke - Mx

AF causing TIA - Mx

A

normal stroke - aspirin first, then lifelong clopi
normal TIA - aspirin first, then lifelong clopi
AF causing stroke - aspirin first, then DOAC
AF causing TIA - immediate DOAC

273
Q

1st line Mx for HTN?

A

Do they have diabetes? Yes = ACEi or ARB if Afro-Carribean
Are they Afro-Carribean or over 55? Yes = CCB
Are they non-Afro-Carribean and under 55? Yes = ACEi

274
Q

Patients with bradycardia and signs of shock require what

A

500micrograms of atropine (repeated up to max 3mg)

275
Q

New onset AF is considered for electrical cardioversion if it presents within

A

48 hours of presentation

276
Q

A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination -

A

ventricular septal defect

277
Q

Mx of aortic dissection?

A

type A - ascending aorta - control BP (IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)

278
Q

ACE inhibitor or ARB in pt who is afro-caribbean (after CCB or 1st line if diabetic)?

A

ARB preferred

279
Q

A right coronary infarct supplies the AV node so can cause what after MI (infarction)?

A

arrhythmias

280
Q

Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a standard-dose thiazide diuretic. K+ > 4.5mmol/l - what should you add?

A

specialist review

add an alpha- eg. carvedilol
58% or beta-blocker

281
Q

Tx if pharmacological cardioversion of AF agreed on?

A

amiodarone

282
Q

A posterior MI causes what on a 12-lead ECG

A

ST depression not elevation

283
Q

What drug class is contraindicated in V Tach?

A

CCB eg. verapamil

284
Q

PR interval over 200ms with an otherwise normal ECG (regular sinus rhythm, no missing QRS complexes) is consistent with

A

1st-degree atrioventricular block.

Isolated 1st degree atrioventricular block is common rarely problematic and a normal variant in athletes

285
Q

Mx of alcohol withdrawl if pt has liver cirrhosis?

A

long acting benzodiazepines eg. lorazepam

chlordiazepoxide C/I in cirrhosis

286
Q

Acute dystonia secondary to antipsychotics is usually managed with

A

procyclidine

287
Q

After starting an ACE inhibitor, significant renal impairment may occur if the patient has

A

undiagnosed bilateral renal artery stenosis

288
Q

Beta-blockers combined with verapamil can potentially cause profound

A

bradycardia and asystole

289
Q

Patients with bradycardia and signs of shock require

A

500micrograms of atropine (repeated up to max 3mg)

290
Q

Bleeding on dabigatran? Can use what to reverse

A

idarucizumab

291
Q

What drug might cause cold peripheries?

A

beta blockers

292
Q

Diabetic ketoacidosis: the IV insulin infusion should be started at what rate?

A

0.1 unit/kg/hour

293
Q

What is suggested by the tender goitre, hyperthyroidism and raised ESR. The globally reduced uptake on technetium thyroid scan is also typical?

A

Subacute thyroiditis

294
Q

hypothyroidism + goitre + anti-TPO

A

Hashimoto’s thyroiditis

295
Q

Symptomatic bradycardia is treated with

A

Atropine (500mcg IV)

296
Q

Hormones in Klinefelter’s vs Kallmans vs Turner’s?

A

Klinefelter’s syndrome= high LH & FSH and low testosterone (CLIMB felters- can’t feel testes too small)

Kallman= low LH & FSH and low testosterone (ALL low/FALL)

Tuners= high FSH & LH (TURNED UP) and low oestrogen

297
Q

Depression, nausea, constipation, bone pain →

A

?primary hyperparathyroidism

298
Q

medication of choice in suppressing lactation when breastfeeding cessation is indicated

A

Cabergoline (dopamine receptor agonist)

299
Q

After 20 weeks, symphysis-fundal height in cm =

A

gestation in weeks +/- 2cm

eg/ 24w= 22-26cm

300
Q

AFP - raised with

A

fetal abdominal wall defects (e.g. omphalocele)

301
Q

The investigation of choice for ectopic pregnancy is

A

transvaginal ultrasound

302
Q

HRT: unopposed oestrogen increases risk of

A

endometrial cancer

303
Q

COCP: If 2 pills are missed in week 1…

A

consider emergency contraception if she had unprotected sex during the pill-free interval or week 1

304
Q

SSRIs of choice in breastfeeding women

A

Sertraline or paroxetine

305
Q

The combined oral contraceptive pill CAN be given if requested 6 weeks postpartum even if breastfeeding. BUT they can get pregnant from day

A

21 postpartum so if they have had unprotected intercourse from day 21 postpartum, a pregnancy test should be performed first

306
Q

The combined oral contraceptive pill CAN be given if requested … w postpartum even if breastfeeding

A

6w

307
Q

The most common cause of PPH by far is

A

uterine atony

308
Q

In patients with urinary incontinence, make sure to rule out

A

UTI and diabetes mellitus

309
Q

HNPCC/Lynch syndrome is a strong risk factor for

A

C.olon
E.ndometrial
O.varian

310
Q

Suspected PE in pregnant women with a confirmed DVT:

A

treat with LMWH first then investigate to rule in/out

311
Q

most common cause of postmenopausal bleeding

A

vaginal atrophy

312
Q

Red eye - glaucoma or uveitis?

A

glaucoma: severe pain, haloes, ‘semi-dilated’ pupil

uveitis: small, fixed oval pupil, ciliary flush

313
Q

Proliferative diabetic retinopathy is the most common underlying cause of a

A

vitreous haemorrhage

314
Q

scleritis vs episcleritis

A

scleritis painful

episcleritis painless

315
Q

sudden painless loss of vision in diabetic

A

? Vitreous haemorrhage

316
Q

Anterior uveitis is most likely to be treated with

A

steroid + cycloplegic (mydriatic) drops

317
Q

red eye, dilated pupil, and a hazy cornea due to increased intraocular pressure

A

Acute angle closure glaucoma

318
Q

In diabetic retinopathy, cotton wool spots represent areas of

A

retinal infarction

319
Q

A patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound. No chest pain ???

A

left ventricular aneurysm

320
Q

AV block can occur following an …. MI

A

inferior

321
Q

ECG findings of sinus tachycardia and right axis deviation are characteristic features of

A

PE

322
Q

A third heart sound is one of the possible features of

A

left-sided HF

323
Q

Complete heart block following a MI? -

A

right coronary artery lesion

324
Q

Offer a ……. in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure

A

mineralcorticoid receptor antagonist eg. spirinolactone

325
Q

Way to remember systolic vs diastolic murmur?

A

MS ARD = Mitral Stenosis (late), Aortic Regurg (early)- Diastolic

MR ASS = Mitral regurg (pan), Aortic Stenosis (ejection) - Systolic

326
Q

What electrolyte disturbances could lead to long QT syndrome?

A

hypocalcaemia, hypokalaemia, hypomagnesaemia

327
Q

For cardioversion of AF: patients must either be

A

anticoagulated (for 3w) or have had symptoms for < 48 hours to reduce the risk of stroke.

eg.
Bisoprolol and oral anticoagulant therapy for 3 weeks and then electrical cardioversion

328
Q

What is contraindicated in aortic stenosis?

A

nitrates eg. GTN spray due to risk of profound hypotension

329
Q

ECG is reported as showing no visible P waves and an irregularly irregular narrow QRS complex?

A

AF

not SVT as AF is irregulary irregular but SVT is regular

330
Q

Narrow complex tachy (<0.12s) vs broad complex tachy (>=0.12s)?

A

Narrow= AF, SVT, atrial flutter

Broad= v tach, v fib (v tach can go into v fib), BBB

331
Q

early diastolic murmur, pulse is collapsing (water-hammer) and has wide pulse pressure

A

aortic regurg

332
Q

The ECG shows monomorphic ventricular tachycardia. The patient still no pulse.

What should be the next step in management?

A

defib

If VF/pVT persists, only after a third shock should adrenaline 1 mg IV and amiodarone 300 mg IV be administered.

333
Q

Aortic dissection can present with

A

neuro complaints

Focal neurological deficits occur due to propagation of the intimal tear to branch arteries, or due to mass effects as the expanding aorta compresses surrounding structures. Eg. man presents with chest pain & with symptoms of Horner’s syndrome (classically ptosis, miosis and anhidrosis) due to compression of the sympathetic trunk by the expanding aortic dissection.

334
Q

Tricuspid regurg type of murmur?

A

pan-systolic murmur

as, during systole, the blood is ejected from the ventricles which are contracting. If the tricuspid valve is ‘leaky’ as in tricuspid regurgitation, the blood will backflow to the right atrium during this process, causing a pansystolic murmur.

335
Q

Expert help should be sought for stable patients with what heart rhythm?

A

IRREGULAR broad complex tachycardia (rare)

336
Q

What heart condition is most associated with S3?

A

dilated cardiomyopathy

337
Q

Mx of cardiac tamponade?

A

Pericardiocentesis

if cancer then Percutaneous balloon pericardiotomy (Pericardiocentesis is good for one off drainage, but these patients need intervention to manage recurrence)

338
Q

when are nitrates contraindicated?

A

hypotension or aortic stenosis

339
Q

Hypertrophic obstructive cardiomyopathy - is classically associated with an

A

S4

340
Q

S3 vs S4?

A

An S3 heart sound occurs early in diastole, signifying rapid ventricular filling, while an S4 heart sound happens late in diastole, just before the S1, and indicates the atria forcefully pushing blood into a stiff ventricle

S3 (threeee) - hard to breeeeeath (LVF and MR can lead to pulmonary oedema)

S4 - hit the floor (HOCM and AS can cause collapse/sudden death)

Also if you noticed
S3 is normal in under 30 (3 is the number to remember)
S4 is normal in over 40 (4 is the number to remember)

DCM = S3 (3 letters)
HOCM = S4 (4 letters)

341
Q

Most common cause of primary adrenal insufficiency?

A

autoimmune so test for 21-hydroxylase antibodies (Addisons)

342
Q

3 types of hyponatraemia?

A

hypervolaemic, hypovolaemic and euvolaemic

343
Q

Causes of hypervolaemic hyponatraemia?

A

secondary hyperaldosteronism= heart failure, liver cirrhosis

nephrotic syndrome

IV dextrose

psychogenic polydipsia

344
Q

Causes of hypovolaemic hyponatraemia?

A

Diarrhoea & vomiting

Medications eg. thiazides, loop diuretics

Addison’s disease

Diuretic stage of renal failure

Burns

345
Q

Causes of euvolaemic hyponatraemia?

A

SIADH

Hypothyroidism

346
Q

How to determine hyponatraemia Mx?

A

1) Acute (<48hrs) or chronic (>48hrs)= look at the trend

2) Severity= mild (130-134), moderate (120-129) or severe (<120)

3) Fluid status:
- hypovolaemic= clinically dehydrated, diuretics, Addisonian crisis, diuretic stage of renal failure
- euvolaemic= SIADH, hypothyroidism
- hypervolaemic= HF, liver failure, nephrotic syndrome

4) Symptomatic?
- early symptoms= headache, lethargy, nausea, vomiting, dizziness, confusion, muscle cramps
- late= seizures, coma, resp arrest

347
Q

Ix for hyponatraemia?

A

serum osmolality; urine osmolality; urine sodium; 9 am cortisol (exclude adrenal insuf- low sodium, high potassium), TSH (?hypothyroidism)

348
Q

Hyponatraemia- check Na how often?

A

every 2hrs (VBG not very accurate); don’t be too aggressive with fluids- just 1L slow then reassess

349
Q

How may hypovolaemic hyponatraemia present?

A

subtle, may just have low urea and low urine output

350
Q

SIADH?

A

high urine osmolality and urine sodium >40

causes= ca (esp lung); meds (SSRI, antipsychotics); chest infections (pnuemonia)

Mx= fluid restrict (to 1L or 750ml); talk to endo, tolvaptan

351
Q

Mx if hypovolaemic hyponatraemia suspected?

A

normal, i.e. isotonic, saline (0.9% NaCl)

this may sometimes be given as a trial

if the serum sodium rises this supports a diagnosis of hypovolemic hyponatraemia

if the serum sodium falls an alternative diagnosis such as SIADH is likely

352
Q

Mx if euvolaemic hyponatraemia suspected?

A

fluid restrict to 500-1000 mL/day

consider medications:
demeclocycline
vaptans

353
Q

Mx if hypovolaemic hyponatraemia suspected?

A

fluid restrict to 500-1000 mL/day

consider loop diuretics

consider vaptans

354
Q

Patients with acute, severe (<120 mmol/L) or symptomatic hyponatraemia?

A

require close monitoring, preferably in an HDU or above setting.

Hypertonic saline (typically 3% NaCl) is used to correct the sodium level more quickly than would be done in patients with chronic hyponatraemia.

355
Q

For type 2 diabetics requiring treatment, metformin is contraindicated in those with

A

eGFR < 30

356
Q

IgA deficiency increases the risk of

A

anaphylactic blood transfusion reactions

357
Q

The main ECG abnormality seen with hypercalcaemia is

A

short QT

358
Q

Hypothermia ECG changes?

A

Jesus Quist It’s Bloody Freezing

J-Waves
QT interval - prolonged
Irregular Rhythm
Bradycardia
First Degree Heart Block

359
Q

Examples of a a long-acting nitrate?

A

ivabradine
nicorandil
ranolazine

360
Q

What is characterised by a positive direct antiglobulin test (Coombs’ test)?

A

Autoimmune haemolytic anaemia

361
Q

Warfarin drug interactions?

A

Inducers: (INR decreases)
“SCARS”
* S → Smoking
* C → Chronic alcohol intake
* A → Anti- epileptics: Phenytoin, Carbamazepine, Phenobarbitone (all barbiturates)
* R → Rifampicin
* S → St John’s Wort

Inhibitors: (INR increases)
“ASS-ZOLES”
* A → Antibiotics: Ciprofloxacin, Erythromycin, Isoniazid
* S → SSRIs: Fluoxetine, Sertraline
* S → Sodium Valproate
* - Zoles → Omeprazole, Ketoconazole, Fluconazole

362
Q

Rhabdomyolysis can cause AKI by causing what damage in kidney?

A

Tubular cell necrosis

363
Q

Myeloma without metastasis is characterised by what electrolyte levels?

A

high calcium, normal/high phosphate and normal alkaline phosphate

364
Q

How to identify bundle branch block on ECG?

A

If QRS is broad look at V1:
If QRS predominantly negative then its a LBBB
If QRS predominantly positive then its a RBBB
So much more reliable than William marrow as it doesn’t rely on you looking at the shape of the QRS

365
Q

Bifascicular block vs
Trifascicular bloc

A

Bifascicular block= RBBB + Left axis deviation
Trifascicular block= RBBB+ Left axis deviation + 1st degree heart block

366
Q

Stokes–Adams syndrome?

A

episodes of syncope due to intermittent complete heart block or other high-grade arrhythmia which compromise cerebral circulation

367
Q

Half life of adenosine?

A

Adenosine has a very short half-life of about 8-10 seconds

Patients who are given adenosine will experience unpleasant, but short-lived, side-effects.

368
Q

chest pain + neurology, always rule out

A

aortic dissection

369
Q

Narrow complex tachy?

A

Regular= SVT but if Mx fails consider flutter

Irregular= AF

370
Q

Broad complex tachy?

A

Regular= V tach or SVT with BBB (if previously diagnosed)

Irregular= torsades de pointes or if stable then AF with BBB

371
Q

Mx of SVT?

A

vagal manoeuvres -> IV adenosine

if fails then ?flutter -> beta blocker

372
Q

MX of AF?

A

BB for rate control

or

onset <48hrs consider rhythm control -> cardioversion

373
Q

Mx of V tach?

A

IV amiodarone

374
Q

Mx of torsades de pointes?

A

IV magnesium sulphate

375
Q

Mx of severe bradycardia (signs of haemodynamic compromise)?

A

1) IV atropine (500mcg)

if no response…
2) atropine, up to a maximum of 3mg

3) transcutaneous pacing

4)isoprenaline/adrenaline infusion titrated to response

376
Q

Mx of narrow or broad complex tachy if unstable?

A

synchronised DC shock

377
Q

A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination -

A

ventricular septal defect

378
Q

What does it mean if patient’s cardiac arrest was witnessed?

A

it was seen in a patient already receiving cardiac monitoring, such as in a coronary care unit

379
Q

Recent sore throat, rash, arthritis, murmur →

A

?rheumatic fever

causes aortic regurg

380
Q

Overview of Mx after having stroke/TIA (after CT ect)?

A

normal stroke - aspirin first, then lifelong clopi

normal TIA - aspirin first, then lifelong clopi

AF causing stroke - aspirin first, then DOAC

AF causing TIA - immediate DOAC

381
Q

Ludwigs angina?

A

NOT CARDIO RELATED, it is a
rare, life-threatening bacterial infection that affects the floor of the mouth and neck.

382
Q

What drug class can cause hyponatraemia, hypokalaemia and hypercalcaemia?

A

thiazide diuretic eg. Bendroflumethiazide

383
Q

…..should be suspected in patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.

A

Vesicovaginal fistulae

384
Q
A

FINALS (37 decks)

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