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Phase 3A > Passmed general > Flashcards

Passmed general Flashcards

1
Q

What are the signs of cardiac tamponade?

A

Raised JVP, pulsus paradoxus, diminished heart sounds

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2
Q

What is the immediate management for anaphylaxis?

A

IM adrenaline (500mg in adults)

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3
Q

What are the guidelines for treatment of an acute anaphylactic response?

A

IM adrenaline, once then 5 mins later if no change. Then seek expert help for consideration of an IV adrenaline infusuon.

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4
Q

What is the common cause of subacute combined degeneration of the cord?

A

B12 deficiency

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5
Q

What other levels must be checked before giving folate?

A

B12 (these should be replaced before giving folate)

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6
Q

What are the symptoms of subacute combined degeneration of the spinal cord?

A

Distal tingling and sensory loss, brisk knee reflexes, absent ankle reflexes, gait abnormalities and positive romberg’s sign

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7
Q

What is the first line treatment for hypertension in an over 55 year old or person with African-Caribbean descent?

A

Calcium Channel Blocker

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8
Q

What is the first line treatment for hypertension in an under 55 year old or type 2 diabetic person?

A

ACE inhibitor

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9
Q

What is the second line treatment for hypertension?

A

If on CCB: add ARB, ACE-I or Thiazide diuretic (ARB in preference to ACE-I in African-Caribbean’s)
If on ACE-I: add CCB or Thiazide diuretic

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10
Q

What is the typical presentation for lyme disease?

A

Erythema migrans - Bulls eye rash that can develop 1-4 weeks after bite
Systemic upset

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11
Q

What is the treatment for lyme disease?

A

Doxycycline if early disease (can give if bulls-eye rash is seen, no need for testing)
Ceftriaxone if disseminated disease

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12
Q

How do you interpret blood gases?

A

ROME
Respiratory = Opposite
low pH + high PaCO2 i.e. acidosis, or
high pH + low PaCO2 i.e. alkalosis

Metabolic = Equal
low pH + low bicarbonate i.e. acidosis, or
high pH + high bicarbonate i.e. alkalosis

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13
Q

Which diabetes drug increases insulin sensitivity?

A

Pioglitazone

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14
Q

What is the typical presentation of an acoustic neuroma/vestibular schwannoma?

A

Vertigo, hearing loss, tinnitus and absent corneal reflex

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15
Q

Which antibody levels are raised in an autoimmune reaction?

A

IgG

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16
Q

Which vitamin should be administered with isoniazid to reduce the risk of peripheral neuropathy?

A

Vitamin B6 - Pyridoxine

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17
Q

Which conditions typically reduce FVC?

A

Restrictive lung diseases - scarring in the lungs - pulmonary fibrosis, asbestosis, neuromuscular disorders

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18
Q

Which conditions typically reduce FEV-1?

A

Obstructive lung diseases - COPD, asthma, bronchiectasis

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19
Q

What is lynch syndrome?

A

Hereditary non-polyposis colorectal cancer

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20
Q

Which cancer is most associated with hereditary non-polyposis colorectal cancer?

A

Endometrial cancer

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21
Q

What is the management of someone with fever who is undergoing chemotherapy?

A

Worried about neutropenic sepsis - immediately prescribe IV piperacillin/tazobactam

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22
Q

In addison’s disease when should the hydrocortisone dose be given?

A

Majority in the morning, remainder in the evening

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23
Q

What are the most common causes of meningitis?

A

0-3months - group B strep
3months-60years - neisseria meningititis
>60years - strep pneumoniae
Immunosuppressed - listeria monocytogenes

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24
Q

Which general investigations should be done in patients with metastatic disease of unknown origin?

A

FBC, U&E, LFT, calcium, urinalysis, CXR, CT chest, abdo, pelvis, AFP, hCG

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25
Q

What is the medical management of neuropathic pain?

A

OTC analgesia, then drugs like amitriptyline, pregabalin as monotherapy. Tramadol is not used as regular medication

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26
Q

Which two angina medications should not be taken together?

A

Verapamil (CCB) and beta blockers

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27
Q

What is the first line test for suspected legionella?

A

Urinary Antigen Test

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28
Q

What is the treatment for legionella?

A

Erythromycin/clarithromycin

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29
Q

What are the ECG changes seen in an acute MI?

A
  • hyperacute t waves (few mins)
  • ST elevation
  • T wave inversion (within 24hrs)
  • Pathological Q waves (several days after)
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30
Q

What test results are seen in type 1 autoimmune hepatitis?

A

Antinuclear antibodies, anti-smooth muscle antibodies, raised IgG levels

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31
Q

What is goodpastures syndrome?

A

Anti-glomerular basement membrane disease - small vessel vasculitis causing haemoptysis and haematuria/proteinuria

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32
Q

In a suspected DVT if the D-dimer or doppler scan cannot be done within 4 hours what do you do?

A

Start DOAC - direct oral anti-coagulant (rivaroxaban/apixaban)

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33
Q

Which score is used for a DVT?

A

Wells

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34
Q

What is the first line treatment for C Diff?

A

Oral Vancomycin for 10 days

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35
Q

What type of medicine is metformin?

A

Biguanide - decreases gluconeogenesis in liver and increases glucose sensitivity

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36
Q

What type of medicine is glicazide?

A

Sulfonylureas - increase insulin release from beta-cells in pancreas

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37
Q

What are the feature of a myeloma?

A

CRABBI
- hypercalcaemia
- renal - dehydration and thirst
- anaemia
- bleeding
- bones - lytic lesions (fractures and pain)
- infection (increased risk)

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38
Q

What are the first line investigations in a confused/forgetful older patient in primary care?

A

Blood screen - FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs. B12, folate

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39
Q

What are the management guidelines for type 2 diabetes?

A
  • 1st line - lifestyle
  • 2nd line - metformin
  • 3rd line - SGLT-2 inhibitors (added in increased CVD risk)
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40
Q

Should you use an ARB with an ACE-I?

A

No

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41
Q

Beta blockers are contraindicated in which condition?

A

Asthma

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42
Q

What type of medication is diltiazem?

A

CCB

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43
Q

What are the guidelines for treatment of stable angina?

A
  • Aspirin, statin (unless contraindicated)
  • plus beta blockers or CCB
  • beta blocker and CCB/ or nitrate
44
Q

What is renal tubular acidosis?

A

Inability to generate acid urine (cant secrete H+ or reabsorb HCO3-) in DCT, causes hypokalaemia

45
Q

At what QRISK score should patients be given statins?

A

=>10%

46
Q

What is the first line treatment for hypercholesteraemia?

A

Atorvastatin 20mg daily for prevention, 80mg for secondary prevention

47
Q

What are ‘B’ symptoms of hodgkin’s lymphoma?

A

Imply a poor prognosis
- fever > 38, weight loss > 10% in last month, night sweats

48
Q

What is the first line treatment for COPD?

A

SABA or SAMA

49
Q

What is the second line treatment for COPD?

A

Add a LABA and LAMA, if already taking a SAMA, discontinue and switch to SABA

50
Q

What are the clinical features of aortic regurgitation?

A

Early diastolic murmur, collapsing pulse, wide pulse pressure, quincke’s sign (nailbed pulsation), De Musset’s sign (head bobbing)

51
Q

What is the first line investigation for patients with a suspected PE?

A

CTPA
If this is negative then proximal leg vein ultrasound
V/Q scan in those who cannot have CTPA

52
Q

What is the Well’s score for?

A

Suspected DVT and PE

53
Q

What are the first line investigations with someone with suspected IBS and no red flags?

A

FBC, ESR, CRP, tissue transglutaminases or endomysial antibodies to test for coeliac disease

54
Q

Which diabetes medication increases likelihood of hypoglycaemia?

A

Sulfonylureas - Chlorpropamide (increase pancreatic insulin secretion)

55
Q

What are the features of duchenne muscular dystrophy?

A

Inherited myopathy. Progressive degeneration and weakness of muscle groups. Cannot walk by age 12 and ventilated by age 25.

56
Q

What are the features of charcot-Marie-Tooth disease?

A

hereditary sensory and motor peripheral neuropathy. Usually LMN signs in all limbs with reduced sensation - more pronounced distally

57
Q

What are the features of sarcoidosis?

A

Erythema nodosum, lymphadenopathy, dyspnoea, lupus pernio, fatigue, weight loss, hypercalcaemia (due to increased vitamin D conversion)

58
Q

What is the most common ECG change in patients with a PE?

A

Sinus tachycardia (sometimes S1Q3T3 but this is more rare)

59
Q

What is barrett’s oesophagus?

A

Metaplasia of the oesophageal mucosa from squamous to columnar

60
Q

What is the management of barrett’s oesophagus?

A

high dose PPI, endoscopic surveillance with biopsies every 3-5 years.
Endoscopic intervention if dysplasia is seen

61
Q

What should be tested for to confirm anaphylaxis?

A

Tryptase

62
Q

What does HbA1c measure?

A

The average blood glucose level over about 3 months - corresponds to the life span of a normal RBC

63
Q

Which conditions cause lower than expected HbA1c levels?

A

Sickle-cell anaemia, GP6D deficiencym hereditary spherocytosis, haemodialysis

64
Q

Which conditions cause higher than expected HbA1c levels?

A

B12/folate deficiency, iron-deficiency anaemia, splenectomy

65
Q

What are the SIGN guidelines for pain prescribing?

A
  • breakthrough dose of morphine is 1/6th of daily dose
  • patients on opioids should be prescribed a laxative
  • opioids should be used with caution in patients with CKD
66
Q

What blood results are seen with DIC?

A

Prolonged prothrombin time, prolonged APTT, prolonged bleeding time and a low platelet count

67
Q

What is the first line test for small bowel bacterial overgrowth?

A

hydrogen breath testing

68
Q

What is the typical presentation of botulism?

A

Descending flaccid paralysis - starts with difficulty swallowing, speech issues, ptosis

69
Q

What ECG changes are seen in patients with hyperkalaemia?

A

Tall tented T waves, absent P waves, broad QRS complexes, sinusoidal wave pattern

70
Q

What is the treatment for hyperkalaemia?

A
  • IV calcium gluconate to stabilise the myocardium
  • Insulin/dextrose IV or salbutamol to remove potassium from ECF
  • diuretics and treat cause
71
Q

What are the investigations for acromegaly?

A
  • 1st line - serum IGF-1
  • confirmed diagnosis by oral glucose tolerance test and serial growth hormone measurements
72
Q

What is the main causative organism of bronchiectasis?

A

Haemophilus influenzae

73
Q

What are the typical features of bronchiectasis?

A

productive cough with crackles that clear on coughing, X-ray: thickened walls in the lower zones (tram-track sign)

74
Q

What are the typical features of staphylococcus aureus gastroenteritis?

A

Short incubation period - severe vomiting after 30mins-8hours, symptoms usually resolve within 2 days.

75
Q

What are the typical features of E.coli gastroenteritis?

A

Incubation period of 3-4 days, diarrhoea that becomes bloody, lasting up to a week

76
Q

What are the typical features of salmonella gastroenteritis?

A

Diarrhoea and fever, symptoms usually occur between 6hrs and 6 days after infection

77
Q

What type of medicine is rampril?

A

ACE-Inhibitor

78
Q

What are some pre-renal causes of AKI?

A

Ischaemia, hypovolaemia secondary to diarrhoea, vomiting, renal artery stenosis

79
Q

What are some intrinsic causes of AKI?

A

glomerulonephritis, acute tubular necrosis, rhabdomyolysis, tumour lysis syndrome

80
Q

What are some post-renal causes of AKI?

A

Kidney stone in ureter or bladder, BPH, external compression of the ureter

81
Q

Which drugs can cause AKI?

A

NSAIDS, aminoglycosides, ACE-I, angiotensin 2 receptor antagonists, diuretics, contrast agents

82
Q

What is the diagnostic criteria for AKI?

A

Any of the following:
- a rise in serum creatinine of >26um/L in 48 hrs
- a 50% rise in serum creatinine in 7 days
- a fall in urine output to less than 0.5ml/kg/hr for more than 6 hours

83
Q

What is the initial management for acute coronary syndrome? (STEMI, NSTEMI)

A

aspirin 300mg
oxygen if sats <94%
morphine for patients in severe pain
nitrates - IV or sublingually

84
Q

What is the acute management of patients with NSTEMI?

A

Aspirin 300mg, fondaparinux if no immediate angiography or PCI planned (angiography for patients who are clinically unstable - hypotensive)

85
Q

What is the main pathology that the US between 16 and 24 weeks detects in twins?

A

Twin-to-twin transfusion syndrome

86
Q

What is the classical presentation of Henoch-Schonlein purpura?

A

Purpuric rash with localised oedema over buttocks and extensor surfaces, abdo pain, polyarthritis, features of IgA nephropathy

87
Q

What is the treatment for aortic dissection?

A

Ascending aorta - IV labetalol and surgery
Descending aorta - IV labetalol

88
Q

What is the most common cause of neutropenic sepsis?

A

Coagulase negative, gram +ve bacteria - staphylococcus epidermidis

89
Q

What is the first line treatment for diabetics with hypertension?

A

ACE inhibitors/ARBs

90
Q

What is achalasia?

A

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter

91
Q

What are the typical features of achalasia?

A

Dysphagia of both liquids and solids
heartburn
regurgitation of food - aspiration pneumonia
bird’s beak appearance on barium swallow

92
Q

What are the features of necrotising fasciitis?

A
  • acute onset
  • pain, swelling and erythema, often presents with worsening cellulitis with pain out of keeping with physical features
  • very tender to touch
93
Q

What is the management of necrotising fasciitis?

A

Urgent surgical debridement, IV antibiotics

94
Q

What are the typical features of Addison’s disease?

A

Primary adrenal insufficiency
- hyponatraemia - confusion
- high ACTH - hyperpigmentation
- Low aldosterone - low BP
- High potassium

95
Q

What is the criteria for a diagnosis of CKD stage 1 and 2?

A

There must be signs of kidney damage for a diagnosis to be made
1 = eGFR < 90ml/min
2 = eGFR 60-90ml/min

96
Q

What are the CKD stages?

A

1 Greater than 90 ml/min,
2 60-90 ml/min
3a 45-59 ml/min,
3b 30-44 ml/min,
4 15-29 ml/min,
5 Less than 15 ml/min,

97
Q

What is the Ann-Arbor staging of Hodgkin’s lymphoma? (name the stages)

A

I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes
A = no systemic symptoms other than pruritus
B = weight loss > 10% in last 6 months, fever > 38c, night sweats (poor prognosis)

98
Q

What are the clinical features of aortic dissection?

A

Widened mediastinum on CXR
Acute fall in BP
Widespread ST depression, normal troponin
BP differences between limbs

99
Q

What investigations should be done for potential aortic dissection?

A

CXR
CT angiography is best
Transoesophageal echocardiography for unstable patients

100
Q

What are the features of Hodgkin’s lymphoma?

A
  • Reed-Sternberg cells - mirror image nuclei
  • large, non-tender, rubbery lymph nodes
  • alcohol induced pain
  • weight loss, pruiritus, night sweats, fever
101
Q

What are the clinical features of acute epiglottitis?

A

Rapid onset, high temperature, stridor, drooling of saliva, tripod position (leaning forward, neck extended in seated position)

102
Q

How do you calculate the units of alcohol per week?

A

Ml of alcohol x strength (ABV)
/ 1000

103
Q

Which organism causes epiglottitis?

A

Haemophilus influenzae type B

104
Q

How does hyperventilation help raised intracranial pressure?

A

Reduced CO2 - vasoconstriction of the cerebral arteries - reduce ICP

105
Q

How do you calculate units of alcohol?

A

Ml x percentage / 1000

106
Q

What is the treatment for angina?

A

aspirin + statin
+ GTN

107
Q
A

Phase 3A (14 decks)

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