PassMed July & August Flashcards
What is Nelson’s Syndrome? How does it present?
Rapidly enlarging ACTH pituitary tumour that occurs after bilateral adrenalectomy
Sx = Hyperpigmentation and brain compression Sx
What is a cephalohaematoma?
Occurs 2-3 days after birth (usually an instrumental delivery). Swelling does NOT cross suture lines
What is a caput succundum?
Occurs immediately after birth and does cross the suture lines
If a patient’s angina is not controlled on Beta blockers and GTN what should you do?
Add calcium channel blocker
Which drug is a direct contraindication to prescribing beta blockers?
Verapamil (risk of complete heart block)
What do diarrhoea and vomiting do to the blood respectivley?
Diarrhoea causes a normal anion gap metabolic acidosis
Vomiting causes metabolic alkalosis
What is Transfusion-Related Acute Lung Injury? How may it present and how should you treat?
Due to too rapid blood transfusion
Hypoxia, fever and hypotension (ARD symptoms)
Give oxygen. STOP transfusion
What is Transfusion-Associated Circulatory Overload? How may it present and how should you treat?
Seen in those with pre-existing heart failure who have blood transfusion
Pulmonary oedema and hypertension
Give IV loop diuretic and oxygen. STOP transfusion
What is Acute Haemolytic Reaction? How may it present and how should you treat?
ABO incompatibility - will occur rapidly after transfusion
Fever, abdo pain and hypotension
STOP transfusion and give fluid resucitation
What should you suspect in a young woman with deranged LFTs and secondary amenorrhoea?
Autoimmune hepatitis
When should you prescribe PPIs in upper GI bleed?
AFTER endoscopy has been performed
How should you treat toxoplasmosis infection in the immunocompromised?
With pyrimethamine and sulphadiazine
What is hepatorenal failure? What are the types?
Chronic liver failure => renal failure
Type 1 = rapid (<2 weeks) onset often following upper GI bleed
Type 2 = gradual decline in renal function associated with ascites
What movement is controlled by C8?
Finger and thumb flexion - grip
What is Actinic Keratoses? How should you treat?
Premalignant skin condition which develops due to chronic sun exposure. Presents with small scaly/crusty lesions on sun exposed sites
Tx = Fluorouracil Cream
How can you manage perianal fistulas in patients with Crohn’s disease?
Metronidazole
Sx of haemachromatosis?
Excess iron build up - liver, pancreatic, heart and pituitary issues. Fatigue, hyperpigmentation and low libido
Tx of haemachromatosis?
1st line - Venesection
What antibiotic should be used to treat animal bites (including human bites)?
Co-Amoxiclav
What is a narrow complex tachycardia? How should you treat it?
SVT
Vasovagal manoeuvres and then if that fails IV adenosine
What is a broad complex tachycardia? How should you treat it?
VT
IV amiodarone if no adverse features
DC cardioversion if adverse features (e.g. shock - systolic BP <90, syncope, MI or HF)
Which drug is known to cause both hyperthyroidism and hypothyroidism due to its high iodine content?
Amiodarone
What is TLCO? How will it change in pulmonary fibrosis?
A gas transfer test which measures the uptake of oxygen in the lungs. It will be reduced in pulmonary fibrosis
Which antibiotic is commonly used as prophylaxis treatment in those with COPD?
Azithromycin
What metabolic abnormality is caused by persistent vomiting?
Hypochloraemic, hypokalaemic metabolic alkalosis
How much adrenaline should you give in cardiac arrest?
1mg (1:10,000)
What adverse effect can citalopram cause?
Dose dependant QT prolongation
What should you use to treat bradycardia with adverse signs (e.g. hypotension and shock)?
500mcg Atropine, repeat up to 3mg
How should you treat recurrent vaginal candidiaisis?
Oral fluconazole
In VF/Pulseless VT what should you give after delivering 3 shocks and adrenaline?
300mg IV amiodarone
Which COPD patients can definitely be offered long term oxygen therapy?
Non smokers with a pO2<7.3
What should you do to investigate abdominal pain with leucocytes and blood in the urine? What are you looking for?
CT abdomen and renal tract. Looking for renal stones
What is transfusion associated circulatory overload? How should you treat it?
Pulmonary oedema and hypertension seen in those with pre-existing HF
Treat with IV loop diuretic and oxygen
What is transfusion related acute lung injury? How should you treat it?
Acute respiratory distress leading to hypoxia, fever and hypotension
Treat with oxygen
What is acute haemolytic reaction? How should you treat it?
ABO incompatibility. Causes fever, abdo pain and hypotension
Treat with fluid resucitation
A young female presents with deranged LFTs and secondary amenorrhoea. What condition should you suspect?
Autoimmune hepatitis
When should you give PPIs in an upper GI bleed?
Not until endoscopy has been performed!
How should you treat toxoplasmosis in the immunocompromised?
Pyrimethamine and Sulphadiazine
What are the characteristic symptoms of Legionella?
Flu like Sx, relative bradycardia, confusion, dry cough, hyponatraemia and deranged LFTs
Before when is post partum birth control NEVER required?
Before 21 days
What is a normal PR interval?
120-200ms
What is a normal QT interval?
<440 in men and <460 in women
Which metabolic abnormalities cam cause prolonged QT syndrome?
Hypokalaemia, hypomagnesia and hypocalcaemia
How should you treat severe cellulitis?
Co-amoxiclav, cefuroxime, clindamycin or ceftriaxone
What should you use during ALS/CPR if you suspect PE?
IV alteplase
What is the treatment for prolonged bradycardia?
Atropine
What can be used in patients with COPD who do not smoke and are optimised on inhalers but still get frequent infections?
Azithromycin
What is cushing’s triad?
Wide pulse pressure, bradycardia and irregular breathing seen in brainstem compression
What is tiotropium?
An LAMA
When should you give adrenaline in a non-shockable rhythm?
As soon as possible
How do you treat animal bites?
Co-amoxiclav
What would you expect to see in iron studies to confirm a diagnosis of iron-deficiency anaemia?
Low ferritin, high total iron-binding capacity, low serum iron and low transferrin saturation (as there is high transferrin and low iron)
Mx of Gonorrhoea?
IM Ceftriaxone
Mx of PID?
Doxycycline, metronidazole and ceftriaxone
Mx of extensive otitis externa?
Flucloxacillin
What are the risks of SSRIs during 1st and 3rd trimester of pregnancy?
1st trimester = congenital heart defects
3rd trimester = pulmonary hypertension
Sx of Dermatomyositis?
Gottron’s papules (rough red papules and plaques over the extensor surfaces of the fingers), extremely dry hands and proximal muscle weakness
What is the preferred management for intertrochanteric (extracapsular) proximal femoral fractures?
Dynamic hip screws
Mx of Dermatomyositis?
Urgent rheumatology referral
What are the characteristic features of mycoplasma pneumonia?
Prodromal flu-like symptoms and an erythema multiforme rash
What is the test for glandular fever diagnosis?
Heterophil antibody test (aka Monospot test) in the 2nd week of illness
Sx of Age Related Macular Degeneration?
Reduced visual acuity (especially for near objects), difficulties in dark adaptation (and reduced nigh vision), fluctuations in visual disturbances, distortion of line perception, photopsia (perception of flickering or flashing lights)
What is Klinefelter’s syndrome?
47 XXY.
Patients are tall and lack secondary sexual characteristics. They have small firm testes, are infertile and can have gynaecomastia.
Will be elevated gonadotrophin levels but low testosterone.
What is seen in Nuclear Scintigraphy in Toxic Multinodular Goitre and Graves Disease?
TMG = Patchy uptake
Grave’s = uniform uptake with diffuse enlargement of the thyroid glands
What is the Cushing’s reflex?
Hypertension and bradycardia as well as wide pulse pressure and irregular breathing
What will be seen on a FBC in acute appendicitis?
Neutrophil predominant leucocytosis
What is the psoas sign?
Lie the patient on their left side and flex the right thigh backwards. Pain indicates an inflamed appendix
Which type of HRT should be used in women at risk of VTE?
Transdermal
To diagnose RBBB the QRS complex must be at least what?
QRS > 120ms
Burkitt Lymphoma is a rapidly proliferating B cell tumour. How does it appear on microscopy? Which disease is it associated with?
Starry sky appearance
It is associated with EBV contracted in adulthood
Mx of H.Pylori?
PPI + Amoxicillin + Clarithromycin
OR
PPI + Metronidazole + Clarithromycin
What is SAAG? What does this number indicate?
Serum Ascites Albumin Gradient
>11g/L = Transudate fluid. Indicates portal hypertension e.g. due to liver cirrhosis or hepatic failure
<11g/L = Exudate fluid (due to inflammation) e.g. due to malignancy or infection
What should patients with HSP monitor on their discharge?
Blood pressure and urine dipsticks to look for proteinuria. This is due to the risk of renal failure
Define Schizoid PD?
Patients prefer solitary activities, they lack interest in sexual interactions or companionship. They are emotionally cold and have few interests and few friends.
Define Schizotypal PD?
Patients are odd and eccentric, they have magical thinking and unusual perceptions. May be paranoid and suspicious of others, they have few friends. Will have inappropriate affect
Which type of ectopic pregnancies MUST be managed surgically?
Those >35mm or with a serum Beta-hCG >5000
What is seen in Progressive Multifocal Leukoencephalopathy?
Caused by the JC virus it is associated with immunosuprression.
Sx = subacute onset, behaviours changes and speech/motor/visual impairment.
MRI will show widespread demyelination
What is Kallman syndrome?
A type of hypogonadotropic hypogonadism
Delayed/absent puberty with an impaired sense of smell
What is Behcet’s disease?
A vasculitis causing oral and genital ulcers and anterior uveitis (painful red eyes and blurred vision)
What is Chondrocalcinosis?
Calcification of the articular cartilage suggestive of pseudogout
Sx of Syringeomyelia?
Cape like loss of sensation of pain and temperature (but preserved light touch, proprioception and vibration), lower limb spastic weakness, upgoing plantars and neuropathic pain
What investigation should be performed in suspected aortic dissection?
CT angiography thorax, abdomen, pelvis
Which type of anti-hypertensive drugs are most associated with ankle oedema?
Dihydropyridines e.g. Amlodipine or Nifedipine
What parameters are measured in the CURB-65 score?
Confusion
Urea >7 mmol/L
Resp rate >= 30
BP <= 90 systolic or <=60 diastolic
Age >65
A patient should take a second dose of levonorgestrel if they vomit within X hours?
3 hours
A child presents with limp, hip pain and a fever. You suspect transient synovitis. What should you do?
Refer for same day assessment.
All children with limp/hip pain and a fever must have a same day assessment
Which type of aortic aneurysms are considered to be high risk of rupture? What should be done with these?
Those that are symptomatic, >= 5.5cm or rapidly enlarging (>1cm/year)
Refer to vascular surgery within 2 weeks
What is the first thing you should check in a male presenting with osteoporosis?
Testosterone levels
Above what aspirin ingestion is considered overdose?
> 125mg/kg
Mx of aspirin overdose?
Activated charcoal (if within 1 hour)
Urinary alkalinisation (with IV NaHCO3)
Haemodialysis (if serum conc >700mg/L)
Sx of salicylate (e.g. aspirin) overdose?
Hyperventilation, tinnitus, pyrexia/sweating, nausea/vomiting, seizures and coma
When is the peak incidence of bronchiolitis in the year?
Autumn
What is cubital tunnel syndrome?
Compression of the ulnar nerve leading to tingling in the 4th and 5th finger which is worse when the elbow is resting on a firm surface or flexed for extended periods
Tennis elbow vs Golfers elbow?
Tennis elbow = lateral epicondylitis, pain worse on wrist extension with the elbow extended
Golfers elbow = medial epicondylitis, pain worse on wrist flexion and pronation
Name on of the 3 conditions which must be present to offer long term oxygen therapy to COPD patients with a pO2 of 7.3-8kPa?
Secondary polycythaemia, peripheral oedema and pulmonary hypertension
Where is the most common site to obtain IO access?
Proximal tibia
What does Glaucoma primarily cause?
Visual field defects - mainly affecting peripheral vision
