Passmed Flashcards
How does oesophagitis present
Odonyphagia
Dysphagia
Systemically well
Risk factors for oral candidiasis
HIV
Steroid inhalers
Difference between primary and secondary addisons
Primary problem is at level of adrenals
Secondary problem is at level of pituitary
Causes of primary adrenal insufficiency
TB
Autoimmune
Metastasised cancer
Waterhouse friederichsen syndrome
Causes of secondary addisonian insufficiency
Tumours, radiation and infiltrative diseases of pituitary
In which type of adrenal insufficiency is hyperpigmented skin seen
Primary
What is most common complication of meningitis
Sensorineural hearing loss
Complications of meningitis
Sensorineural hearing loss Intracerebral abscess Sepsis Hydrocephalus Epilepsy
If have acute mastoiditis what is most important cause to rule out
Meningitis
What factors would suggest rythm control as opposed to rate
Under 65
Symptomatic
Secondary to identifiable source like alcohol
First presentation
What factors would suggest just rate control in a fib
Over 65
IHD history
What is drug given in HF for AF
Digoxin
Alternatives to beta blockers in AF rate control
CCB
Digoxin
Rythm controlling drugs AF
Flecainide
Amiodarone
Sotalol
Does ablation reduce stroke risk
No- must anticoagulate still for life
If having ablation what is preparation
Anticoagulate for 4 weeks
Complications of ablation
Cardiac tamponade
Pulmonary valve stenosis
Stroke
What gives AF or an SVT a broad complex tachycardia
A bundle branch block
Treatment for torsades des pointes
IV magnesium sulphate
Contraindications for a chest drain
Bullae
INR less than 1.3
Platelets less than 75
Pleural adhesions
What test is used to diagnose herpes
Nucleic acid amplification test
Stage 1 AKI
Creatinine 1.5-1.9 x baseline
Stage 2 AKI
Creatinine 2.0-2.9x baseline
Stage 3 AKI
Creatinine >3X baseline or on RRT
What does tumour lysis syndrome lead to
AKI
Affected motility in ank spond
Reduced lateral flexion
Reduced forward flexion
What happens to spine shape in ank spond
Loss of lumbar lordosis
Accentuated thoracic kyphosis
What is main valvular disease associated with ehlers danlos
Mitral regurg
In questions how does ehlers danlos present
Hypermobility of joints
Striae
What type of disorder is ehlers danlos
Collagen disorder
First line treatment for all generalised seizures
Sodium valproate
First line treatment for all focal seizures
Carbamezapine
Second line tx for tonic clonic seizures
Lamotrigine
Problem with carbamezapines for generalised seizures
Can exacerbate absence and myoclonic seizures
What does it mean if glucose unrecordable
That its extremely high not low as can always be measured no matter how low
Pathophysiology of DKA
Insulin should inhibit lipolysis but this process becomes poorly controlled leading to conversion of fatty acids to ketones
If patient has low GRACE risk what do
Dual antiplatelets
In NSTEMI and UAP when would you not immediately give fondaparinaux
If having PCI soon
When must EBV testing be done
In second week of disease
What is NICE diagnostic criteria for EBV
Monospot and FBC in second week of disease
Which are 2 beta blockes shown to improve mortality in HF
Carvedilol
Bisoprolol
Causes of hyposplenism
Coeliac disease
Splenectomy
Blood film findings of hyposplenism
target cells Howell-Jolly bodies Pappenheimer bodies siderotic granules acanthocytes
Investigations for subacute thyroiditis
ESR
Iodine 131 radiouptake
Iodine 131 radio uptake finding de quervains
Reduced globally
Management of subacute thyroiditis
NSAIDS
Normally self limiting
What is name of thyroid iodine 131 uptake scan
Thyroid scintigraphy
If present with STEMI after 12 hours what would indicate PCI
Cardiogenic shock
On going ST elevation
What is associated spleen complication of coeliac
Hyposplenism
What do you do for someones regular insulin in DKA
Stop short acting and continue long acting insulin
What happens to PR segment in pericarditis
PR segment depression
If a patient has antiphospholipid syndrome and severe new onset headache what is most likely cause
Cavernous sinus thrombosis
Medical causes of third nerve palsies
DM
Vasculitis
Associated conditions of IgA nephropathy
alcoholic cirrhosis
coeliac disease/dermatitis herpetiformis
Henoch-Schonlein purpura
Most common exacerbating organism for COPD and bronchiectasis
Haemophilus influenzae
Who is isolated systolic HTN seen in
The elderly
How is isolated systolic HTN managed
Same as normal HTN
How should patients on methotrexate or other immune modifying drugs be managed when have gastroenteritis
Stool sample and abx
Which BP drug gives cold peripheries
Beta blockers
Management of idiopathic bilateral adrenal hyperplasia
Spironolactone
What is conns syndrome
Aldosterone producing adenoma
What is most common cause of primary hypperaldosteronism
Idiopathic bilateral adrenal hyperplasia
2 most common cause of primary hyperaldosteronism
Idiopathic bilateral adrenal hyperplasia
Conns syndrome
How does primary aldosteronism present
HTN
Hypokalaemia sx like polyuria and weakness
First investigation for suspected primary hyperaldosteronism
Aldosterone/renin ratio
Rfx for carpal tunnel
Pregnancy
Diabetes
Acromegaly
2 tests for carpal tunnel
Tinnels- tap on the wrist to elicit tingling
Phalensflexion of hands for 1 minute against eachother
What drug can lead to post prandial hyperglycaemia problems
Thiazides
When can aspirin only be given in stroke
Once CT performed
Most common source of mets to brain
Lung
What is test used to track eradication of H pylori
urease breath test
What conditions are associated with thymomas
MG
SLE
SIADH
Dermatomyositis
In NSTEMI if is high risk of bleeding what is given alongside aspirin
Clopidogrel
In NSTEMI if is no high risk of bleeding what is given alongside aspirin
Ticagrelor
How does a myxoedema coma tend to present
Confusion
Hypothermia
How can macrocytic anaemia be classified
Megaloblastic
Normoblastic
What rythm control is used AF in HF
Amiodarone
What antibiotic most commonly cause C diff
Ceftriaxone
What causes painful stiff joint after trauma in young person with normal x ray
Haemophilia A
Management plan for inducing remission crohns
1st line- glucocorticoids
2nd line- 5-ASA drugs
3rd line- mercatopurine or azathioprine/methotrexate
Management plan for maintaining remission crohns
1, azathioprine or mercatopurine
2. methotrexate
What causes recurrent hypoglycaemia in a chronic T1DM sufferer
Neuropathy of autonomic NS
Most important dietary tip with ascites
Restrict sodium
What is headache with swinging fever typically
Brain abscess
Causes of hypoglycaemia
Too much insulin Missing meals Liver disease Insulinoma in pancreas Autonomic neuropathy in long term T1DM
How does UC appear on barium swallow
loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow and short -‘drainpipe colon’
What are fusion and capture beats
When P wave and QRS complex merge often seen in VT
When are only times try to manage rythm in AF
If HF
First presentation
Is reversible cause
What are 4 types of AF
First time detected
Paroxysmal
Permenant
Persistent
What is paroxysmal AF
Recurrent episodes that termiante spontaneously lasting less than 7 days
What is permenant AF
When AF refractory to cardioversion so is continuous
What is persistant AF
Episodes of AF lasting more than 7 days that dont spontaneously terminate
What is likely cause of parkinsons in a young person
Wilsons
What shows a starry night appearance on histology
Burkitts lymphoma
What presents with tall R waves in leads V1-4
Posterior MI
Features of beta thalassaemia trait
Disproportionate microcytic anaemia
Raised HbA2
Causes of resp alkalosis
anxiety leading to hyperventilation pulmonary embolism salicylate poisoning early on CNS disorders: stroke, subarachnoid haemorrhage, encephalitis altitude pregnancy
Wihch cause of nephrotic syndrome has strong association with malignancy
Membranous change nephropathy
What is PTH in tertiary hyperparathyroidism
Massive
O/E of liver abscess
RUQ tenderness
Fever
Hepatomegaly
Jaundice
Risk factors for liver abscess
Underlying biliary tree disease
Intrahepatic procedures
DM
When cant aspirate liver abscess
If entamoeba suspected
Main way to tell if ramsay hunt syndrome
Vesicles in ear
What presents with red eye lids
Blepharitis
Management abx for COPD infective excacerbation
Amox then either clarithomycin or doxycycline
If Chad Vasc score is 0 in recently diagnosed AF what is next step in management
Do an echo to exclude valvular disease
What is main condition get torsades des pointes from
Long QT
How to assess volume status
Skin turgor
Mucosal membranes
Look at BP and HR
Cap refill
What can cause ST elevation with no coronary blockage
Takotsubo
What is drug given in myxoedema coma
Liothyroxine as is active T3
What type of MI do you often see new onset HB
Inferior as AVN is supplied by RCA
What oxygen should all critically ill COPD patients be given
15L as hypoxia kills
What causes AKI in patients who have fallen and been there dor a while
Rhabdomyolysis
Most appropriate fluid replacement in rhabdomyolysis
Normal saline
What happens to calcium in rhabdomylolysis
Low as binds to myoglobin
What happens to phosphate in rhabdomyolysis
High as releases from myocytes