Passmed 4 Flashcards
1
Q
TTP presents with
A
pentad of fever, neuro signs, thrombocytopenia, haemolytic anaemia and renal failure
2
Q
Holmes Adie pupil =
A
= DIlated pupil, females, absent leg reflexes
3
Q
myositis ab
A
anti-jo1
4
Q
persistent ST elevation + LVF following MI
A
Left vent aneurysm
5
Q
pericarditis vs dresslers syndrome
A
- pericarditis: common in first 48 hrs after MI
- dresslers: 2-6 weeks followng MI - fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.
6
Q
A 22-year-old male falls of a ladder. He complains of neck pain and cannot feel his legs. His GCS suddenly deteriorates and a CT head confirms an extradural haematoma. What is the best imaging for his neck?
A
CT c spine
7
Q
left v free wall rupture
A
- cardiac tamponade symptoms - raised JVP, quiet heart sounds, pulsus paradoxsus
8
Q
acute mitral regurg
A
- due to ischaemia or rupture of papillary muscle
- pulm oedema and hypotension
9
Q
The risk factors for congenital hip dislocation include:
A
- Female gender
- Breech presentation
- Family history
- Firstborn
- Oligohydramnios
10
Q
rf for adhesive capsulitis
A
diabetes
11
Q
posterior vs ant shoulder dislocations
A
- Anterior shoulder dislocation is associated with FOOSH;
- posterior shoulder dislocation is more likely associated with seizures and electric shock
12
Q
painful arc between 90-120 degrees
A
subacromial impingement
13
Q
TB drug -> lupus
A
isonazid
14
Q
ITP is which type of HSN
A
2
15
Q
Ottowa ankle rules
A
bony tenderness over the malleoli zones OR an inability to walk four weight-bearing step
16
Q
For children aged 5 to 16 with suspected asthma, if the FeNO is >= 35 ppb then
A
asthma can be diagnosed
17
Q
what should be done b4 starting ab for pyelo
A
midstream urine culture then ab
18
Q
scleritis
A
- EXTREMELY PAINFUL AND RED INJECTED EYE
- associated with SLE
19
Q
MEN 1
A
Peptic ulceration, galactorrhoea, hypercalcaemia
20
Q
Sus venous ulcer ->
A
do ABPI before compression stockings
21
Q
What is the most appropriate time to take blood samples for therapeutic monitoring of phenytoin levels?
A
immediatelly b4 next dose
22
Q
BV in pregnancy
A
still use oral metro
23
Q
de clerambaults syndrome =
A
he presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms
24
Q
Indications for thoracotomy in haemothorax include
A
- > 1.5L blood loss intiially
- > 200ml per hour loss > 2 hrs
25
Othello syndrome
delusional jealously, usually believing their partner is unfaithful
26
what can be used within an hour of aspirin OD
Activated charcoal
27
localising feature of temporal lobe seizure
- typically a rising epigastric sensation
- also psychic or experiential phenomena, such as dejà vu, jamais vu
- hallucinations
- !! automatisms e.g. lip smacking
28
frontal lobe seizures
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
29
parietal lobe seizure =
parasthesia, sensory
30
occipital lobe seizures
floaters/ flashers
31
HAP Mx
- occurs > 48 hrs of hosp admission
- co-amox
32
features of TOF
Pulm stenosis
RVH
Overriding aorta
VSD
33
most common cause of chronic panc
alcohol
34
koebner phenomenon
psoriasis. new skin lesions at sites of injury
35
medullary thyroid cx tumour marker
- calcitonin (think medulla of bones)
36
- Returning traveller with fever, RUQ pain → ?
- ?amoebic liver abscess
- ultrasound scan of the liver shows a homogeneous hypoechoic round lesion.
37
CRC - monitoring
CEA
38
Mx of a venous ulcer
compression banding
39
Persistent unexplained vulval skin lesion should
prompt 2www
40
Infant < 8 weeks, presents with milky vomits after feeds, often after being laid flat, excessive crying → ?
- GORD
- CMPA presents with diarrhoea & rash
41
why should we give albumin cover with paracentesis
- to reduce mortality
42
mx of PCOS - oligmenorrhoea
- inc risk of endometrial cancer
- so use a COCP, IUS or COCP to induce a withdrawal bleed
43
Mx hirtutism w PCOS
- cocp
- topical elfornithine can be tried if no resp
44
tardive dyskinesia
can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics
45
flexor tendon sheath infection
- kanavels signs@
- fixed flexion, fusiform swelling, tenderness and pain on passive extension
46
most effective form of EC
IUD - not affected by BMI also
47
PD vs Essential tremor
- PD: asymmetrical worse at rest
- ET: worse on arms being stretched out, made better by alcohol
48
Deaths occurring within 24 hours of admission to hospital should be
should be discussed w coroner before death certificate is ussed
49
Mx of meningitis > 60
IV ceftriaxone + amox/ ampicillin
50
Prolapsed disk Mx
- physio & NSAIDs
if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate
51
typical eczema sites in an infant
face and trunk
52
how is chalmydia dx
NAAT
53
troubling GI sx with alendrinate ->
change to risedronate or etidronate
54
Dukes staging of CRC
a: Tumour confined to mucosa
b: tumour invading bowel wall
c: lymph node mets
d: distant mets
55
Patients with GORD being considered for fundoplication surgery require
oesophageal pH and manometry studies
56
epigastric hernia =
lump in the midline between umbilicus and the xiphisternum
57
para-umbilical hernia =
asymmetrical bulge directly above or below umbilicus
58
mx of aurical haematomas
urgent ENT ref for same day assessment
59
non resolving unilateral ear discharge
- suggest cholesteatoma
- refer to ENT
60
main neurovascular structure that is compromised in a scaphoid fracture
dorsal carpal arch of the radial artery
61
1st line for knee arthritis
topical NSAID
62
Mx of constipation in kids
- osmotic laxative - e.g. macrogol
- stimulant is 2) e.g. senna
63
is an important CF-specific contraindication to lung transplantation
chronic infection w burkholderia cepacia
64
normal CO2 in an asthma attack ->
life threatening
65
Burning thigh pain - ?
meralgia paraesthetica - lateral cutaneous nerve of thigh compression
66
marfans features
- Hypermobility, tall stature, long fingers
- petus excavatum and pes planus are features
- assoc w aortic dissection
67
mx of interctrochanteric/ extracapsular hip fractures
dynamic hip screw
68
? are associated with an increased risk of atypical stress fractures
bisphosphonates
69
neoplastic SCC
high dose dexamethasone then MRI
70
Features of keratitis:
red eye, photophobia and gritty sensation
71
On examination the ring and little fingers of his left hand are flexed and unable to extend completely. He is able to make a fist with the hand. Palpation reveals thickened nodules on the medial half of the palm. ->
DUPUYTRENS CONTRACTURE
72
Herbendens nodes ->
DIP swelling
73
where are keloid scars more common
sternum
74
most common type of inherited CRC
HNPCC
75
Children and young people with unexplained bone swelling or pain:
immedate xr for bone sarcoma
76
Moderate/severe psoriatic arthropathy →
methotrexate
77
most common pres of test cancer
painless testicular lump in 15-35 y.o
78
Primary hyperaldosteronism: manage with
spironolactone
79
non haem febrile reaction
- fevers, chills
- slow or stop the tranfusion + paracetamol
80
minor allergic reaction to blood transfusion
- pruitis + urticaria
- temp stop the transfusion
- give an antihistamine
81
anaphylaxis to blood transfusion
- Hypotension, dyspnoea, wheezing, angioedema
- stop tranfusion
- IM adrenaline
82
acute haem reaction
- ABO incompatbile blood
- fever, abdo pain, hypotension
- stop transfusion + send blood for direct Coombs
- fluid resus
83
TACO
- rf: fast transfuion or pre-existing HF
- pulm oedema or HTN
84
Mx of TACO
IV furosemide
85
TRALI
- Hypoxia, hypotension, pulmonary infiltrates on xr
- stop transfusion
- give o2
86
mx of sudden onset sensorineural hearing loss
urgently refer to ENT +high dose oral steroids
87
In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a
Twice daily basal insulin determir + insulin aspart bolus with meals
88
mx of animal bite
- co-amox - co for cat
- doxy + metro if penicillin allergic
89
immediate mx of acute epiglottitis
- refer to hosp, consider intubation
90
useful mirtazepine side effects
sedation & increased appetite
91
mx of vg thrush
- single dose of oral fluconazole
- if preg: topical comitrazole
92
late sign of CES
Urinary incontinence
93
In a patient with long-standing type 1 diabetes, impaired hypoglycaemia awareness is most commonly due to
neuropathy in the autonomic NS
94
When should amitriptyline be avoided
BPH - risk of urinary retention
95
Short stature + primary amenorrhoea ?
turners syndrome
96
definitive mx of cardiac tamponade
thoracotomy
97
Firm and well-circumscribed mass that transilluminates on the dorsal aspect of the wrist →
- ganglion
- surgical excision is indicated for cysts associated with severe symptoms or neurovascular manifestations
98
Prerenal disease - raised
urea: creatnine ratio
99
pseudohallucinations
- patients understand what they're seeing is not real
- part of non-pathological grief reaction
100
Ongoing loin pain, haematuria, pyrexia of unknown origin → ?
rcc
101
what to do if u get a needlestick injury
ask someone else to complete the risk assessment and take the patient's blood
102
spider naevia are assoc w
Liver disease, pregnancy, COCP
103
Abdominal pain, bloating and vomiting following bowel surgery → ?
Post-op ileus
104
first line for suspected primary hyperaldosteronism
plasma aldosterone/renin ratio
105
first line Ix for pagets
plain radiographs for pelvis and lumbar spine
106
what can precipitate renal failure in MM
naproxen
107
spirometry in PF
- Raised FEV1: FVC
- impaired TLCO
108
first line ab for CAP
Amox
109
low molecular weight heparin has the greatest inhibitory effect on which one of the following proteins involved in the coagulation cascade?
factor 10a
110
LT feeding in a neuro/ stroke pt
PEG feeding
111
hypothermia is a cause of
panc
112
poor prognostic factors in schizo
- low IQ
- gradual onset
- Fhx
- lack of obvs precipitant
113
what is classically impaired in frozen shoulder
external rotation (think of not being able to do their bra up)
114
Widespread convulsions without conscious impairment is likely to represent
pseudoseizure
115
bulbar MND vs MG
eye movements spared in MND
116
fasiculations think
mnd
117
Primary haemorrhage within hours after tonsillectomy requires
- immediate return to threatre
- secondary haemorrhage: admit + antibiotics (assoc w wound infection)
118
when should intranasal steroids be considered in sinusitis
if symptoms > 10 days
119
ototoxic meds
- gentamicin
- quinine
- aspirin
- furpsemide
120
when does a thyrglossal cyst present
usually under 20
121
soft, fluctulant and highly transilluminable neck lump
cystic hygroma
122
In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is negative then they should have
sentinal node biopsy
123
bilateral cream coloured discharge ->
prolactinoma
124
In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is negative then they should have
pagets -> urgent referral to BC
125
Diagnostic Ix of choice in NHL
exisional LN biopsy
126
what is used to assess drug sensitivites in TB
sputum culture
127
Mx acute, severe, symptomatic hyponatraemia (< 120 mmol/L)
- hypertonic saline - 3% NaCl
128
features of life threatening asthma
- Cyanosis
Poor respiratory effort *normal CO2)
Peak expiratory flow rate < 33%
Silent chest
Altered level of consciousness
129
First lines for opiod detox
Methadone or buprenorphine
130
Cervical cancer screening: if 1st repeat smear at 12 months is still hrHPV +ve →
- repeat smear 12 months later (i.e. at 24 months)
- after 2x repeat smears -> colp
131
If new BP >= 180/120 mmHg + ? -> refer for assessment
- new onset confusion
- CP
- signs of HF
- AKI
132
what is assoc w bisferiens pulse
HCOM or aortic stenosis/ regurg
133
common cause of MS
Rheumatic fever - prodomal illness + erythema marginatum (bulls eye rash)
134
SE of adenosine
- CP, bronchospasm, transient flushing
- half life of 10s
135
HCOM inheritance
autosomal dominant
136
New onset AF is considered for electrical cardioversion if it
presents within 48 hours of presentation
137
A new left bundle branch block should prompt investigation for
ACS - do a high sensitivity trop
138
antibiotic prophylaxis for IE for dental procedures
NONE
139
AKI - stop the DAMN drugs
Digoxin and Diuretics
ACEi/ ARBs
Metformin and Methotrexate
NSAIDs
140
In hypothermia, rapid re-warming can lead to
peripheral vasodilation and shock
141
best Ix for aoritc dissection
CT angio thorax, abdo, pelvis
142
Major bleeding on warfarin
stop warfarin, give intravenous vitamin K 5mg, prothrombin complex concentrate
143
which diuretics -> ED
THIAZIDE LIKE E.G. INDAPAMIDE
144
ACS symptoms but normal tropnonins ->
unstable angina
145
which drug -> anal ulcers
- nirconadil
- can lead to sigmoid perforation espec in pts with diverticular disease
146
which angina drugs can lead to olerance
isosorbide monoitrate
147
In AF, if a CHA2DS2-VASc score suggests no need for anticoagulation
arrange an echo to exclude valvular HD
148
Massive PE + hypotension -
THROMBOLYSIS
149
INR 5.0-8.0 (no bleeding)
withhold 1-2 doses of warfarin and restart at a lower dose
150
? should be considered if a bradycardia doesn't respond to drugs or transcutaneous pacing
transvenous pacing
151
Asymmetric dosing regimes should be used for
Asymmetric dosing regimes should be used for standard-release ISMN to prevent nitrate tolerance
152
what type of pulse is seen in a mized aortic valve disease
bisferiens pulse
153
amiodarone skin SE
grey
154
hypercal sx
: painful bones, renal stones, abdominal groans and psychic moans
155
In the context of a tachyarrhythmia, a systolic BP < 90 mmHg →
DC cardiovert
156
NSTEMI (managed with PCI) antiplatelet choice:
- if the patient is not taking an oral anticoagulant: prasugrel or ticagrelor
- if taking an oral anticoagulant: clopidogrel
157
ECG changes of hypokal
- small or absent T waves
- prolonged PR interval
- Long QT
158
NSTEMI management: unstable patients should have immediate
coronary angiography
159
mx of aortic dissection
- type A - ascending aorta - control BP (IV labetalol) + surgery
- type B - descending aorta - control BP(IV labetalol)
160
If thrombolytic drugs are given during ALS then (CPR duration)
prolonged duration of 60-90 min should be considered
161
Mechanical valves - target INR:
aortic: 3.0
mitral: 3.5
162
Most common cause of endocarditis:
- Staphylococcus aureus
- Staphylococcus epidermidis if < 2 months post valve surgery
163
what should be done in those with multiple episodes of loss of consciousness with quick recovery times
24 HR ECG
164
In ALS, if IV access cannot be achieved then drugs should be given via
Intraosseous route via proximal tibia
165
- Following a TIA, anticoagulation for AF should start immediately once
imaging excludes a TIA. Lifelong apixaban usually
166
In a hypertensive patient < 55 years old who is on an ACE-i and is intolerant to calcium channel blockers, ? are the next line therapy
thiazide-like diuretics
167
NSTEMI (managed conservatively) antiplatelet choice
- aspirin, plus either:
- ticagrelor, if not high bleeding risk
-clopidogrel, if high bleeding risk
168
most commonly affected valve in IE
Mitral. Tricuspid affected first
169
A patient with AF + an acute stroke (not haemorrhagic) should have
aspirin for 14 days then switch to apixaban lifelong
170
PE first line Ix
- CTPA
- v/q if preg or renal impairment
171
Post MI driving advice
- cannot drive for 4 weeks
172
Most common causes of VT
- hypokalaemia 1)
- hypomg
173
