Passmed Flashcards
what should people with STEMI undergoing thrombolysis be given
Alteplase and antithrombin (fondaparinux)
what drugs can cause ear ringing
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
first line for acute bronchitis
doxycycline
which type of carcinoma is associated with polycythemia
renal adenocarcinoma
widening of the mediastinum
vascular problems: thoracic aortic aneurysm
lymphoma
retrosternal goitre
teratoma
tumours of the thymus
Ulnar nerve motor innvervation
medial two lumbricals
aDductor pollicis
interossei
hypothenar muscles: abductor digiti minimi, flexor digiti minimi
flexor carpi ulnaris
responsible for finger abduction, thumb adduction, and muscle bulk of hypothenar eminence
Ulnar nerve sensory innervation
medial 1 1/2 fingers (palmar and dorsal aspects)
Trachea pushed away from white-out CXR
Pleural effusion
Diaphragmatic hernia
Large thoracic mass
Trachea pulled toward the white-out
Pneumonectomy
Complete lung collapse e.g. endobronchial intubation
Pulmonary hypoplasia
most common organism for osteomyelitis
stpah aureus most common except in those with sickle-cell disease, where salmonella species dominate
HAP treatment
within 5 days: co-amoxiclav or cefuroxime
more than 5 days: piperacillin with tazobactam
Immediate management of acute angle closure glaucoma
- parasympathomimetic eyedrops (pilocarpine)
- beta blocker eye drops (timolol)
what is required before fundoplication can occur
- oesophageal ph
- manometry studies
HUS triad
- acute kidney injury
- microangiopathic haemolytic anaemia
- thrombocytopenia
Wernike’s encephalopathy
chronic alcohol –> thiamine deficiency
- confusion
- gait ataxia
- nystagmus + opthalmoplegia
Kleinfelters vs Kallman
Kleinfelters
- small testes
- infertility
- gynaecomastia
- above average height
Kallmans
- anosmia
- NO gynaecomastia
which organism stains with India Ink
cryptococcus neoformans
heart failure management
1st - ACEi and Beta blocker
2nd - Aldosterone antagonist or ARB or hydralazine and nitrate (especially in people of African or Carribean origin)
3rd - cardiac resynchronisation therapy OR digoxin
aphasia regions and artery supplie
Wernike’s - superior temporal gyrus supplied by inferior MCA
broce’s - inferior frontal gyrus supplied by superior MCA
ataxia - where in the cerebellum
peripheral ‘ finger-nose ataxia’ - cerebellar hemisphere
gait ataxia - cerebellar vermis
where is th elesion cut-off for autonomic dysreflexia
T6 or above
bells palsy
- give oral prednisolone within 72 hours
- if no sign of improvement in 3 weeks, then urgent referral to ENT
brain absess management
surgery
a craniotomy is performed and the abscess cavity debrided
the abscess may reform because the head is closed following abscess drainage.
IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
intracranial pressure management: e.g. dexamethasone
what area of the brain does Huntington’s affect
caudate nucelus of the basal ganglia
what area of the brain does Parkinsons suggest
substantia nigra of the basal gangia
brown sequard syndrome
- ipsilateral weakness below lesion
- ipsilateral loss of proprioception and vibration sensation
- contralateral loss of pain and temperature sensation
common peroneal nevre lesion
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles
lower motor neuron facial nerve palsy causes
Bell’s palsy
Ramsay-Hunt syndrome (due to herpes zoster)
acoustic neuroma
parotid tumours
HIV
multiple sclerosis*
diabetes mellitus
4th nerve palsy
vertical diplopia
deviate upwards and outwards
damage at the wrist - median nerve
paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity)
sensory loss to palmar aspect of lateral (radial) 2 ½ fingers
damage at the elbow - median nerve
unable to pronate forearm
weak wrist flexion
ulnar deviation of wrist
LOAF muscles of the hand
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
narcolepsy symptoms
typical onset in teenage years
hypersomnolence
cataplexy (sudden loss of muscle tone often triggered by emotion)
sleep paralysis
vivid hallucinations on going to sleep or waking up
investigation for genital herpes
NAAT
spastic MS treatment
baclofen or gabapentin
blood film of hyposplenism
target cells
howell-jolly bodies
what dementia is associated with MND
frontotemporal dementia
chronic schistosoma features
frequency
haematuria
bladder calcification
‘eggshell calcification’
chronic schistomoa investigations
asymptomatic - schistosome antibodies preferred
symptomatic - urine ot stool microscopy looking for eggs
SE - nicorandil
ulceration anywhere in the GI tract
reynolds pentad
- fever
- RUQ pain
- jaundice
- hypotension and confusion
stable angina - investigations
1st - CT coronary angiography
pain relief to use in CKD
mild-moderate: oxycodone
severe: bupremorphien or fentanyl
electrolyte anomaly most associated with RBC transfusion
hyperkalaemia
ITP treatment
1st - oral prednisolone
if urgent prcedure required IVIG
when is aortic valve replacement considered
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
if symptomatic then valve replacement
role of hypoglossal nerve
- motor innervation of the tongue
- lesion will cause the tongue to deviate towards the affected side
what medication needs to be stopped before a CT scan
metformin
serum osmolaitiy equation
2 x(Na) + Urea + glucose
visual difference between BCC and SCC
BCC - pale, rolled edges, slow in growth, overlying telangiectasia
SCC - usually red, more rapid in growth
which anti-TB drug needs visual monitoring
ethambutol
PTH in primary hyperparathyroidism vs bony metasteses
pirmary - normal or raised
bony metasteses - suppressed
indiaction for bariatric surgery
obesity in patients with BMI > 40 kg/m2, or BMI > 35
kg/m2 with comorbidities such as diabetes and hypertension
lesion is macula sparing…
occipital cortex
when is radiotherapy offered - brest cancer
all women with wide-local excision
mastectomy - only if tumor T3-T4 and those with 4 or more positive axillary nodes
cellulitis near the nose
co-amoxiclav
adverse effects of sulfalezine
oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses
DKA when to start potassium and glucose
glucose <14 - infusion of 10% dextrose at 125mls/hr
Potassium between 3.5 - 5.5
DKA resolution definition
pH >7.3
blodo ketones <0.6 and
bicarb >15
primary hyperaldosteronism - invesitgations
1st plasma aldosterone/renin ration
high -resolution CT
if CT normal, adrenal venous sampling can distinguish between adenoma and bilateral hyperplasia
cut-offs for impaired glucose tolerance
fasting glucose greater than or equal to 6.1 - 7
OGTT >= 7.8 and <11.1
bacterial keratitis causes
staphylococcus aureus
contact lenses - psudomonas aeruginosa
AAA screenign results
<3 -dishcarge
3 - 4.4 - rescan every 12 months
4.5 - 5.4 - rescan every 3 months
5.5 and above - refer to vascular 2 week wait
chromosome anomaly of Turner’s
45XO
squamous cell carcinoma of the oropharynx - assocation
HPV
hodgekins lymphoma - 1 st line
chemotherapy
sodium correction complications
hyponatraemia - osmotic demyelination syndrome
hypernatraemia - cerebral oedema
lateral epicondylitis
wrsit extension
elbow supination with extended forearm
medial epicondylitis
wrist flexion
pronation
what is given with isoniazid
pyridoxine
prevent peripheral neuropathy
eletrolyte anomaly - prolonged diarrhoea
hypokalaemia
what medicaiton should all people with CKD be given
statin
propofol
anti- emetic properties
maintaining sedation on ITU, total IV anaesthesia and daycase surgery
sodium thiopentone
used for rapid sequence of induction
ketamine
induction of anaesthesia
best for those heamodynamically unstable
etomidate
no analgesic properties
post-op vomititng common
medication in STEMI treated with PCI
aspirin 300 mg
praugrel/ticagrelor/clopidogrel
unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor (tirofiban)
medication in STEMi treated with fibrinolysis
aspirin 300mg
alteplase + antithrombin
follwing procedure give ticagrelor
medication in NSTEMI
300 mg aspirin and fondaparinux if no immediate PCI planned
low risk
- ticagrelor/clopidogrel
high risk
- ticagrelor/prasugrel
- unfractionated heparin
medication of preventative oesophagela bleeds
propanolol
yellow nail syndrome
yellow nails
lymphoedema
pleural effusion
vaccination in splenectomy
if elective - done 2 weeks prior to operation
Hib, meningitis A&C
annual influenza vacciantion
pneumococcal vaccine every 5 years
