Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 diagnosis and management > Other > Flashcards

Other Flashcards

1
Q

Investigations for anaphylaxis following an attack?

A
  • Allergen skin test

* IgE immunoassay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Management for anaphylaxis?

A
  1. ABCDE
  2. IM adrenaline
  3. High flow oxygen
  4. Chlorpheniramine (antihistamine)
  5. Hydrocortisone

Observe every 6-12 hours

Repeat adrenaline every 5 mins on anterolateral aspect of middle third of thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation of aspirin (salicylate) overdose? Early and late.

A

Early
• Hyperventilation
• Tachycardia
• Tinnitus

Later
• Respiratory depression
• Lethargy

  • Dehydration and hypokalaemia due to compensation to respiratory alkalosis (from hyperventilation)
  • Leads to metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Investigations for aspirin overdose?

A
  • ABG - respiratory alkalosis => metabolic acidosis
  • U+Es - hypokalaemia
  • Salicylate - positive or negative
  • High PT
  • High AST + ALT

ECG - flat/inverted T waves, U waves (hypokalaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is multi-organ dysfunction syndrome?

A
  • Progressive and potentially resersible physiological dysfunction of 2+ organ systems
  • Induced by variety of insults including sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MODS is the final stage in a continuum beginning with what?

A

Systemic inflammatory response syndrome + infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the presentations of MODS, using the MOD score (4 stages)

A 
Stage 1 
• increased volume requirements
• respiratory alkalosis
• oliguria
• hyperglycaemia
Stage 2
• tachypnoea
• hypocapnia and hypoxaemia
• moderate liver dysfunction
• haematologic abnormalities
Stage 3
• shock
• azotaemia (high nitrogen)
• acid-base disturbance
• coagulation abnormalities
Stage 4
• vasopressor dependent
• oliguria/anuria
• ischaemic colitis
• lactic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Symptoms and signs of opiate overdose?

A
  • Constipation (chronic)
  • Drowsiness (acute)
  • Nausea and vomiting
  • Loss of appetite
  • Sedation
  • Respiratory depression
  • Hypotension and tachycardia
  • Pinpoint pupils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigations for opiate overdose?

A
  1. Therapeutic trial of naloxone
  • ECG - in respiratory compromise, look for MI or QRS prolongation in propoxyphene overdose
  • CXR - ARDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How much paracetamol can cause hepatic necrosis?

A

> 12g

but > 4g is overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common intentional drug overdose in the UK?

A

Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Signs and symptoms of paracetamol overdose (with reference to timing)

A

0-24 hours
• Asymptomatic
• Mild nausea, malaise

24-72 hours
• RUQ pain
• Vomiting
• Hepatomegaly

72+ hours
• Confusion (encephalopathy)
• Jaundice
• Renal angle tenderness
• Coagulopathy
• Hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations for paracetamol overdose?

A
  1. Serum paracetamol - positive or negative, peaks at 4 hours
  • ABG - elevated lactate
  • Raised PT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline duct ectasia

A
  • Dilation of terminal breast ducts
  • Creamy (yellow/green) discharge
  • May leak into periductal tissues and cause periductal mastitis
  • Tender lump around areola
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is duct ectasia most common?

A

Menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline duct papilloma

A
  • Local epithelial proliferation in large mammary ducts
  • Hyperplastic - benign tumour
  • Blood stained discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Investigations for benign breast disease?

A

Triple assessment

  1. Clinical examination
  2. Mammography over 35 years, ultrasound under 35 years
  3. FNA or biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk factors for breast cancer?

A
  • Prolonged oestrogen exposure
  • Age
  • FHx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Signs of breast cancer?

A
  • Firm, irregular, fixed breast lump
  • Peau d’orange
  • Skin tethering
  • Fixed to chest wall
  • Skin ulceration
  • Nipple inversion
  • Paget’s disease of the nipple (eczema-like)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

On top of the triple assessment, what other investigations would you carry out for breast cancer?

A
  1. Sentinel lymph node biopsy - radioactive tracer injected into tumour
  2. Staging - CXR, liver USS, CT (brain/thorax), bloods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Presentation of breast cyst?

A
  • Smooth discrete lump

* May be fluctuant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does a fibroadenoma develop from and how does it present

A
  • Develops from whole lobule
  • Mobile, firm breast lumps
  • Smooth
  • Most common breast mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk of malignancy with fibroadenoma, breast cyst, duct papilloma?

A

Fibroadenoma - no increase
Breast cyst - increase
Duct papilloma - no increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management of fibroadenoma?

A

Conservative

Surgical if > 3cm
• Excision of fibroadenoma
• Mastectomy if large lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

2 types of breast abscess?

A
  • Lactational

* Non-lactational (not pregnant or breastfeeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cause of breast abscess?

A

S. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Risk factor for breast abscess and mastitis (especially non-lactational)?

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does a breast abscess present?

A

Both types:
• Fever
• Breast warmth and tenderness (general inflammation)
• Breast firmness

Non-lactational:

  • History of previous infections
  • Less pronounced systemic upset
  • Scars or tissue distortion from previous episodes
  • Signs of duct ectasia (e.g. nipple retraction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Investigations for breast abscess?

A
  1. Ultrasound - hypoechoic lesion
  2. FNA
  3. MC&S
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management for breast abscess?

A

• FNA (therapeutic drainage)
• Antibiotics
- lac: flucloxacillin
- non-lac: flucloxacillin + metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management for mastitis?

A
  1. Continue breastfeeding
  2. If systemically unwell, nipple fissure, symptoms don’t improve, +ve infection:
    • Flucloxacillin for S. aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Outline BPPV (including cause)

A
  • Vertigo on changing head position (e.g. gazing upward)
  • Seconds to minutes (usually 10-20sec though)
  • Associated with nausea
  • Displacement of otoliths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Investigations for BPPV?

A

Positive Dix-Hallpike manoeuvre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Outline Meniere’s disease (including cause)

A

Recurrent episodes of:
• Tinnitus
• Paroxysmal vertigo
• Unilateral fluctuating hearing loss

Bilateral symptoms may develop after a number of years

  • Aural fullness
  • Nystagmus and positive Romberg test
  • Minutes to hours

• Disturbed homeostasis of endolymph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Investigation for Meniere’s disease?

A

No diagnostic test
• Air and bone conduction for hearing
• Exclusion of other causes of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a classic feature of infectious mononucleosis in the peripheral blood?

A

Atypical lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Features of infectious mononucleosis?

A

Triad:
• Sore throat
• Lymphadenopathy
• Pyrexia

  • Palatal petechiae
  • Hepatosplenomegaly
  • Exudate on tonsils
  • Jaundice in some
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What happens to a patient with infectious mononucleosis who receives ampicillin/amoxicillin?

A

Maculopapular, pruritic rash

40
Q

Investigations for infectious mononucleosis?

A
  1. Bloods - lymphocytosis, raised AST/ALT
  2. Heterophile antibodies - IgM agglutination of animals RBCs when mixed
  3. Best - EBV-specific antibodies:
    - viral capsid antigen antibodies rise first (IgM/IgG)
    - nuclear antigen antibodies remain for life (IgG)
41
Q

Management for infectious mononucleosis?

A
  • Bed rest
  • Paracetamol/NSAIDS
  • Corticosteroids if severe
42
Q

What is the mean age of presentation of a thyroglossal cyst?

A

5 years

43
Q

Presentation of thyroglossal cyst?

A
  • Midline, smooth, rounded swelling
  • Between thyroid isthmus and hyoid bone
  • Moves upwards on protrusion of tongue
  • Can be transilluminated
  • Painful if infected
44
Q

Investigations for thyroglossal cysts?

A

None really needed
• TFTs if suprahyoid to exclude lingual thyroid
• Ultrasound/MRI - exclusion

45
Q

Cause of tonsillitis?

A
  • Usually viral

* Can be bacterial - group A streptococci

46
Q

Presentation of tonsillitis?

A
  • Sore throat
  • Painful swallowing
  • Referral to ears
  • Yellow exudate
  • Swollen anterior cervical glands

Strep:
• Acute onset
• Headache
• Abdominal pain

47
Q

Investigations for tonsillitis?

A

Not needed
• Throat culture - diagnostic
• Rapid strep antigen test - lower sensitivity but faster

48
Q

What are the 2 main types of abscesses?

A
  • Skin abscess

* Internal abscess

49
Q

Major risk factor for skin abscess?

A

IV drug use

50
Q

Characterisation of internal abscesses?

A
  • Pain in affected area / reffered
  • Swinging fever
  • Malaise
51
Q

Investigations for visualising abscesses?

A

Ultrasound

52
Q

Management for abscesses?

A
  • Incision and drainage (check for foreign object before)

* Antibiotics

53
Q

What is Behcet’s disease (including presentation)?

A
  • Inflammatory multisystem disease

* Often presents with orogential ulceration and uveitis

54
Q

Investigations for Behcet’s disease?

A

Clinical
• Pathergy test - skin prick in forearm, sterile pustule in 48 hours
• HLA-B51, complement levels, positive FHx

55
Q

Difference between keratoconjunctivitis and blepharoconjunctivitis?

A

Keratoconjunctivitis - inflammation of conjunctiva + cornea

• Blepharoconjunctivitis - inflammation of conjunctiva + eye lid

56
Q

What symptom suggests corneal involvement in conjunctivitis?

A

Photophobia

keratoconjunctivitis

57
Q

How is visual acuity affected in conjunctivitis?

A

It isn’t

58
Q

Signs of conjunctivitis?

A
  • Conjunctival injection (blood shot)
  • Dilated vessels
  • Conjunctival chemosis - swelling
  • Conjunctival follicles - collection of lymphocytes appearing as nodules
  • Conjunctival papillae - associated with allergic immune response
59
Q

Investigations for conjunctivitis?

A

Clinical

Rapid adenovirus immunoassay

60
Q

What is the most common mode of transmission of HIV (specifically)?

A

Heterosexual intercourse

61
Q

Features of HIV in each of the 3 phases?

A 
Seroconversion
• fever
• sore throat
• night sweats
• lymphadenopathy
• oral ulcers, rash, headache, diarrhoea

Early
• Apparently well
• Some with persistent lymphadenopathy
• Progressive minor symptoms e.g. weight loss

AIDS
• Secondary disease from immunodeficiency

62
Q 
What are the direct effects of HIV:
• Neurological
• Lung
• Heart
• Haematological
• GI
• Eyes
A
  • Neurological - dementia
  • Lung - lymphocytic interstitial pneumonitis
  • Heart - cardiomyopathy
  • Haematological - anaemia
  • GI - anorexia
  • Eyes - cotton wool spots
63
Q 
What are the secondary effects of HIV from immunodeficiency:
• Bacterial
• Viral
• Fungal
• Protozoal
• Tumours
A
  • Bacterial - TB
  • Viral - CMV
  • Fungal - Pneumocystis jiroveci, oesophageal candidiasis
  • Protozoal - toxoplasmosis
  • Tumours - Kaposi’s sarcoma
64
Q

Investigations for HIV?

A

ELISA: enzyme-linked immunosorbent assay

65
Q

What is the most serious and most common type of malaria?

A

Plasmodium falciparum

parasite

66
Q

Who has immunity to malaria? (4)

A
  • Sickle cell trait
  • G6PD deficiency
  • Pyruvate kinase deficiency
  • Thalassaemia
67
Q

Symptoms and signs of malaria?

A 
Cylical
• fever
• sweating
• rigors
(• cerebral - headache, disorientation, coma)
  • haemolytic anaemia
  • hepatosplenomegaly
68
Q

Investigations for malaria?

A
  • Thick and thin blood smears - detection of trophozoites/schizonts
  • Bloods - anaemia, acidosis
  • Urinalysis - protein
69
Q

Diagnostic criteria for neutropenic sepsis?

A

Temp > 38

Neutrophils < 0.5 x 10^9

70
Q

Why can patients have neutropenic sepsis without a fever?

A

They may be on anti-pyretics or steroids

71
Q

What is neutropenic sepsis a common complication of?

A

Chemotherapy for cancer - usually 7-14 days after

72
Q

Investigation for neutropenic sepsis?

A
  • FBC - neutropenia

* Blood cultures - sepsis

73
Q

What is cataracts?

A

Opacifications of lens

74
Q

Most common cause of cataracts?

A

Normal ageing process

75
Q

Symptoms and signs of cataracts?

A
  • Reduced vision (including colour)
  • Glare and halos around lights
  • Loss of red reflex
  • Hazy lens appearance
76
Q

Investigations for cataracts?

A
  1. Opthalmoscopy after pupil dilation: normal fundus and optic nerve
  2. Slit-lamp examination of anterior chamber: cataract visible
77
Q

Most common cause of curable blindness in the world?

A

Cataracts

78
Q

What is glaucoma?

A

Optic neuropathy associated with raised intraocular pressure

79
Q

What are the 3 primary causes of glaucoma?

A
  • Acute closed-angle
  • Chronic closed-angle
  • Primary open-angle

Closed-angle: obstruction of outflow of aqueous humour
Open-angle: resistance to outlflow through trabecular network

80
Q

Symptoms of acute closed-angle and primary open-angle glaucoma?

A 
ACAG
• Painful red eye
• Vomiting
• Impaired vision
• Halos around lights

POAG
• Asymptomatic
• Peripheral visual field loss

81
Q

Signs of acute closed-angle and primary open-angle glaucoma?

A 
ACAG
• Loss of red reflex
• Red eye
• Fixed dilated pupil
• Tender and hard eye
• Cupped optic disc

POAG
• Usually no signs
• Optic disc may be cupped

82
Q

Investigations for glaucoma?

A

ACAG
• Gonioscopy - diagnostic for angle closure
• Slit-lamp
• Perimetry

POAG
• Tonometry - most accurate for open angle
• Fundoscopy - flame haemorrhages, cupped disc
• Perimetry

83
Q

What is uveitis?

A

Inflammation of iris and ciliary body

84
Q

Causes of uveitis?

A

Infection e.g. HSV

Inflammatory disorders e.g.
• ankylosing spondylitis
• reactive arthritis
• IBD
• Behcet's disease
• Sarcoidosis
85
Q

What is sympathetic opthalmia?

A
  • Inflammation of contralateral eye weeks/months later

* T cells detect same eye antigens from initial injury in the contralateral eye

86
Q

Symptoms and signs of uveitis?

A
  • Pain during accomodation
  • Intense photophobia
  • Red eyes
  • Reduced visual acuity
  • Ciliary flush
  • Hypopyon - inflammation in inferior angle of anterior chamber
  • Small irregular pupil due to adhesion of iris to lens
87
Q

4 types of dementia in order of occurence?

A
  1. Alzheimer’s disease
  2. Vascular dementia
  3. Lewy body dementia
  4. Frontotemporal dementia / Pick’s disease
88
Q

Presentation of the 4 types of dementia?

A
  • Alzheimer’s - memory deficits => motor/language/personality
  • Vascular - stepwise, function deficit => memory
  • Lewy body dementia - fluctuating consciousness, cognitive activities => falls and Parkinsonism. Visual hallucinations.
  • Frontotemporal dementia - disinhibition, personality change
89
Q

What are the 2 core symptoms for diagnosing major depression?

A
  • Persistent sadness or low mood nearly every day

* Loss of interests or pleasure in most activities

90
Q

How long should symptoms have persisted in depression?

A

At least 2 weeks

91
Q

How does depression present differently to dementia?

A

Depression
• Short history, rapid onset
• Sleep disturbance
• Global memory loss (rather than recent memory loss)

92
Q

Assessment tools for depression? (3)

A
  • Patient health questionnaire PHQ-9
  • Hospital Anxiety and Depression (HAD) scale
  • DSM-IV criteria
93
Q

Management: smoking cessation

A

• Nicotine replacement therapy (gum/lozenge)

Then
• Varenicline - nicotinic receptor partial agonist
or
• Bupropion - NA + dopamine reuptake inhibitor, and nicotinic antagonist

Just before the stop date

94
Q

How is management for cigarette cessation different for those smoking < 10 a day, or ‘time to first cigarette’ is ≤ 30 minutes

A

< 10 a day - as-needed nicotine replacement

TTFC ≤ 30 minutes - higher dose nicotine replacement

95
Q

What characteristics increase risk of tumour lysis syndrome?

A

High cell turnover rate, rapid growth, chemo-sensitive tumours e.g. lymphoma

TLS is due to sudden lysis of tumours during treatment - most commonly lymphomas and leukaemias

96
Q

Presentation of tumour lysis syndrome?

A

Hyperkalaemia - main intracellular ion
• arrhythmia
• muscle weakness/paralysis

Hyperphosphataemia - intracellular ion
• acute kidney failure due to calcium phosphate crystals

Hypocalcaemia - used to make calcium phosphate because of hyperphosphataemia
• convulsions
• arrythmias
• tetany
• numbness

Hyperuricaemia - purine degradation from nucleic acids
• gout

Lactic acidosis

Year 3 diagnosis and management (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions