PASSMED 04/04 - 07/04 Flashcards
UKMEC 3 conditions:
> 35 years old and smoking <15 cigarettes per day
BMI >35
FHx thromboembolic disease
Controlled hypertension
Wheelchair use
Carrier of BRCA1/2
Current gallbladder disease
UKMEC 4 conditions:
> 35 years old and smoking >15 cigarettes a day
Thromboembolic disease
Migraine with aura
Current breast cancer
Post partum and breastfeeding <6 weeks
Uncontrolled hypertension
Positive antiphospholipid antibodies e.g. SLE
History of stroke / VTE
Triad of renal cell cancer:
Loin pain
Haematuria
Abdominal mass
An unresolving varicocele can be due to renal tract cancer, due to compression. What are the investigation steps?
Cystoscopy if painless haematuria because could be bladder cancer.
Renal tract cancer = renal tract ultrasound.
Non-shockable rhythms:
PEA
Asystole
Shockable rhythms:
VF
Pulseless VT
VF / Pulseless VT witnessed vs non-witnessed management:
Witnessed: 3 successive shocks
Non-witnessed: 1 shock then CPR
Drug delivery during cardiac arrest:
IV first line
IO if IV not available
Non-shockable rhythms initial management:
Adrenaline asap for non-shockable rhythms
(Adrenaline is given in shockable rhythms after the 3rd shock, alongisde amiodarone 300mg)
Red flags of secondary dysmenorrhoea:
Ascites +/or pelvic or abdominal mass
Abnormal cervix
Persistent IMB or PCB (without associated PID symptoms)
SSRI of choice for children and adolescents:
Fluoxetine
Lithium toxicity can be precipitated by dehydration, renal failure, and certain drugs. List some of the drugs, and give 2 management options.
Diuretics esp thiazides, ACEi/ARB, NSAIDs and metronidazole.
IV fluids with isotonic saline. Monitor sodium closely to watch for nephrogenic diabetes insipidus.
Haemodialysis for severe cases e.g. seizures, profound renal failure.
Cut off protein level for exudates and transudates, and light’s criteria:
> 30 = exudate
<30 = transudate
Pleural fluid protein / serum protein >0.5
Pleural fluid LDH / serum LDH >0.6
Pleural fluid LDH >2/3 upper limit of normal serum LDH
What does a) low glucose b) raised amylase c) low complement and d) heavy blood staining indicate in pleural fluid?
a) RA, TB
b) Pancreatitis, oesophageal perforation
c) SLE
d) Mesothelioma, PE, TB
A pleural infection is suspected - when should a chest tube be placed to drain it?
Fluid is cloudy / turbid
Fluid is clear but pH is <7.2
Most common type of glomerulonephritis in adults?
Membranous GN
Management of membranous GN;
ACEi or ARB (reduce proteinuria)
Only give steroids + cyclophosphamide if severe
?anticoagulation
Triad of shaken baby syndrome:
Subdural haemorrhage
Retinal haemorrhage
Encephalopathy
Diagnosis of G6PD deficiency:
At and 3 months after presentaiton
G6PD ENZYME ASSAY
Treatment for suspected epididymo-orchitis:
IM Ceftriaxone once only + Oral doxycycline for 10-14 days
First line investigation for cholangitis, and management:
US to look for bile duct dilatation and stones
IV abx and ERCP after 24-48 hours to relieve any obstruction
Which steroid is used for fetal lung maturation?
Dexamethasone
Weakened femoral pulses, upper limb hypertension, left sternal edge / back murmur, tachycardia:
Coarctation of the aorta
Cyanosis, tet spells, harsh systolic ejection murmur, RVH, reduced o2 sats:
TOF
pda and coarctation are which type of shunt?
Left to right shunt
Features of PDA:
continuous machinery murmur
Bounding pulses, wide pulse pressure, respiratory distress. O2 sats typically normal unless pulmonary hypertension develops.
6th nerve palsy (abducens):
Lateral rectus affected; eye abduction limited.
CNVI has a long intracranial course therefore making it more likely to be damaged by raised ICP.
Familial hypercholesterolaemia is an AD inherited disorder. Which protein is mutated in this condition?
LDL receptor
What does a positive head impulse test indicate?
Pathology with the vestibulocochlear nerve on the IPSILATERAL side of the positive test.
Discuss the meaning of uni and bidirectional nystagmus:
Unilateral is reassuring, likely to be peripheral in origin.
When the nystagmus changes direction or is vertical, it is more likely to be central in origin.
Bidirectional is highly specific for stroke - saccadic movement beats in the direction that the patient is looking.
Hoffman’s sign positive indicates an upper motor neuron lesion. Give 2 diseases that a positive Hoffman’s sign may be associated with:
Degenerative cervical myelopathy
Multiple sclerosis
Management pathway for endometriosis:
NSAIDs / paracetamol
COCP or progestogen
GnRH analogue (inducing pseudomenopause)
Laparoscopic excision or ablation to improve chances of conception
How often should a patient with a spontaneous pneumothorax be followed up?
2-4 days until resolution
4 ways to assess frailty in primary care:
PRISMA-7 questionnaire
Informal gait speed assessment
Self reported health status
Formal assessment of gait speed - >5 second to walk 4m = frail
2 extra tools to assess frailty that can be used in the outpatient settingL
Timed Up and Go test
Physical Activity Scale for the Elderly
What tool can be used to optimise elderly patient’s medications?
STOPP / START
% values for 1SD, 2SD and 3SD of the mean:
68.3%
95.4%
99.7%
Most common cause of pleural exudate vs transudate respectively:
Pneumonia exudate
Heart failure transudate
Causes of transudative pleural effusion:
Heart failure
Hypoalbuminaemia e.g. nephrotic syndrome, liver disease, malabsorption
Hypothyroididm
Meig’s syndrome
Causes of exudative pleural effusion:
Pneumonia
TB
CTD e.g. RA, SLE
Lung cancer, mesothelioma, mets
Pancreatitis
PE
Dressler’s syndrome
