Passmed General 2 Flashcards
What is the typical presentation of Guillain-Barre syndrome?
Ascending, progressive, symmetrical weakness of all the limbs often preceded by an infection. Reduced reflexes,
What is the pathophysiology of Guillain-Barre syndrome?
immune-mediated demyelination of the PNS
Where are the majority of ectopic pregnancies?
97% are in the fallopian tubes
Which location are fibroids that are likely to prevent embryo implantation?
Submucosal
What medications are used to manage menorrhagia secondary to fibroids?
NSAIDs (mefenamic acid), tranexamic acid, COCP, POP
What medications can be used to shrink fibroids?
GnRH agonists
What tests are included in the combined test for Down’s syndrome?
bHCG (raised)
PAPP-A (low)
nuchal translucency (thickened)
What tests are included in the quadruple test for Down’s, Edwards syndrome and neural tube defects?
alpha-fetoprotein, unconjugated oestriol, HCG, inhibin A
What tests can be offered after combined screening?
Non-invasive prenatal screening (looks at cell-free fetal DNA)
Amniocentesis and Chorionic villous sampling
Which part of the pituitary secretes ADH and oxytocin?
Posterior
What is a glaucoma?
Optic neuropathy associated with raised intraocular pressure
What is the treatment for primary open-angle glaucoma?
1st Selective laser trabeculopathy, 2nd prostaglandin analogue eye-drops, 3rd BB eye-drops, carbonic anhydrase, sympathomimetic eye-drops
Which cranial nerve lesion causes a dilated fixed pupil?
CN III
What does Phenelzine do?
Monoamine oxidase inhibitor
Name three SSRIs
1st Citalopram and fluoxetine
2nd Sertraline
What investigations do you do in an acute exacerbation of asthma?
Vital signs
ABG if O2 sats are below 92%
What ECG change is associated with Wolff-Parkinson-White syndrome?
Short PR interval, wide QRS - with delta wave
What blood levels can you use to distinguish an upper GI bleed from a lower GI bleed?
High urea in upper GI bleed - due to blood being digested
What is the immediate management of patients with bradycardia and signs of shock?
500ug atropine - repeated up to 3mg max
What is the first line management of acute pericarditis?
NSAIDs (Naproxen) and Colchicine
What are the features of pericarditits?
Chest pain, relieved by sitting forwards, pericardial rub, saddle-shaped ST elevation, PR depression
What is the first line treatment for painful diabetic neuropathy?
Duloxetine/amitriptyline/gabapentin/pregabalin
What is the difference in findings of pre-renal and renal AKI?
Pre-renal = low urinary sodium - kidneys hold onto sodium to preserve volume
Renal = high urinary sodium - kidneys cannot retain it
What is the criteria for malignant hypertension?
BP over 180/120mmHg - send to secondary care immediately
What are the ECG findings on patients with hypokalaemia?
U waves, small or absent T waves, long PR interval, ST depression, long QT
What is the clinical indication for giving patients with acute bronchitis antibiotics?
CRP level > 100mg/L give Abx immediately
CRP level 10-100mg/L offer delayed prescription
What is the typical presentation of acute bronchitis?
Cough that typically starts off dry then becomes productive, usually resolves within 3 weeks.
How can you tell the difference between pneumonia and acute bronchitis?
bronchitis - no focal chest signs other than wheeze
pneumonia - dull to percussion, crepitations, bronchial breathing, systemic features
What is the difference between bronchitis and pneumonia?
Pneumonia is an infection of the alveoli, bronchitis affects the larger airways
What are the three stages of AKI?
1: increased creatinine to 1.5-1.9 x the baseline
reduced urine output by 0.5 for > 6 hours
2: Increased creatinine to 2-2.9 x the baseline
reduced urine output by 0.5 for > 12 hours
3: Increased creatinine to >3 x the baseline
reduced urine output by 0.3 for > 24 hours
What are the complications of acute lymphocytic leukaemia?
Anaemia, low IgG leading to infections, autoimmune haemolytic anaemia, transformation to high-grade lymphoma (Richter’s transformation)
What is the treatment for necrotising fasciitis?
Surgical debridement, IV abx
What changes are seen in different kidney diseases?
diabetic nephropathy - bilaterally enlarged then bilaterally normal
CKD - shrunken kidneys
Congenital defect - horseshoe kidney
What is the management of a patient with a wells score for 2 +?
Proximal leg US within 4 hours, interim anti-coagulation
What is the management of a patient with a wells score of 1 point or less with a suspected DVT?
D-dimer within 4hrs with interim anticoagulation
What are the first line anticoagulants used in DVT?
Apixaban or rivaroxaban
How long should people with DVTs have anticoagulation?
3 months if provoked
6 months if unprovoked
Which blood marker is used to assess severity of a C.Diff infection?
Raised white cell count
What is the first line treatment of C.Diff?
Oral Vancomycin for 10 days
What blood gas changes are seen in vomiting?
Metabolic alkalosis - loss of protons, potassium and chloride ions
What is the motor section of the GCS score?
- obeys commands
- localises to pain
- withdraws from pain
- abnormal flexion to pain
- extending to pain
- none
What is the verbal response section of the GCS score?
- orientated
- confused
- words
- sounds
- none
What is the eye-opening response for the GCS score?
- spontaneous
- to speech
- to pain
- none
Can you give a blood transfusion to the child of jehovah’s witnesses in a life-threatening situation?
Yes
Which infectious disease presents with koplik spots (small white lesions on buccal mucosa)?
Measles
What is the treatment for stress incontinence?
Pelvic floor exercises, duloxetine (SNRI)
What is the first line treatment of urinary incontinence?
urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training
What are the features of roseola infantum?
high fever: lasting a few days, followed later by a maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
What is the causative organism of roseola infantum?
Human Herpes Virus 6
What are the features of hypernatremia?
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
What is a raised Gamma GT indicative of?
Liver problems, alcohol misuse disorder
What is the first line medication used in stress incontinence?
duloxetine
What is the first-line investigation in reflux nephropathy?
Micturating cystography
What is the treatment for pain in palliative patients with mild-moderate renal failure?
Oxycodone
(Fentanyl or buprenorphine for severe renal impairment (<30ml/min))
Give an example of a macrolide antibiotic
axithromycin/clarithromycin
What is the action of metformin?
It increases peripheral insulin sensitivity
What age do men have AAA screening?
65
What screening tests are offered to women at their booking appointment?
Syphilis, HIV, hep B, sickle cell and thalassaemia
What is the first line antibiotic for tonsillitis?
Phenoxymethypenicillin - 10 day course
How do you treat Ramsey-hunt syndrome?
Oral aciclovir and corticosteroids
What is the treatment for suspected PE with confirmed DVT?
low molecular weight heparin
How does the progesterone only pill interact with antibiotics?
No interactions
What must you give in patients with an SSRI and NSAID?
PPI
What type of pulse is associated with patent ductus arteriosus?
bounding, collapsing pulse
Which medications are used for migraine prevention?
Propanolol
Topiramate (not in women of childbearing age or on contraceptives)
amitriptyline
What is a common trigger of cluster headaches?
Alcohol
In gestational diabetes with a fasting glucose of <7 what is the first line management?
Diet and exercise for 1-2 weeks
What do you give to a woman exposed to chicken pox for the first time in pregnancy?
Varicella Zoster IgG
What is the mechanism of action of benzodiazepines?
Enhances the effects of GABA
What is otosclerosis?
Adherence of the stapes footplate to the middle ear - bilateral conductive hearing loss with a family history
What is presbyacusis?
bilateral sensorineural hearing loss - age related, gradual onset, affects higher frequencies first
What is open-angle glaucoma?
Most common glaucoma - increased intraocular pressure with visual field loss
What can be used to manage open angle glaucoma?
topical prostaglandins, topical beta-blockers, topical carbonic anhydrase inhibitor, topical alpha agonist (all decrease amount of aqueous humour)
What are the features of acute angle glaucoma?
subacute - episodic halos, impaired vision, eye pain, worse in the dark. fixed dilated pupil, hazy cornea
What is the treatment for acute angle glaucoma?
refer to ophthalmology, drainage
What are the common causes of central vision loss?
B12 deficiency, MS, macular degeneration
What are the stages of hypertension?
Stage 1 – 140/90
Stage 2 – 160/100
Severe - >180 systolic or >100 diastolic
What are the symptoms of hypercalcaemia?
Bones, stones, abdominal groans and psychic moans (high Ca low PO4)
What is the first-line management of stable angina?
BB/CCB/long-acting nitrate
BB - if previous MI
CCB - if hypertension
Nitrates - if preferred or cannot have the other meds
What medications can be used to treat an overactive bladder?
anti-muscarinics - oxybutynin and tolterodine
What conditions are generally autosomal recessive and dominant?
Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias
Autosomal dominant conditions are ‘structural’
