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passmed corrections april part 1 Flashcards

1
Q

symptoms of haemolysis

A

shortness of breath on exertion, pallor (anaemia), jaundice (bilirubinaemia) and dark urine (haemoglobinuria)

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2
Q

Ectopic pregnancy most dangerous location

A

localised to the isthmus increases the risk of rupture

ampulla most common

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3
Q

what antibiotics to avoid in uti with methotrexate use

A

Co-trimoxazole, which contains trimethoprim and sulfamethoxazole
Trimethoprim
combo of trimeth + methotrexate inhibits dihydrofolate reductase, increasing the risk of severe bone marrow suppression (myelosuppression).

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4
Q

risk sizes and management for AAA

A

<3 normal
3-4.5 low risk see every 12 months
4.5-5.4 mod risk see every 3 months
>5.5 refer for within 2 weeks for in intervention

high risk is symptomatic, aortic diameter >=5.5cm or rapidly enlarging (>1cm/year)

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5
Q

when to check lithium levels

A

7 days after dose chznge the sample should be taken 12 hours post-dose. due to half life of 24 hours

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6
Q

why are coalic patients given vaccine and what

A

pneumococcal every 5 years
due to hyposplenism

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7
Q

management of giant cell arteritis inc eye problems

A

high dose prednisolone
if eye problems started then IV methylprednisolone
patients with visual symptoms should be seen the same-day by an ophthalmologist
bone protection with bisphosphonates is required as long, tapering course of steroids is required

steroids should not be discontinued if negative biopsy as skip lesions can occur

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8
Q

gold standard for diverticulitis inv

A

CT with contrast
first line too

consider erect chest X-ray if perforation suspected – may show free intraperitoneal air under the diaphragm

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9
Q

neonatal hypoglycaemia roughly

A

<2.6
admit if v low blood sugars or symptomatic and give IV dextrose 10%

Transient hypoglycaemia in the first hours after birth is common.

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10
Q

noenatal sepsis presentation

A

Respiratory distress (85%)
Grunting
Nasal flaring
Use of accessory respiratory muscles
Tachypnoea

tachycardia
poor feeding
vomiting
seizures

intravenous benzylpenicillin with gentamicin as a first-line regimen for suspected or confirmed neonatal sepsis

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11
Q

uric acid levels in gout

A

a uric acid level ≥ 360 umol/L is seen as supporting a diagnosis
if uric acid level < 360 umol/L during a flare repeat the uric acid level measurement at least 2 weeks after the flare has settled cus can gte false negatives

needle shaped negatively birefringent monosodium urate crystals under polarised light

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12
Q

acute intermittent porphyria

A

combination of abdominal, neurological and psychiatric symptoms. classically urine turns deep red on standing. elevated urine porphobilinogen
assay of red cells for porphobilinogen deaminase
raised serum levels of delta aminolaevulinic acid and porphobilinogen

Management
avoiding triggers
acute attacks
IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available

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13
Q

complications of tumour lysis syndrome

A

hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure

needs raised serum creatinine, cardiac arrhythmia or a seizure to have occurred for diagnosis

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14
Q

thyroid meds in pregnancy

A

thyroxine is safe
women require an increased dose of thyroxine during pregnancy
by up to 50% as early as 4-6 weeks of pregnancy
propylthiouricil over carbimazole in first trimester may be associated with an increased risk of congenital abnormalities
thyrotrophin receptor stimulating antibodies should be checked at 30-36 weeks gestation - helps to determine the risk of neonatal thyroid problems
radioiodine therapy contraindicated

Untreated thyrotoxicosis increases the risk of fetal loss, maternal heart failure and premature labour

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15
Q

inv for orbital cellulitis

A

CT with contrast to assess orbital tissues deep to septum and sinusitis
WBC elevated, raised inflammatory markers.

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16
Q

tumour marker in pancreatic cancer

A

CA19-9

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17
Q

myeloma criteria diagnostic

A

1 and 1 or 3 of minor

Major criteria
Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
30% plasma cells in a bone marrow sample
Elevated levels of M protein in the blood or urine

Minor criteria
10% to 30% plasma cells in a bone marrow sample.
Minor elevations in the level of M protein in the blood or urine.
Osteolytic lesions (as demonstrated on imaging studies).
Low levels of antibodies (not produced by the cancer cells) in the blood.

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18
Q

treatment for neutropenic sepsis

A

piperacillin w tazobactam

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19
Q

sickle cell crisis with reticulocyte count levels

A

low - aplastic due to bone marrow suppression
high- sequestration

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20
Q

management of perianal abscess

A

incision and drainage
a draining seton may also be placed if a tract is identified

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21
Q

management of perianal fistulae

A

MRI is imaging of chocie
symptomatic perianal fistulae are usually given oral metronidazole
anti-TNF agents such as infliximab may also be effective in closing and maintaining closure
a draining seton is used for complex fistulae

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22
Q

management of crohns - inducing remission

A

glucocorticoids
5-ASA drugs (e.g. mesalazine) second-line
azathioprine or mercaptopurine third line ADD ON
Methotrexate alternative to azathioprine
infliximab in refractory disease and fistulating Crohn’s.- continue on azathioprine or mercapt

metronidazole is often used for isolated peri-anal disease

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23
Q

management of crohns- maintaing remission

A

azathioprine or mercaptopurine is used first-line
check TPMT activity first
then methotrexate second line
stop smoking

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24
Q

how to work out units of alcohol in a drink

A

number of millilitres by the ABV and divide by 1,000

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25
Migratory thrombophlebitis and non specific cancer symptoms
Pancreatic cancer refer a patient for a high-resolution CT scan of the pancreas if aged 60 or over with weight loss and any one of diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation or new-onset diabetes
26
first line for anxiety and depression for children
Fluoxetine
27
Risk factors for bile stones (4 not obvious ones)
Fat Female Fertile (pregnancy) Forty Crohns Diabetes Rapid weight loss Drugs - COCP and Fibrates
28
dresslers syndrome
autoimmune pericarditis weeks to months after MI (pericarditis can occur 1-3 days after MI as well but not dresslers syndorme)
29
when to intubate
Intubate if the GCS is less than 8 with cuffed endotracheal tube.
29
what cancers cause pericarditis
lung cancer breast cancer
30
For a patient with symptomatic stable angina on a calcium channel blocker but with a contraindication to a beta-blocker, the next line treatment should be
long-acting nitrate (such as isosorbide mononitrate), ivabradine, nicorandil or ranolazine
31
treatment of infective exacerbations of COPD
amox. Doxycycline and clarithromycin also azithromycin is prophylaxis for (typically 4 or more per year)
32
treatment for UC inducing remission
topical aminosalicylate add oral aminosalicylate add corticosteroid if extensive - topical aminosalicylate and a high-dose oral aminosalicylate and if not then take away topical and add steroid keep oral aminosalicylate if severe- IV steroids add IV ciclosporin or consider surgery
33
treatment maintaining remission UC
mild-to-moderate- proctitis and proctosigmoiditis- topical aminosalicylate (5ASA) alone (daily or intermittent) or an oral plus topical or an oral alone left-sided and extensive ulcerative colitis- low dose oral 5ASA severe relapse or >=2 exacerbations in the past year- oral azathioprine or oral mercaptopurine
34
Beck's triad
hypotension, raised jugular venous pressure (JVP) and muffled heart sounds = cardiac tamponade
35
Reynold's pentad
= Charcot's triad plus hypotension and confusion
36
PPH meds contraindications
oxytocin is fine ergometrine not in hypertension carboprost not in asthma
37
management addisonian crisis
hydrocortisone IM or IV IV fluids saline include dextrose if hypoglycaemic no fludrocortisone is required once stable, convert to oral replacement after approximately 24 hours, reducing to maintenance dosing over 3–4 days
38
MEN I things
pituitary adneoma Parathyroid- hyperparathyroidism due to parathyroid hyperplasia Pancreatic tumours (insulinoma or gastrinoma) Also: adrenal and thyroid MEN1 gene c]hypercalcaemia
39
MEN IIa things
2ps Parathyroid Phaeochromocytoma Medullary thyroid cancer RET oncogene
40
MEN IIb things
Medullary thyroid cancer Phaeochromocytoma Marfanoid body habitus Neuromas RET oncogene
41
thyroid acropachy, a triad of:
digital clubbing soft tissue swelling of the hands and feet periosteal new bone formation found in graves hyperthyroidism
42
sweating, headaches, and palpitations in association with severe hypertension/ failed management of hypertension despite polypharmacy
pheochromocytoma Diagnosis is with urinary metanephrines which should be expected to be elevated. Surgery is the definitive management. The patient must first however be stabilized with medical management: alpha-blocker (e.g. phenoxybenzamine), given before a beta-blocker (e.g. propranolol)
43
cushings disease dexamethasone test results
high dose- cortisol suppressed, ACTH suppressed (dex mimics cortisol)
44
alpha 1 antitrypsin symptoms
persistent shortness of breath, a lack of significant smoking history, lower lobe emphysema, and abnormal LFTs. lungs: panacinar emphysema, most marked in lower lobes liver: cirrhosis and hepatocellular carcinoma in adults, cholestasis in children caused by a lack of a protease inhibitor (Pi) normally produced by the liver
45
squamous cell carcinoma (lung) features
typically central associated with parathyroid hormone-related protein (PTHrP) secretion → hypercalcaemia finger clubbing cavitating lesions are more common than other types hypertrophic pulmonary osteoarthropathy (HPOA)
46
lung adenocarcinoma features
typically peripheral most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers
47
Large cell lung carcinoma features
typically peripheral anaplastic, poorly differentiated tumours with a poor prognosis may secrete β-hCG
48
small cell lung cancer features
usually central arise from APUD* cells associated with ectopic ADH, ACTH secretion ADH → hyponatraemia ACTH → Cushing's syndrome ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome
49
anaphylaxis management doses with ages
< 6 months = 100-150micrograms 6 months - 6 years = 150micrograms 6-12 years= 300micrograms Adult and child > 12 years = 500 micrograms all 1 in 1000
50
investigation of choice for PE in renal impairment
VQ scan
51
when is Oxygen used in management of acute coronary event
indicated if saturations drop below 94%.
52
when to check fertility levels and how
progesterone levels at peak which is 7 days after ovulation (length of period minus 7 as luteal phase is always 14 days for some reason) < 16 nmol/l Repeat, if consistently low refer to specialist 16 - 30 nmol/l Repeat > 30 nmol/l Indicates ovulation
53
emergency contraception types and time windows
levonorgestrel pill- effective up to 72 hours (3 days) after UPSI, Ulipristal- effective up to 120 hours (just under 5 days) after UPSI. cautioned in asthma. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period. reduces effectiveness of hormonal contraception. breastfeeding should be delayed for one week IUD - within 5 days of UPSI, or up to 5 days after the likely ovulation date
54
DOACs used for
Af and venous thromboembolisim. not PAD. For PAD use clopidogrel and statin
55
oral ulcers, genital ulcers and anterior uveitis
behcets syndrome affect young adults (e.g. 20 - 40 years old) associated with HLA B51 also thrombophlebitis and deep vein thrombosis arthritis neurological involvement (e.g. aseptic meningitis) GI: abdo pain, diarrhoea, colitis erythema nodosum
56
new diagnosis of dermatomyositis do what
screen for underlying malignancy. usually idiopathic but can be caused by cancer- typically ovarian, breast and lung cancer (antiJo antibody)
57
types of oesophageal cancer
adenocarcinopma- assoc with gord and barrets (normal squamous epithelium in the lower oesophagus with columnar epithelium) , most common in uk and us squamous cell- smoking and alcohol
58
causes of LBBB
New LBBB is always pathological. MI- Sgarbossa criteria can help diagnose hypertension aortic stenosis cardiomyopathy rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia
59
loop diuretics cause what electrolyte imbalances
hyponatraemia hypokalaemia, hypomagnesaemia hypochloraemic alkalosis hypocalcaemia hyperglycaemia
60
treatment of torsades de pointes
iv mag sulphate
61
restrictive spirometry picture
(FEV1:FVC >70%, decreased FVC) FEV1 decreased but FVC decreased more cus its all tight and old and scarred. expiring is okay but lung volume is bad both forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) decrease proportionally due to lung stiffness and reduced compliance
62
obstructive spirometry picture
(FEV1:FVC <70%) decreased FEV1 more expiring is shit compared to their lung volume
63
Left ventricular aneurysm
occurs 2 weeks after MI with symptoms mimicking heart failure (shortness of breath, cough, and crackles on auscultation) alongside persistent ST elevation
64
Inducers of warfarin: cause decrease in INR
“SCARS” * S → Smoking * C → Chronic alcohol intake * A → Antiepileptics: Phenytoin, Carbamazepine, Phenobarbitone (all barbiturates) * R → Rifampicin * S → St John's Wort
65
Inhibitors of warfarin: cause increase in INR
“ASS-ZOLES” * A → Antibiotics: Ciprofloxacin, Erythromycin, Isoniazid, Clarithromycin * S → SSRIs: Fluoxetine, Sertraline * S → Sodium Valproate * - Zoles → Omeprazole, Ketoconazole, Fluconazole
66
management of aortic dissection
Type A - ASS (also reminds you it's ASScending): aortic root replacement, systolic 100-120 and surgery Type B - BooBs: bed rest and beta blockers
67
location of hernias
ISM inguinal- superior medial FIL Femoral- inferior lateral

Finals (9 decks)

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