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My notes - med > PassMed Cards > Flashcards

PassMed Cards Flashcards

1
Q

Inverted P wave, right axis deviation, loss of R wave progression

A

Dextrocardia

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2
Q

PE ECG

A

sinus tachycardia, right bundle branch block if in R ventricle, T wave inversion, right axis deviation

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3
Q

kartagener’s syndrome

A

situs inversus, chronic sinusitis, bronchiectasis

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4
Q

causes of left axis deviation

A
  • left anterior hemiblock
  • left BBB
  • inferior MI
  • WPW syndrome
  • hyperkalemia
  • ostrium primum ASD
  • tricuspid atresia
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5
Q

causes of right axis deviation

A
  • right ventricular hypertrophy
  • left posterior hemiblock
  • lateral MI
  • chronic lung disease –> cor pulmonale
  • PE
  • ostium secundum ASD
  • WPW
  • normal <1y
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6
Q

Complications of chronic lymphocytic leukemia

A
  • anemia
  • hypogammaglobulinemia leading to recurrent infections
  • warm autoimmune hemolytic anemia
  • transformation to high-grade lymphoma
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7
Q

Tension pneumo sx

A
  • tracheal deviation
  • decreased air entry
  • hyper resonant
  • hemodynamic instability (tachy, hypotension,
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8
Q

tension pneumo tx

A

Aspirate (2 ICS, MCL)

Chest drain into triangle of safety ( 5th ICS, MAL, anterior ax line –>above rib)

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9
Q

Ix acute mesenteric ischemia

A

serum lactate

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10
Q

Mesenteric ischemia sx

A
  • Small bowel
  • Embolism usually
  • Sudden and severe
  • Urgent surgery
  • High mortality
  • Abdo pain out of proportion to exam
  • rectal bleeding
  • diarrhea
  • fever
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11
Q

Predisposing factors to bowel ischemia

A
  • increasing age
  • a fib
  • other causes of emboli (endocarditis, malignancy)
  • CVS disease rf (smoker, HTN, DM)
  • cocaine
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12
Q

Ischemic colitis

A

Acute but transient compromise in blood flow to large bowel, often at splenic flexure
See thumbprinting on XR

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13
Q

Chonic mesenteric ischemia - intestinal angina sx

A
  • severe colicky post prandial abdo pain
  • weight loss
  • abdominal bruit
    usually due to atherosclerotic disease in arteries
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14
Q

Whiteout lung with trachea pulled towards it ddx

A
  • Pneumonectomy
  • complete lung collapse
  • pulmonary hypoplasia
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15
Q

Whiteout lung with trachea central ddx

A
  • consolidation
  • pulmonary edema
  • mesothelioma
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16
Q

Whiteout lung with trachea pushed away ddx

A
  • Pleural effusion
  • diaphragmatic hernia
  • large thoracic mass
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17
Q

Early lyme disease (<30d) sx

A
  • erythema migrans (bulls eye 1-4 weeks after bite, painless, 80%)
  • headache, lethargy, fever, arthralgia
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18
Q

Late lyme disease (>40d) sx

A
  • heart block
  • peri/myocarditis
  • facial nerve palsy
  • radicular pain
  • meningitis
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19
Q

Lyme mgmt

A

Doxycycline if early (amoxicillin if contraindicated eg preg)
Ceftriaxone if disseminated

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20
Q

Live attenuated vaccines

A
  • BCG
  • MMR
  • Oral polio
  • Yellow fever
  • Oral typhoid
  • Intranasal flu
  • Oral rotavirus
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21
Q

Pansystolic murmur and low grade fever: dx

A

Infective endocarditis

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22
Q

Most common cause of infective endo

A

Staph aureus (particularly in acute presentation and IVDUs)
Staph epidermidis in those with indwelling lines and post prosthetic valve surgery
Strep viridans following dental procedure
SLE, malignancy

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23
Q

Golfers elbow

A

Medial epicondylitis

Pain aggravated by wrist flexion and pronation

Numbness/tingling in 4th/5th fingers from ulnar nerve

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24
Q

Tennis elbow

A

Lateral epicondylitis

Pain worse on resisted wrist extension with elbow extended OR supination of forearm with elbow extended

Lasts 6m-2y, acute pain for 6-12w

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25
Q

Cubital tunnel syndrome

A

Compression of ulnar nerve
4/5th tingling fingers
worse if elbow on hard surface

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26
Q

Radial tunnel syndrome

A

Compression of posterior interosseous branch of radial nerve, usually from overuse

Similar to lat epicondylitis
Pain 4-5cm distal to lat epi
Worse by extending elbow and pronating forearm

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27
Q

SLE blood tests

A

+ Anti-dsDNA
+ Anti-smith antibodies
low C3 C4

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28
Q

+ anti-centromere antibody

A

systemic sclerosis/scleroderma

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29
Q

positive ANA

A

autoimmune disease including lupus and certain meds.

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30
Q

SLE general ft

A

fatigue
fever
ulcers in mouth
lymphadenopathy

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31
Q

SLE skin ft

A 
Malar rash
Discoid rash
Livedo reticularis
Raynaud's
Non scarring alopecia
Photosensitivity
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32
Q

SLE MSK ft

A

arthralgia

non erosive arthritis

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33
Q

SLE CVS ft

A

pericarditis (most common)

Myocarditis

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34
Q

SLE resp ft

A

pleurisy

fibrosing alveolitis

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35
Q

SLE renal ft

A

proteinuria

glomerulonephritis (diffuse proliferative most common)

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36
Q

SLE neuro ft

A

psychosis
depression
anxiety
seizures

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37
Q

Fever + back pain w pain on extension of hip

A

iliopsoas abscess

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38
Q

Potts disease

A

TB seen in vertebrae

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39
Q

Iliopsoas abscess causes

A

Primary: Heamtogenous spread of bacteria (staph aureus)

Secondary: Crohns, diverticulitis, colorectal cancer, UTI, GU cancer, vertebral osteomyelitis, femorath catheter, endocarditis

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40
Q

Iliopsoas abscess mgmt

A

Abx
Percutaneous drainage
Surgery

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41
Q

Antihistone antibodies

A

drug induced lupus

- hydralazine and procainamide

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42
Q

Anti-Mi-2

A

dermatomyositis

Myalgia and cutaneous changes (heliotrope rash, Gottron’s papules)

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43
Q

Anti-Ro

A

Sjogren’s syndrome
- lymphocytic infiltration into exocrine glands
Reduces exocrine functions (dry mouth, dry eyes, dry airways)

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44
Q

Osteochondritis dissecans sx

A

knee pain/swelling after exercise

locking and “clunking”, giving way, loose bodies

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45
Q

Intracapsular hip fracture tx

A
  • displaced: hemi or total hip replacement (young and fit–> internal fixation)
  • undisplaced: hemiarthroplasty or internal fixation
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46
Q

Extracapsular hip # (reverse oblique, transverse, subtropchanteric) and femoral shaft # tx

A

intramedullary nail

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47
Q

Extracapsular intertrochanteric proximal femoral # tx

A

dynamic hip screw

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48
Q

Ank spond associated gene

A

HLA-B27

Seronegative

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49
Q

Ank Spond features

A 
Reduced flexion: lateral and forward
Reduced chest expansion
-Apical fibrosis
-Anterior uveitis
-Aortic regurg
-Achilles tendonitis
-AV node block
-Amyloidosis
-Arthritis (peripheral)
-Anemia
-Cauda equina
Dactylitis
Enthesitis
Aortitis
Restrictive lung disease
IBD
**Bamboo spine
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50
Q

Ank spond
Reactive arthritis
Psoriatic arthritis

A

Seronegative

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51
Q

Schober’s test

A

Back flexion test

L5 +10, -5, bend and should be >20cm

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52
Q

Ank spond tx

A 
NSAIDS
Steroids (oral, IM, joint)
Tumour necrosis factor 
- anti-TNF - entanercept
- monoclonal Ab (infliximan, adalimumab, certolizumab)
Mono Ab via IL 7 - secukinumab

Physio
Bisphosphonates
No smoking
Tx other comps

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53
Q

Hydroxychloroquine

A

RA, SLE, malaria

Safe in preg

SE: bulls eye retinopathy

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54
Q

Marfans and the heart

A

Associated with dilation of aortic sinuses which can lead to aortic dissection. Do echo.

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55
Q

Marfan’s Ft

A 
Tall
high arched palate
arachnodactyly
pectus excavatum
pes planus (flat feet)
scoliosis
mitral valve prolapse
upward eye lens dislocation, blue scera, myopia
dural ectasia
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56
Q

Malignancy + raised CK

A

? polymyositis

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57
Q

Drugs raising CK

A

Statins

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58
Q

Polymyositis ft

A 
proximal muscle weakness +/- tenderness
Raynaud's
respiratory muscle weakness
interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia
dysphagia, dysphonia
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59
Q

Weekly prescriptions

A

bisphosphonates

methotrexate

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60
Q

Usually taken at night

A

statins

amitriptyline

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61
Q

carbimazole

A

anti thyroid

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62
Q

carbmazepine

A

anti epileptic

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63
Q

chlorophenamine

A

anthistamine

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64
Q

chlorpromazine

A

antipsychotic

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65
Q

carbocisteine

A

mucolytic

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66
Q

carboplatin

A

chemo

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67
Q

carbetocin

A

like oxytocin after birth

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68
Q

Ciprofloxacin in BF mom

A

no

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69
Q

Tetracycline in BF mom

A

no

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70
Q

Chloramenphenicol in BF mom

A

no

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71
Q

sulphonamides in BF mom

A

no

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72
Q

lithium in BF mom

A

no

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73
Q

benzos in BF mom

A

no

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74
Q

aspirin in BF mom

A

no

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75
Q

catbimazole in BF mom

A

no

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76
Q

methotrexate in BF mom

A

no

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77
Q

sulfonylureas in BF mom

A

no

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78
Q

cytotoxic drugs in BF mom

A

no

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79
Q

amiodarone in BF mom

A

no

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80
Q

penicillin in BF mom

A

yes

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81
Q

digoxin in BF mom

A

yes

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82
Q

warfarin in BF mom

A

yes

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83
Q

heparin in BF mom

A

yes

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84
Q

beta blocker in BF mom

A

yes

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85
Q

hydralazine in BF mom

A

yes

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86
Q

TCAs in BF mom

A

yes

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87
Q

antipsychotics in BF mom

A

yes

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88
Q

salbutamol in BF mom

A

yes

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89
Q

theophyllines in BF mom

A

yes

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90
Q

sodium valproate in BF mom

A

yes

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91
Q

carbamazepine in BF mom

A

yes

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92
Q

steroids in BF mom

A

yes

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93
Q

levothyroxine in BF mom

A

yes

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94
Q

trimethoprim in BF mom

A

yes

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95
Q

cephalisporins in BF mom

A

yes

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96
Q

clozapine in BF mom

A

no

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97
Q

paracetamol dose

A

1g qds

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98
Q

ibuprofen dose

A

200-400mg tds

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99
Q

codein dose

A

30-60mg qds

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100
Q

cyclizine dose (antiemetic)

A

50mg tds

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101
Q

metoclopramide dose (antiemetic)

A

10mg tds

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102
Q

Amoxicillin dose

A

500mg tds

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103
Q

Clarithromycin dose

A

500mg bd

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104
Q

lansoprazole dose (PPI)

A

15-30mg od

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105
Q

omeprazole

A

20-40mg od

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106
Q

Aspirin dose

A

75-300mg od

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107
Q

Clopidogrel dose

A

75-300mg od

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108
Q

Simvastatin dose

A

10-80mg on

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109
Q

Ramipril dose

A

1.25-10mg od

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110
Q

Atenolol dose

A

25-100mg od

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111
Q

furosemide dose

A

20mg od-80mg bd

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112
Q

amlodipine dose

A

5-10mg od

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113
Q

metformin dose

A

500mg od-1g bd

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114
Q

levothyroxine dose

A

25-200mcg od

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115
Q

co-codamol dose

A

2 tabs qds

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116
Q

Relative contraindications for COCP

A 
>35 and smoking <15cig/day
BMI > 35
Fhx thromboembolic disease first degree
controlled HTN
immobility
known BRCA1/2
gallbladder disease
DM >20y ago
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117
Q

Absolute contraindications for COCP

A 
>35 smoking >15/d
migraine w aura
history of thromboembolic
history of stroke/ischemic heart
BF <6w postpartum
uncontrolled HTN
breast Ca
major surgery w immobil
DM >20y ago
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118
Q

Common issue w deranged LFTs in UC

A

Primary Sclerosing Cholangitis

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119
Q

PSC features

A

cholestasis (jaundice, pruritus
raised bilirubin + ALP)
right upper quadrant pain
fatigue

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120
Q

Tx small bowel overgrowth syndrome

A

rifaximin

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121
Q

Pen V (phenoxymethylpenicillin) uses

A

ENT infections (tonsilitis), long term prophylaxis after splenectomy

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122
Q

Linezolid

A

for gram positive bacteria, used against MRSA

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123
Q

SBBOS diagnosis

A
  • hydrogen breath test
  • small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
  • clinicians may sometimes give a course of antibiotics as a diagnostic trial
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124
Q

SBBOS RF

A

neonates w congenital GI abnormalities
scleroderma
DM

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125
Q

SBBOS sx

A

chronic diarrhoea
bloating, flatulence
abdominal pain

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126
Q

Vit C deficiency

A

Scurvy

  • gingivitis, loose teeth
  • poor wound healing
  • bleeding from gums, haematuria, epistaxis
  • general malaise
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127
Q

Most common esophageal CA

A

adenocarcinoma
More likely in those w GERD or Barrett’s

Lower third: adenocarcinoma
Upper 2/3: squamous cell

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128
Q

Esophageal adenocarcinoma RF

A 
GORD
Barrett's
Smoking
Achalasia
Obesity
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129
Q

Esophageal Squamous cell RF

A 
Smoking
Alcohol
Achalasia
Plummer-vinson syndome
Diet rich in nitrosamines
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130
Q

Esophageal CA features

A
  • dysphagia: the most common presenting symptom
  • anorexia and weight loss
  • vomiting
  • other possible features include: odynophagia, hoarseness, melaena, cough
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131
Q

Esopageal Ca tx

A

Surgical resection

Adjuvent chemo

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132
Q

Pharyngeal pouch sx

A 
dysphagia
regurgitation
aspiration
neck swelling which gurgles on palpation
halitosis
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133
Q

Crohns features

A 
Colonoscopy
-features suggest of Crohn's include deep ulcers, skip lesions
Histology
-inflammation in all layers from mucosa to serosa
-goblet cells
-granulomas
Small bowel enema
-high sensitivity and specificity for examination of the terminal ileum
-strictures: 'Kantor's string sign'
-proximal bowel dilation
-'rose thorn' ulcers
-fistulae
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134
Q

Primary Biliary Cholangitis M rule

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

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135
Q

PBC sx

A

fatigue and pruritus

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136
Q

high ALP and GGT but not ALT

A

cholestatic picture

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137
Q

How to induce Crohns flare remission

A

Glucocorticoids only

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138
Q

Crohns remission mgmt

A

1st Steroids
2nd Azathioprine/mercaptopurine/methotrexate
3rd Sulfasalazine
4th infliximab useful in refractory disease

** TPMT activity tests before aza or mercapto

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139
Q

Crohns stricturing location

A

Terminal ileum –> ileocecal resection

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140
Q

Crohns risks

A

Small bowel CA
Colorectal CA
Osteoporosis

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141
Q

H Pylori trip/quad therapy

A

Amoxicillin +
clarithromycin or metronidazole +
PPI

QUAD
Bismuth subcitrate potassium + tetracycline + metronidazole + omeprazole

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142
Q

Urgent endoscopy referal

A

Dysphagia
Upper abdo mass consistent w stomach CA
>55y w weight loss AND either upper abdo pain/reflux/dyspepsia.

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143
Q

Meds causing dyspepsia

A 
alpha-blockers, 
antimuscarinics, 
aspirin, 
benzodiazepines, 
beta-blockers, 
bisphosphonates, 
calcium-channel blockers, 
corticosteroids, 
nitrates, 
non-steroidal anti-inflammatory drugs (NSAIDs), 
theophyllines,
tricyclic antidepressants
144
Q

H Pylori test

A

Carbon 13 urea breath test or stool antigen test or lab based serology

145
Q

Hemochromatosis bloods

A

High ferritin (>500)
High transferrin saturation (>55%)
low total iron binding capacity

146
Q

Hemochromatosis genetics

A

C282Y and H63D mutations

147
Q

Management of variceal hemorrhage

A 
High flow O2
Fluids
Blood products (FFP, vit K)
Abx (ceftriaxone)
Telipressin - reduces portal blood flow (or octreotide)

Endoscopy - variceal band ligation
Sengstaken-Blakemore tube (if uncontrolled)
TIPSS (connect hepatic to portal vein)

148
Q

Upper GI bleed not caused by variceal - tx

A

Omeprazole IV

149
Q

Warfarin reversal factors

A

2, 9, 10

150
Q

Prevention of esophageal varices bleeding/re-bleen

A

Propranolol (non cardioselective beta blocker)

151
Q

Non cardio selective b blocker works on:

A

vascular smooth muscle B2

cardiac beta 1

152
Q

Amlodipine works on

A

arterial vessels

153
Q

Primary sclerosing cholanigitis assoc with

A 
Ulcerative colitis
- 80% PSC have UC
- 4% UC have PSC
Crohns
HIV
154
Q

PSC on Ix

A

MRCP - beaded appearance

p-ANCA might be positive

155
Q

Carcinoid sydrome

A

mets present in liver, release serotonin into systemic circulation
Can also happen w lung carcinoid

156
Q

Carcinoid features

A
  • flushing (often earliest symptom)
  • diarrhoea
  • bronchospasm
  • hypotension
  • right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
  • other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
  • pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
157
Q

Carcinoid test

A

Urine 5-HIAA (hydroxyindoleacetic acid)

plasma chromogranin A y

158
Q

Carcinoid tx

A 
somatostatin analogue (octreotide)
cyproheptadine for diarrhea
159
Q

Most common cause of hepatocellular carcinoma

A

Hep B worldwide

Hep C Europe

160
Q

Hepatocellular CA RF

A 
Hep B,C
Alcohol
Hemochromatosis
PBC
alpha-1 antitrypsin deficiency
hereditary tyrosinosis
glycogen storage disease
aflatoxin
drugs: oral contraceptive pill, anabolic steroids
porphyria cutanea tarda
male sex
diabetes mellitus, metabolic syndrome
161
Q

Hepatocellular CA Sx

A

tends to present late
features of liver cirrhosis or failure may be seen: jaundice, ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly
possible presentation is decompensation in a patient with chronic liver disease
raised AFP

162
Q

HBsAg

A

ongoing infx

acute or chronic

163
Q

HB core Ab

A

C = Caught it (negative if immunized)
IgM in acute
IgG forever

164
Q

HBsAb

A

immunization

165
Q

HBcAb pos + HBsAG neg

A

prev hep, not a carrier

166
Q

HBcAb pos + HBsAg pos

A

prev hep, now a carrier

167
Q

HBeAg

A

infectivity

168
Q

Malnutrition definition

A

BMI <18.5 OR
unintentional weight loss >10% within 3-6 months OR
BMI <20 + weight loss >5% in 3-6 months

169
Q

Definitive Ix for celiac disease

A

duodenal biopsy

170
Q

Conditions assoc w celiac

A

dermatitis herpetiformis (vesicular, pruritic skin eruption)
T1 DM
Autoimmune hepatitis

171
Q

Celiac duodenal biopsy findings

A

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

172
Q

Life threatening C Diff infection tx

A

ORAL vancomycin and IV metronidazole

173
Q

Severe, non life-threatening C Diff tx

A

oral vancomycin

first line usually oral metronidazole 10-14d

174
Q

C Diff gram

A

gram positive rod

175
Q

C Diff sx

A

diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop

176
Q

Caution when prescribing to pt with asthma

A

NSAID - bronchospasm
B blocker - cause bronchospasm
adenosine - bad for asthma and COPD. Use verapamil instead.

177
Q

Lithium monitoring

A

12 hr post dose

Range: .4-1 mmol/l

178
Q

Ciclosporin monitoring

A

trough levels right before next dose

179
Q

Digoxin monitoring

A

at least 6 hr post-dose/just before next dose for ease
monitor ventricular rate at rest
U & E and renal func if tox suspected

180
Q

Digoxin use in a fib

A

slows ventricular rate in pt where beta blocker contraindicated (Asthma)

181
Q

Do not prescribe in epilepsy

A
  • alcohol, cocaine, amphetamines
  • cirprofloxacin, levofloxacin
  • aminophylline, theophylline
  • bupropion
  • methylphenidate (in ADHD)
  • mefenamic acid

p450 inducers/inhibitors

182
Q

Antihypertensive CI in preg

A

Linisopril (ACEi)

183
Q

avoid in heart failure

A 
NSAID/glucocorticoid
- fluid retention
Verapamil
- neg inotrope
Thiazolidinediones
-fluid retention (pioglitazone)
Class 1 antiarrhythmics
- flecainide
184
Q

Lithium monitoring

A

serum levels
U & E
TFTs

Can cause QT prolongation but dont need to re check.

185
Q

Statin Monitoring

A

LFTs

-baseline, 3mo, 12mo

186
Q

ACEi Monitoring

A

U&E

- prior, after increase dose, annually

187
Q

Amiodarone Monitoring

A

TFT, LFT
prior to tx, every 6 mo
U&E and CXR prior to tx

188
Q

Methotrexate Monitoring

A

FBC, LFT, U&E

- before, weekly until stabilised, 2-3 monthly

189
Q

Azathioprine Monitoring

A

FBC, LFT
- before tx, everyy 3 mo
FBC weekly first 4 weeks

190
Q

Sodium Valproate Monitoring

A

LFT
- and FBC before tx
LFT periodically in first 6 mo

191
Q

Glitazones Monitoring

A

LFT

- before tx, regularly during tx

192
Q

Psoriasis exacerbating factors

A
  • trauma
  • alcohol
  • drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
  • withdrawal of systemic steroids
  • strep –> guttate psoriasis
193
Q

Verapamil indications

A

Ca Channel Blocker

  • Angina, HTN, arrhythmias
  • neg inotrope
  • NOT w BBlocker
194
Q

Diltiazem indications

A

Ca Ch blocker

  • angina, HTN
  • caution w BB
195
Q

Nifedipine, amlodipine, felodipine indications

A

Ca ch blockers

  • HTN. angina, Raynaud’s
  • works on peripheral vascular SM, so not making HF worse but will cause ankle swelling
196
Q

Verapamil SE/cautions

A 
HF
constipation
hypotension
bradycardia
flushing
197
Q

Diltazem SE/cautions

A

Hypotension
bradycardia
HF
ankle welling

198
Q

Nifedipine, amlodipine, felodipine SE/cautions

A

Flushing
Headache
Ankle swelling

199
Q

HTN: <55 or T2DM

A

1: ACEi or ARB
2: Ace + CCB or ARB + thiazide
3: ACE/ARB + CCB + thiazide
4: K <4.5 –> spironolactone

200
Q

HTN: >55 and no T2DM or Afro + no DM

A

1: Ca Ch Blocker
2: Ace + CCB or ARB + thiazide
3: ACE/ARB + CCB + thiazide
4: K>4.5 –Alpha or Beta blocker

201
Q

Simvastatin in preg?

A

NO

202
Q

Drugs to avoid in ischemic heart disease

A

NSAID
Estrogens (COCP, HRT)
Varenicline

203
Q

Give acetylcysteine if:

A

staggered overdose or doubt about time of ingestion, regardless of conc.

if plasma conc is on or about tx line

204
Q

Gentamicin type

A

aminoglycoside abx, given IV or topical

205
Q

Gentamicin SE

A

ototoxicity

nephrotoxicity (secondary to ATN)

206
Q

Gentamicin CI

A

myasthenia gravis

207
Q

Potentially toxic dose of paracetamol calculation

A

150mg/kg x weight = max dose.

208
Q

Tamoxifen

A

Post estrogen positive breast CA (SERM)
5 yr after mastectomy
SE: VTE and hot flush, menstrual disturbance (bleed, amenorrhea), endo CA
Can cause fibroids

209
Q

Lithium tox causes

A

dehydration
renal failure
drugs (diuretics, ACEi, ARB, NSAID, metronidazole)

210
Q

Lithium tox sx

A 
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
211
Q

NSAIDs and AKI/CDK?

A

NO

212
Q

Tetracycline in renal failure

A

no

213
Q

nitrofurantoin in renal failure

A

no

214
Q

NSAIDs in renal failure

A

NO

215
Q

lithium in renal failure

A

no

216
Q

metformin in renal failure

A

no

217
Q

warfarin in renal failure

A

yes

218
Q

diazepam in renal failure

A

yes

219
Q

erythromycin in renal failure

A

yes

220
Q

rifampicin in renal failure

A

yes

221
Q

Digoxin use

A

slow rate in AF and A flutter

Increases force of contraction

222
Q

Digoxin tox

A

unwell, lethargy, N/V, anorexia, confusion, yellow-green vision
Arrhythmias (AV block, brady)
gynecomastia

223
Q

Digoxin tox causes

A

HYPOKALEMIA
Older
Renal failure

224
Q

Digoxin tox mgmt

A

Digibind
correct arrhyth
monitor K

225
Q

Acute asthma attack mgmt

A 
admit: if life threatening or not responding to initial tx
O2: if hypoxemic, 15L
Bronchodilate: SABA high dose (salbutamol). Nebulised better
Steroid: prednisolone PO 5d
Ipratropium bromide if still no resp
IV MgSO4 
IV aminophylline
Intubation/ventilation/ECMO
226
Q

Statin in established CVD

A

80mg PO, ON

227
Q

Statin for primary prevention

A

20mg PO, ON

228
Q

Starin SE

A 
Myopathy
Liver impair (LFTs baseline, 3mo, 12mo)
229
Q

Statin CI

A

macrolides (erythromycin, clarithromycin)

Pregnancy

230
Q

SVT tx

A

Vagal maneuvers (Valsalva, carotid massage)
Adenosine 6mg IV stat (but not in asthma)
Electrical cardioversion

231
Q

Exacerbation of chronic bronchitis tx

A

Amox
Tetracycline
Clarithromycin

232
Q

Uncomplicated community-acquired pneumonia tx

A

Amox (doxy or clarithro if allergic)

Staph –> add fluclox

233
Q

Pneumonia possibly caused by atypical pathogens tx

A

clarithromycin

234
Q

Hospital-acquired pneumonia tx

A

<5d: Co-amox or cefuroxime

>5d: piperacillin w tazobactam OR ceftazidime OR ciprofloxacin

235
Q

L-UTI tx

A

Trimethoprim or Nitrofurantoin

alt: amox, cephalosporin

236
Q

Acute pyelo tx

A

Broad spectrum cephalosporin (ceftazidime)

237
Q

Acute protatitis tx

A

Quinolone or trimethoprim

238
Q

Impetigo tx

A

topical hydrogen peroxide

oral fluclox or erythromycin if widespread

239
Q

Cellulitis tx

A

Floclox (claruthro/erythro/doxy if allergy)

240
Q

Cellulitis near eyes tx

A

co-amox

clarith + metronidazole if allergy

241
Q

Erysipelas tx

A

fluclox

clarithro/erythro/doxy if allergy

242
Q

Animal/human bite tx

A

co-amox

doxy + metronidazole if allergy

243
Q

Mastitis tx

A

Flucloxacillin

244
Q

Throat infx tx

A

Phenoxymethylpenicillin

erythro

245
Q

Sinusitis tx

A

Pen V

246
Q

Otitis media tx

A

Amox (erythro)

247
Q

Otitis externa tx

A

fluclox (erythro)

248
Q

Pariapical or periodontal abscess tx

A

Amox

249
Q

Gingivitis tx

A

Metronidazole

250
Q

Gonorrhea tx

A

IM ceftriaxone

251
Q

Chlamydia tx

A

Doxy or azithromycin

252
Q

PID tx

A

Oral ofloxacin + oral metronidazole OR

IM ceftriaxone + oral doxy + oral metronidazole

253
Q

Syphillis tx

A

Benzathine benzylpen OR doxy OR erythro

254
Q

Bact vag tx

A

Oral/topical metronidazole or topical clindamycin

255
Q

C Diff tx

A

1st time: metronidazole

2nd: vancomycin

256
Q

Campylobacter enteritis tx

A

clarithromycin

257
Q

Salmonella tx

A

Cipro

258
Q

Shigellosis tx

A

Cipro

259
Q

Abx causing C Diff

A

clindamycin, 2nd/3rd gen cephalosporins, PPI

260
Q

CURB 65 score

A 
Confusion
Uremia (BUN > 20)
RR (>30)
BP (<90, <60)
>65y
0-1: home tx
2: hosp tx
3: hops, severe
261
Q

Most common first line antihypertensive in >55y`

A

CCB - amlodipine

262
Q

Stage 1 HTN

A

140/90

263
Q

Stage 2 HTN

A

160/100

264
Q

Severe

A

180 sys or 110 dia

265
Q

Meningitis empiric tx

A

Cefotaxime 2g IV

Ceftriaxone 2g IV

266
Q

Meningitis from meningococci tx

A

IV benzylpenicillin or cefotxime/ceftriaxone

267
Q

Meningitis suspected in GP

A

IM benzylpen and transfer to hospital

268
Q

Meningitis <3mo tx

A

IV cefotaxime + amox (or ampicillin)

269
Q

Meningitis >50y tx

A

IV cefotaxime/ceftriaxone + amox/ampicillin

270
Q

Pneumococcal meningitis tx

A

IV cefotaxime/ceftriaxone

271
Q

Hemoph influenza meningitis tx

A

IV cefotaxime/ceftriaxone

272
Q

Listeria meningitis

A

IV amox/amp + gentamicin

273
Q

Meningitis Ix

A 
FBC
CRP
Coag screen
Blood culture
Whole bloos PCR
Blood glucose
Blood gas
Lumbar punc if no raised ICP
274
Q

Meningitis prophylaxis

A

1st: ciprofloxacin
2nd: Rifampicin

275
Q

Esophagitis in edoscope yx

A

Full PPI 1-2mo, then low dose as needed

No resp–> double dose PPI x 1mo

276
Q

Endoscopically neg refluc tx

A

full dose PPI x 1mo
If resp –> PRN los dose
No resp –> H2RA or prokinetic x 1mo

277
Q

Croup tx

A

Dexamethasone 0.15mg/kg x 1 dose PO

278
Q

Depression first line tx

A

Fluoxetine 20mg PO OD

Citalopram 20mg (long QT)

Sertraline 50mg (good post MI)
Paroxetine 20mg
279
Q

Depression tx w warfarin or aspirin

A

mirtazapine

280
Q

VTE prophylaxis

A

Dalteparin/Enoxaparin/Tinzaparin (LMWH)
-2500-5000 units, SC, OD

If renal failure - Unfractionated heparin

281
Q

Incontinence Ix

A

bladder diary x 3d
Vag exam - exclude prolapse
Urine dip + culture
Urodynamic studies

282
Q

Urge incontinence tx

A
  • bladder retraining
  • bladder stabilizing drugs - antimuscarinics first: oxybutnin (avoid in frail old women), tolterodine
  • mirabegron (b 3 agonist) if concern about anticholinergic effects in frail patients
283
Q

Stress incontinence tx

A
  • pelvic floor training
  • retropubic mid-urethral tape procedure
  • duloxetine if no surg. SSNRI
284
Q

Common osmotic laxative - soften stool

A

Lactulose, macrogols

285
Q

Stimulant laxative - increase motility

A

senna, docusate, glycerol

286
Q

Bulk-forming laxatives - for diets low in fiber

A

Methylcellulose

287
Q

Angina meds

A

B-Blocker (atenolol, 2nd line CCB - verapamil)
Aspirin
Statin
GTN

288
Q

Emergency contaception

A

Levonorgesterel 1.5mg PO stat (72h)

Ulipristal acetate 30mg PO stat (120h)

289
Q

Achalasia sx

A

trouble swallowing both solids and liquids

regurgitation of food

290
Q

Esophageal spasm sx

A

pain w swallowing

291
Q

Bulbar palsy

A

weakness - drooling, weak and wasted tongue
dysphonia
problems articulating

292
Q

Progressive dysphagia, weight loss

A

Esophageal CA, can compress laryngeal nerve

293
Q

Causes of hepatomegaly

A

Cirrhosis - non-tender, firm
Malig - mets or primary. Hard, irreg edge
RHF - firm, smooth, tender liver edge. Can be pulsatile

Viral hep
Glandular fever
Malaria
Abscess
Hydatid disease
Hematological CA
Hemochromatosis
PBC
Sarcoidosis
294
Q

Colostomy info

A

Flush to skin

Poop in bag

295
Q

Ileostomy info

A

spouted

often right side but doesn’t have to be

296
Q

Monitoring bloods of hepatocellular CA

A

AFP

297
Q

Pancreatic cancer marker

A

CA 19-9

298
Q

Ovarian CA marker

A

CA 125

299
Q

Bowel CA marker

A

CEA

300
Q

Autoimmune Hep Ft

A 
Fever, jaundice - acute (25%)
Amenorrhea
ANA/SMA/LKM1 antibodies
Raised IgG
Young females
301
Q

Autoimmune hep tx

A

steroids +/- immunosuppression (azathioprine)

Liver transplant

302
Q

TIPS (transjugular intrahepatic portosystemic shunt) dangerr

A

exacerbation of hepatic encephalopathy

- blood from portal system into systemic, bypassing liver –> no metabolism of nitrogenous waste like ammonia.

303
Q

distal UC first line tx for moderate flare

A

rectal mesalazine or sulphasalazine (aminosalicylates)
Oral if extensive disease

2nd line: oral/rectal steroids

304
Q

UC proctitis induce remission

A

topical aminosalicylates (mesalazine)
If not remit in 4w, add oral
still not working - oral cortico

305
Q

UC proctosigmoiditis + left sided UC remission induction

A

topical aminosalicylate
4 weeks nothing - add oral or switch to high dose oral and topical cortico
Still not remit - oral amino + oral cortico

306
Q

extensive UC induce remission

A

topical aminosalicylate + high dose oral amino

No remission in 4 w - oral amino + oral cortico

307
Q

Severe ulcerative colitis tx

A

Hospital, IV steroids or if CI contraindicated

308
Q

UC mod. flare maintenance

A

Proct - topical aminosalicylate OR oral + topical OR oral only
Left sided/extensive: oral amino

309
Q

UC severe flare maintenance

A

oral azathioprine or mercaptopurine

310
Q

Acute cholecystitis tx

A

IV abx + laparoscopic cholecystectomy within 1 week

311
Q

Acute cholecystitis sx

A

RUQ pain - radiate to R shoulder
Fever + systemic upset
Murphys sign
LFTs normal

312
Q

Acute cholecystitis Ix

A

US

HIDA scan

313
Q

UC flare triggers

A

often w/o trigger
stress
meds (NSAID, Abx)
quitting smoking

314
Q

Thrombosed hemorrhoid

A

Pain and tender lump @ anus
purple, edematous, subcut tender perianal mass
Can do excision within 72 of onset - if not, stool softener, ice pack, analgesia

315
Q

Perianal abscess

A

fever

cellulitis surrounding it

316
Q

Viral hep sx

A 
N/V, anorexia
Myalgia
Lethargy
RUQ pain
IVDU or foreign travel
317
Q

Congestive hepatomegaly sx

A

congestive heart failure causes liver to stretch, can lead to cirrhosis.
RUQ pain

318
Q

Biliary colic sx

A

intermittent RUQ pain, sudden onset, slow to subside
Often after eating
Nausea
Female,Fat,Forties,Fair

319
Q

Ascending cholangitis sx

A

infected bile ducts secondary to gallstones

Fever, RUQ pain, Jaundice

320
Q

Gallstone ileus sx

A

Abdo pain, distension, vom

321
Q

Cholangiocarcinoma

A

Persistant biliary colic sx w anorexia, jaundice, weight loss
Palpable mass in RUQ (Courvoisiers sign), periumbilical lymphadenopathy, left supraclavicular adenopathy (Virchow)

322
Q

Pancreatic CA sx

A 
painless jaundice (pale stools, dark urine, pruritus & cholestatic LFTs)
Loss of exocrine func (steatorrhea)
Loss of endocrine func (DM)
can epi have pain
anorexia, weight loss
323
Q

Acute pancreatitis sx

A 
Due to alcohol or gallstones
Severe epigastric pain
Vomiting
Tenderness, ileus, fever
Periumbilical discolouration (Cullen's) and flank discolouration (Grey-Turner)
324
Q

Amoebic liver abscess sx

A

malaise
anorexia
weight loss
mild RUQ pain

325
Q

Defective bilirubin conjugation from deficiency in UDP-glucuronosyltranferase

A

Gilbert’s syndrome

326
Q

Gilbert’s sx

A

high unconj bili in serum

jaundice during illness, exercise or fasting

327
Q

Acute pancreatitis tx

A

Fluid resusc -crystalloids
Urine output >.5mls/kg/h
Analgesia - opioids
Nutrition - normal diet

328
Q

Pseudocyst

A

4+ weeks post acute pancreatitis
retrogastric
assoc w persistent raised amylase
TX: observe x 12w

329
Q

Liver abscess tx

A

abx (amox + cipro + metronidazole) and image-guided percutaneous drainage

Staph aureus in kids, E Coli in adults

330
Q

Non-urgent endoscopy ref for:

A

Hematemesis
Pt >55 w: tx-resistant dyspepsia OR UAP w low Hb OR raised platelets with nausea/vom/weight/reflux/dyspepsia/UAP OR N/V with weight loss/reflux/dyspepsia/UAP

331
Q

Causes of liver decompensation in cirrhosis

A 
Constipation
Infection
Electrolyte imbalances
dehydration
Upper GI bleed
Increased alcohol intake
332
Q

H Pylori assoc with

A

Peptic ulcer disease
Gastric CA
B cell lymphoma of MALT (curing HP causes regression in 80%)
Atrophic gastritis

333
Q

Dark urine + pale stools

A

Cholestasis

334
Q

Colicky RUQ pain postprandially, worse following fatty meal

A

Gallstones

335
Q

Biliary colic Ix/Tx

A

Imaging (US)

If gallstones –> laparoscopic cholecystectomy

336
Q

Dukes Staging: A

A

Limited to mucosa

337
Q

Dukes Staging: B

A

outside mucosa, invading local tissue/muscular layer of colon, no nodes

338
Q

Dukes Staging: C

A

Regional nodes

339
Q

Dukes Staging: D

A

Distant mets

340
Q

Celiac annual bloods

A 
FBC
Ferritin
TFT
LFT
B12
Folate
341
Q

Gluten-free foods

A

rice, potatoes, corn

342
Q

Hemochromatosis + joints

A

Chondrocalcinosis

343
Q

B12 and Folate Def sx

A

Fatigue, poor concentration, pallor
Low B12, low Folate, anemia, polymorphs
Peripheral neuropathy and ataxia

344
Q

When to refer B12 deficiency urgently to hematology

A

If neuro sx (loss of sensation, weakness, optic neuropathy, psych issues, symmetrical neuropathy, urinary/fecal incont)
If preggo

345
Q

B12 or Folate first

A

B12 first, then folate. If not –> subacute combined degeneration of spinal cord

346
Q

Pernicious anemia

A

Autoimmune dx affecting gastric mucosa leading to B12 deficiency

347
Q

Causes of B12 deficiency

A

Pernicious anemia
atrophic gastritis (from H Pylori)
gastrectomy
malnutrition (alcoholism)

348
Q

B12 def RFs

A

female
middle/old age
assoc with autoimmune dx (thyroid, T1DM, Addisons, rheumatoid, Vitiligo)
More common in blood group A

349
Q

B12 def features

A

Anemia:lethargy, pallor, dyspnoea
Neuro:
- peripheral neuropathy: ‘pins and needles’, numbness. Typically symmetrical and affects the legs more than the arms
- subacute combined degeneration of the spinal cord: progressive weakness, ataxia and paresthesias that may progress to spasticity and paraplegia
- neuropsychiatric features: memory loss, poor concentration, confusion, depression, irritabiltiy
Other:
- mild jaundice
- glossitis

350
Q

Most common pancreatic CA

A

adenocarcinoma

351
Q

Palliative pain relief in severe renal impairment

A

fentanyl
buprenorphine

oxycodone in moderate

352
Q

Opioid use in palliation

A

oral MR morphine (20-30mg/day) + oral IR (5mg) for breakthrough + laxatives

353
Q

Frontotemporal dementia (Picks)

A

personality change
impaired social conduct
hyperorality, disinhibition, high appetite, perseveration

354
Q

frontotemporal dementia macro/micro changes

A

Macro: atrophy of fronto and temp lobes
Micro: pick bodies (aggregation of tau protein), gliosis, neurofibrillary tangles, senile plaques

355
Q

Frontotemporal dementia - CPA

A

chronic progressive aphasia
non-fluent speech
comprehension preserved

356
Q

Fontotemporal semantic dementia

A

fluent progressive aphasia, speech is fluent but empty

My notes - med (14 decks)

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