Paper 2 prep Flashcards
Mx of fibromyalgia?
Explain + CBT
Aerobic exercise - best evidence
neuropathic pain meds
Shoulder dislocations - which is when?
95% + = anterior (external rotation and abduction)
Seizure = posterior
Calf squeeze + absent plantar flexion = ???
Ix?
Achilles tendon rupture (simmonds test +ve)
US + refer to ortho
What to do when starting allopurinol for gout prevention?
Provide NSAID or colchine cover as it can trigger acute flare up
Which nerve is used for finger abduction and adduction? How can you distinguish if leison is at the wrist or elbow?
Ulnar (palmer and dorsal interossei muscles)
Ulnar injury at wrist : marked claw
Ulnar injury at elbow : less claw but get worse before getting better
(The closer to the paw, the bigger the claw)
Which is better to diagnose ank spond:
Lumbar XR = bamboo spine
Pelvic XR = sacro iliits
Pelvic XR = sacro iliits - the other is a late stage sign
Loss of foot dorsiflexion + sensory loss of dorsum of foot = what nerve root leison?
L5
How to distinguish between L3 and L4 nerve root compression?
Both cause:
- Reduced knee reflex
- +ve femoral stretch test
L3:
- Sensory loss over anterior thigh
- Weak hip flexion, knee extension and hip adduction
L4:
- Sensory loss anterior aspect of knee and medial malleolus
- Weak knee extension and hip adduction
Mx of achilles tendonitis?
Rest, NSAIDs, and physio if symptoms persist beyond 7 days
What are some RFs for achilles tenrdon disorders?
quinolone use (e.g. ciprofloxacin) is associated with tendon disorders
hypercholesterolaemia (predisposes to tendon xanthomata)
ITP type of hypersenitivity?
Type II hypersensitivity reaction
DMARD w/ mouth ulcers?
Methotrexate
What drug can cause dupuytrens contracture?
Phenytoin
The humeral head is seen in a subcoracoid position in anteroposterior view on X-ray
Anterior shoulder dislocation
Compression of what nerve root = present with back, groin, and anterior thigh pain. There may be weakness of hip flexion but lower limb reflexes tend to be normal.
L2
Compression of what nerve root = present with back, groin, and anterior thigh pain. There may be weakness of hip flexion but lower limb reflexes tend to be normal.
L2
Ulnar parasthesia + weak digit flexion (inc thumb) =??
C8 radiculopathy
A knee radiograph identifies a triangular area of new subperiosteal bone in the metaphyseal region of the femur, with a ‘sunburst’ pattern
Dx??
Osteosarcoma
Signs of primary raynauds (disease)?
Bilateral raynauds + onset <40y
Best initial mx of open fractures?
IV Abx
photography of wound
application of a sterile soaked gauze and impermeable film
Behcets - derm finding?
Erythema nodosum
Nursemaid elbow mx (subluxation of radial head - pulled elbow)?
Passive supination of the elbow joint whilst flexed to 90 degrees
Mx of patellar fractures?
Undisplaced fractures with intact extensor mechanism:
- Non-operative management
- Hinged knee brace for 6 weeks
- Full weight bearing allowed
Displaced fractures or those with disrupted extensor mechanism:
- Operative management with various techniques (tension band wire, interfragmentary screws or cerclage wires)
- Hinged knee brace for 4 to 6 weeks
- Full weight bearing allowed
allergic contact dermatitis - hypersenitivity type?
Type 4 (IV)
What is antisynthetase syndrome?
Myositis with +ve anti-Jo1 antibodies can predispose to lung fibrosis
Why may a pt w/ temporal arteritis have a pale and oedematous optic disc on fundoscopy?
Anterior ischaemic optic neuropathy
What nerve is damaged:
Weakness in hip adduction, numbness over the medial thigh
Obturator
What nerve is damaged:
Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle
Sciatic
What nerve is damaged:
Weakness in ankle dorsiflexion, numbness of the calf and foot
Lumbosacral
Weakness in knee extension, loss of the patella reflex, numbness of the thigh
Femoral
Mx of suspected scaphoid fracture w/ no signs on initial XR?
This could well be a scaphoid fracture and should be temporarily immobilised pending further review.
A futura splint will immobilise better than an arm sling for this problem.
Clinic review @7-10d
Chemo pts - gout or pseudogout?
GOUT
Which antibodies are associated w drug induced lupus?
Which drugs can cause this?
Anti histone
Drugs:
- Most common = Procainamid + hydralazine
- Less common = Isoniazid, minocycline and phenytoin
What indicates that hip pain may be due to referred lumbar spine pain?
+ve femoral nerve stretch test
Gout meds - cause of diarrhoea?
Colchicine
What can cause a false +ve VDRL / RPR (for syphilis)
SLE, TB, Malaria, HIV
Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests what infection?
Leptospirosis
Mx of chlamydia trachomatis - in pregnancy and otherwise?
Pregnancy = azithro, erythro / amox
Non-pregnant = doxycycline
Mx of pubic lice?
Malathion / permethrin
Mx of flagellated protozoa - STI?
Trichomonas vaginalis -> Metronidazole
PainLESS penile ulcer - likely organism?
Treponema pallidum - syphilis
Ix for symptomatic schistosomiasis?
Stool + Urine microscopy - look for eggs
chronic infection mx = 1 dose praziquantel
Exudative tonsiliits - organism
Strep pyogenes
What is post exposure prophylaxis for HIV?
Refer to ED and oral ART 4w
Ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss +/- recent travel → ???
ix?
mx?
Giardiasis
ix = stool microscopy, antigen detection assay = more sensitive + quicker
mx = metronidazole
Syphilis test result interpretations:
RPR and TPHA
Skin hypopigmentation + Loss of sensation = ???
Leprosy
mx = RDC - rifampicin, dapson and clofazimine
MRSA (when pt is vancomycin allergic)
Linezolid
Most common cause of diarrhoea in HIV pts?
Cryptosporidium
Pt w/ previous TB + An X-ray is taken which shows a target-shaped lesion in the right upper lobe with air crescent sign present
Likely dx?
Aspergilloma - developing in lung cavity caused by TB
Farmer, fever, transaminitis - dx and mx?
Q fever - Coxiella burnetti (from animals)
Doxycycline
When to suspect reinfection w/ syphilis?
If RPR rises by 4x or more
What is CSF glucose like in bacterial meningitis?
CSF glucose is <1/2 of serum glucose
HIV, neuro symptoms, widespread demyelination - dx?
progressive multifocal leukoencephalopathy (PML) - JC / BK Virus
IDA + itchy rash + Eosinophilia -> dx?
Hookworm
Man returns from trip abroad with maculopapular rash and flu-like illness
HIV seroconversion
What pneumonia is often preceeded by influenza infection?
Staph aureus
Returning south american traveller + primary skin leisons w/ mucosal involvement - dx?
Leishmaniasis
undercooked pork - which hep?
HEP E
Avoid usuing hypotonic (0.45%) in paeds pts - why?
Risk of hyponatraemic encephalopathy
When should suxamethonium be avoided in anasthesia?
Suxamethonium is contraindicated for patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure
Ix for anastomotic leak
CT abdo
Adhesions - more common in laparoscopic or open surgeries?
Open - lap reduces risk
Mx of hypocalcaemic tetany following thyroidectomy?
IV ca
How much should morphine doses be increased by in palliative pt if pain isnt conrolled by current dose?
30-50%
Mx of Warm AIHA?
Steroids +- Rituximab
What drug can cause renal failure in MM?
NSAIDs
typical blood film findings of hyposplenism?
Howell-Jolly bodies and siderocytes
