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Finals Revision > Passmed Concepts > Flashcards

Passmed Concepts Flashcards

1
Q

What is required for patients taking prednisolone before surgery?

A

Hydrocortisone supplementation

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2
Q

Why is hydrocortisone given before surgery?

A

if patients have their HPA axis suppressed by prednisolone then they will not be able to cope with the stress of surgery and need hydrocortisone to replace

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3
Q

Complete fracture

A

Both sides of cortex are breached

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4
Q

Toddlers fracture

A

Oblique tibial fracture in infants

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5
Q

Plastic deformity

A

Stress on bone resulting in deformity without cortical disruption

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6
Q

Greenstick fracture

A

Unilateral cortical breach only

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7
Q

Buckle fracture

A

Incomplete cortical disruption resulting in periosteal haematoma only

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8
Q

Fracture through the physis only (x-ray often normal)

A

I

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9
Q

Fracture through the physis and metaphysis

A

II

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10
Q

Fracture through the physis and epiphyisis to include the joint

A

III

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11
Q

Fracture involving the physis, metaphysis and epiphysis

A

IV

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12
Q

Crush injury involving the physis (x-ray may resemble type I, and appear normal)

A

V

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13
Q

Why does OSA cause hypertension?

A

due to the drop in blood oxygen levels and rise in carbon dioxide during apnoea

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14
Q

malignant tumour that occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure

A

osteosarcoma

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15
Q

What are PDE 5 inhibitors e.g. sildenafil contraindicated by?

A

Nitrates and nicorandil

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16
Q

What is a normal QT interval

A

430ms in males, 450 ms in females

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17
Q

What are the causes of long QT interval?

A

Congenital
>Jervell-lange-neilsen syndrome
> romano-ward syndrome

Drugs
> amiodarone, sotalol
> TCAs, SSRIs
> Methadone
> chloroquine
> terfenadine
> erythromycin
> haloperidol
> odansetron 
Other
> electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
> MI
> Myocarditis
> hypothermia
> SAH
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18
Q

Investigation for anastamotic leak

A

abdominal CT

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19
Q

Classical findings in primary hyperparathyroidism

A

high serum calcium

low phosphate

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20
Q

How do thrombosed haemorrhoids present?

A

significant pain and tender lump

o/e: purplish, oedematous, tender subcutaenous perineal mass

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21
Q

management of thrombosed haemorrhoids

A

if patient presents within 72 hours then referral should be considered for excision. Otherwise patients can usually be managed with stool softeners, ice packs and analgesia. Symptoms usually settle within 10 days

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22
Q

Action if one COCP is missed

A

take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed

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23
Q

Action if two COCP are missed

A

> take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms or abstain from sex until she has taken pills for 7 days in a row.

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*

if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

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24
Q

infusion rate in severe hypokalaemia

A

The infusion rate should not exceed 10mmol/hr.

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25
Q

Types of testicular cancer

A

Germ cell
> seminoma
> non-seminoma= embryonal, yolk sac, teratoma and choriocarcinoma

Non-germ cell
>leydig cell tumour
>sarcoma

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26
Q

peak incidence for testicular teratomas and seminoma respectively

A

25 and 35

27
Q

RF for testicular cancer

A 
Infertility
cryptoorchidism
FHx
kleinfelters
mumps orchitis
28
Q

management of testicular cancer

A

orchidectomy

chemotherapy and radiotherapy

29
Q

seminomas have a _____ prognosis than teratomas

A

better

30
Q

What can hyperparathyroidism cause

A

pseudogout

chondrocalcinosis

31
Q

cause of hepatic encephalopathy

A

excess absorption of ammonia and glutamine from bacterial breakdown of protein in gut

32
Q

Features of hepatic encephalopathy

A

> confusion, altered GCS (see below)
asterix: ‘liver flap’, arrhythmic negative myoclonus with a frequency of 3-5 Hz
constructional apraxia: inability to draw a 5-pointed star
triphasic slow waves on EEG
raised ammonia level (not commonly measured anymore)

33
Q

Grading of hepatic encephalopathy

A

Grade I: irritability
Grade II: confusion, inappropriate behaviour
Grade III: incoherent, restless
Grade IV: coma

34
Q

Precipitating factors of hepatic encephalopathy

A 
> infection e.g. spontaneous bacterial peritonitis
> GI bleed
>post transjugular intrahepatic portosystemic shunt
> constipation
> drugs: sedatives, diuretics
> hypokalaemia
> renal failure
> increased dietary protein (uncommon)
35
Q

Management of hepatic encephalopathy

A

> Treat any underlying precipitating cause
NICE recommend lactulose first-line, with the addition of rifaximin for the secondary prophylaxis of hepatic encephalopathy

lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria

antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production

other options include embolisation of portosystemic shunts and liver transplantation in selected patients

36
Q

Which murmur are IV drug users at risk for?

A

right sided cardiac valvular endocarditis

37
Q

what makes aortic sclerosis more likely than aortic stenosis

A

if not radiating to carotids

38
Q

how to prevent tumour lysis syndrome

A

giving allopurinol or rasburicase prior to chemo

39
Q

what is TLS

A

related to the treatment of high-grade lymphomas and leukaemias.

usually triggered by the introduction of combination chemotherapy.

can occur with steroid treatment alone.

40
Q

What happens in TLS

A

breakdown of the tumour cells and the subsequent release of chemicals from the cell

high potassium and high phosphate level in the presence of a low calcium

41
Q

when should TLS be suspected

A

any patient presenting with an acute kidney injury in the presence of a high phosphate and high uric acid level

42
Q

Jittery + hypotonic baby

A

neonatal hypoglycaemia

43
Q

Side effects of ciclosporin

A

everything is increased - fluid, BP, K+, hair, gums, glucose

44
Q

When does functional tricuspid regurgitation occur?

A

2ry to pulmonary hypertension

45
Q

Types of AF

A

first-detected episode

recurrent episodes; paroxysmal or persistent

permanent AF

46
Q

For cardioversion of AF: patients must either be …

A

anticoagulated or have had symptoms for < 48 hours to reduce the risk of stroke.

47
Q

Investigating suspected PE, CTPA -ve

A

consider proximal leg vein USS

48
Q

what is d-dimer used for?

A

exclude PE in patients with wells of 4 or less

49
Q

Management of chickenpox exposure in pregnancy

A

check if mum has antibodies

if < 20 weeks & she doesnt then give VZIG ASAP

if > 20 weeks & she doesnt then give VZIG or antivirals

if develops chickenpox give oral acivlovir if > 20 weeks

50
Q

thyrotoxicosis with tender goitre

A

subacute (de quervains thyroiditis)

51
Q

phases of de quervains thyroiditis

A

Phase 1 (3-6 weeks): hyperthyroidism, painful goitre, raised ESR

Phase 2: (1-3 weeks) euthyroid

Phase 3 (weeks-months): hypothyroid

Phase 4: return to normal

52
Q

What are Thiazolidinediones

A

PPAR-y agonists

natural ligands are free fatty acids and it is thought to control adipocyte differentiation and function.

53
Q

adverse effects of Thiazolidinediones (pioglitazone)

A

weight gain
liver impairment
fluid retention
bladder cancer

54
Q

maturation time for AV fistula

A

6-8 weeks

55
Q

benefit of SGLT-2 inhibitors

A

empagliflozin

weight loss

56
Q

management of type 2 respiratory failure

A

BiPAP

57
Q

medical therapy in exacerbation of COPD

A

> O2 to keep patient within the individualised target range
Nebulised bronchodilators
Steroid therapy
Antibiotics if indicated
Chest physiotherapy
Intravenous theophyllines would be considered if the response to nebulised bronchodilators is poor.

58
Q

long term topical treatment for psoriasis

A

calcipotriol

59
Q

patients with asthma who are not controlled with a SABA + ICS

A

add LTRA not LABA

60
Q

macrocytic anaemia in presence of hyper-segmented neutrophil polymorphs

A

megaloblastic anaemia

61
Q

signs of B12/folate deficiency

A

anaemia, glossitis, macrocytosis, hyper-segmented neutrophils

62
Q

antibiotic for BV

A

metronidazole

63
Q

antibiotic for human bite

A

co-amoxiclav

64
Q

antibiotic for campylobacter

A

clarithromycin

Finals Revision (29 decks)

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