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Passmed Knowledge 2 Flashcards

1
Q

What drug/dose do you give for anaphylaxis

A

500 micrograms, 1 in 1000 adrenaline

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2
Q

What blood test is useful to determine if someone has had a true episode of anaphylaxis

A

Tryptase - can remain elevated for 12 hours

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3
Q

What chemo drug causes peripheral neuropathy

A

Vincristine

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4
Q

How do you differentiate between a pseudo-seizure and a seizure

A

Serum prolactin will be raised in a seizure

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5
Q

What is the first line antibiotics for bacterial meningitis in someone

A

Cefotaxime

add amoxicillin if over 50 years old

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6
Q

What are the causes of primary postpartum haemorrhage

A

Tone (uterine atony) most common
Trauma (perineal tear)
Tissues (retained placenta)
Thrombin (bleeding)

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7
Q

What are the steps in management for a postpartum haemorrhage

A

Medical: Oxytocin, ergometrine, carboprost

Surgical: intrauterine balloon tamponade (Bakri catheter); ligate uterine, internal iliac artery; hysterectomy last line

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8
Q

Why is adrenaline added to local anaesthetic

A

To prolong its affect

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9
Q

What is the treatment for adrenaline induced ischaemia

A

Phentolamine

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10
Q

What is the treatment for anaesthetic toxicity

A

Lipid emulsion

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11
Q

Where is the lesion of a patient who has a loss of vision in the RUQ of the visual field in both eyes

A

Inferior optic radiations in left temporal lobe (PITS)

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12
Q

Where is the lesion of a patient who has a loss of vision in the RLQ of the visual field in both eyes

A

Inferior optic ration in left parietal lobe (PITS)

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13
Q

What investigations need to be done on people with TIA

A

CT head
Carotid doppler

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14
Q

What is the pathophysiology of Gullian-Barre syndrome

A

Immune-mediated demyelination of the PNS triggered by infection usually with Campylobacter jejuni

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15
Q

What bacteria is associated with Gullain-Barre syndrome

A

Campylobacter jejuni

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16
Q

What are the features of Guillain-Barre syndrome

A

Back pain/leg pain
Progressive, ascending, symmetrical weakness in the limbs
Reduced reflexes

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17
Q

What are the findings on lumbar puncture for Guillain-Barre syndrome

A

Rise in protein with a normal white blood cell count

Albuminocytologic dissociation

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18
Q

What are Osler’s nodes

A

Painful red raised lesions associated with autoimmune complexes (oSLEr’s nodes)

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19
Q

What are Bouchard’s nodes

A

Proximal interphalangeal joint outgrowth (osteoarthritis)

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20
Q

What are Heberden’s nodes

A

Distal interphalangeal joint swelling, bony outgrowth that leaves the fingertip skewed (Heberedens = outer hebrides = far away = DIP)

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21
Q

What is a ganglion on the hand

A

Soft swelling associate with tendon sheath near a joint - asymptomatic usually

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22
Q

What does the ‘target sign’ indicate on ultrasound

A

Intussusception

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23
Q

What is the pattern of distribution of seborrhoeic dermatitis

A

Areas of sebum production: nasolabal folds, neck, behind ears

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24
Q

What is first line management of organophosphate poisoning

A

Atropine

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25
Q

What are the features of orbital compartment syndrome

A

Eye pain/swelling
Rock hard eyelids
RAPD = relative afferent pupillary defect

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26
Q

What is the treatment for orbital compartment syndrome

A

Urgent lateral canthotomy to decompress orbit

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27
Q

What do you see on fundoscopy for retinal vein occlusion

A

Severe retinal haemorrhages (stormy sunset)

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28
Q

What are the symptoms of retinal vein occlusion

A

Sudden painless vision loss in one eye

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29
Q

What are the risk factors for retinal vein occlusion

A

Age
HTN
CVD
Glaucoma
Polycythaemia

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30
Q

What sort of anaemia does Crohn’s disease cause

A

B12 Deficiency (macro) + Iron deficiency (micro) = mixed

Red blood cell width distribution will be raised

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31
Q

If a patient is suspected to have a PE, CTPA is negative; what is the next investigative step

A

Proximal leg vein ultrasound

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32
Q

What is the first line investigation for a PE

A

If Well’s score is > 4 (likely): CTPA, then leg ultrasound if negative
If Well’s score < 4 (unlikely): D-dimer

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33
Q

What is the first line option for management of achalasia

A

Pneumatic dilation

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34
Q

What is the option for managing achalasia in patients who are high surgical risk

A

Botox injection in to the oesophageal sphincter

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35
Q

What are the features of Lewy body dementia

A

Progressive cognitive impairment which may fluctuate
Impairments in attention and exeuctive function
Hallucinations

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36
Q

What is the management of Lewy body dementia

A

Aceylcholinesterase inhibitors (donepezil, rivastigmine,)
Memantine

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37
Q

Give examples of acetylcholinesterase inhibitors used in Lewy body dementia

A

Donepezil
Rivastigmine

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38
Q

What kind of dementia can present with fluctuating mental state

A

Lewy body dementia

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39
Q

How do you prevent a stroke in someone with AF; how long after a stroke should you initiate management

A

Warfarin/DOAC
in TIA - anticoag immediately
In stroke - antiplatelet immediately; anticoag after 2 weeks

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40
Q

What is the definition of prediabetes

A

HbA1c of 42-47 (6-6.4%)

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41
Q

What dose of adrenaline is given to children over 12 and adults for anaphylaxis

A

500mcg 1:1000

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42
Q

What dose of adrenaline is given to children 6months to 6 years for anaphylaxis

A

150mcg 1:1000

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43
Q

What dose of adrenaline is given to children <6 months for anaphylaxis

A

100-150mcg 1:1000

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44
Q

What dose of adrenaline is given to children between 6 years and 12 years for anaphylaxis

A

300mcg 1:1000

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45
Q

How does the dose of adrenaline change (for anaphylaxis) by age

A

<6 months: 100-150 mcg
6m-6y: 150mcg
6y-12y: 300mcg
12y + adults: 500mcg
all 1:1000

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46
Q

How often can adrenaline be given in anaphylaxis

A

Every 5 minutes

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47
Q

What is the definition of refractory anaphylaxis

A

Anaphylaxis not responding to 2 doses of IM adrenaline

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48
Q

How do you treat refractory anaphylaxis

A

Expert: IV adrenaline infusion

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49
Q

What are the stages of AKI

A

Creatinine and urine output <0.5mg/kg/hr
1: 1.5-2x baseline; U/O 6hrs
2: 2-3x baseline; U/O 12 hrs
3: >3x baseline; U/O 24 hrs

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50
Q

What is Hutchinson’s sign

A

Shingles rash extending to the tip of the nose - indicated nasociliary involvement and is a risk factor for ocular involvement

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51
Q

How do you treat herpes zoster ophthalmicus

A

Antiviral treatment for 7-10 days

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52
Q

What are the risk factors for age related macular degeneration

A

Age
Smoking
Family history

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53
Q

What is the most common type of macular degeneration

A

Dry - 90% of ccases (aka atrophic)

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54
Q

What characteristics can be used to differentiate between dry and wet age related macular degeneration

A

Dry - drusen = yellow round spots
Wet - choroidal neovascularisation = red patches

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55
Q

What are the features of macular degeneration

A

Reduction in visual acuity
Glare around objects, difficulty in dark adaptation
Distortion of line perception on Amsler grid testing

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56
Q

How do you investigate age related macular degeneration

A

Slit lamp microscopy

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57
Q

What are the types of diabetic retinopathy

A

Proliferative or non-proliferative; maculopathy

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58
Q

What are the signs of non-proliferative diabetic retinopathy

A

Cotton wool spots , microaneurysms

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59
Q

What are the features of proliferative diabetic retinopathy

A

Neovascularisation - haemorrhage

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60
Q

How do you manage diabetic retinopathy

A

Optimise glycaemic control

Panretinal laster photocoagulation if proliferative or very severe non

Intravitreal vascular endothelial growth factor (VEGF) inhibitors

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61
Q

What are the features of acute angle closure glaucoma

A

Severe pain
decreased visual acuity
hard red eye, haloes around lights
semi-dilated non reactive pupil

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62
Q

What investigations should be done for acute angle closure glaucoma

A

Tonometry - IOP
Gonioscopy - slit lamp to measure angle

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63
Q

What may cause optic neuritis

A

MS
diabetes
syphilis

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64
Q

What are the features of optic neuritis

A

Decreasing visual acuity
Colour vision loss
Pain on eye movement
RAPD

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65
Q

How do you investigate optic neuritis

A

MRI with contrast brain and orbits

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66
Q

What is Horner’s syndrome

A

Miosis
Ptosis
anhidrosis on one side
enopthalmos

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67
Q

What are the causes of anhidrosis of the face arm and trunk

A

Central lesion
Stroke, syringomyelia, MS, tumour, encephalitis

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68
Q

What are the causes of anhidrosis of the face

A

Pancoast tumour (tumour at top of lung)
Thyroidectomy
Trauma
cervical rib

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69
Q

What is the first line management of primary open angle glaucoma

A

360* selective laser trabeculoplasty (SLT)

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70
Q

In the treatment of open angle glaucoma, how does latanoprost help

A

Increases uveoscleral outflow

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71
Q

What medication causes brown pigmentation of the iris

A

Latanoprost (prostaglandin analogue)

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72
Q

What drugs can be given to to reduce aqueous production in open angle glaucoma

A

Beta-blockers, brimodine

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73
Q

How do you treat open angle glaucoma

A

Latanoprost (prostaglandin analogue) or beta-blocker

Dorzolamide (carbonic anhydrase inhibitor)

Brimodine

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74
Q

How does pilocarpine work in treatment of open angle glaucoma

A

Increase uveoscleral outflow

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75
Q

What are the side effects of pilocarpine

A

Constricted pupil
Headache
Blurred vision

76
Q

What are the features of keratitis

A

Inflammation of the cornea
Red painful eye
photophobia
foreign body/gritty sensation
hypopyon
Associated with contact lens use

77
Q

How do you treat keratitis

A

Antibiotics (quinolones)
Cycloplegics - pain relief eg cyclopentolate

78
Q

How do you tell the difference between Horner’s syndrome and CNIII palsy

A

Both give ptosis
Constricted pupil in Horner’s
Dilated pupil in CNIII

79
Q

How do you treat infective conjunctivitis

A

Topical chloramphenicol

80
Q

What are the causes of relative afferent pupillary defect

A

Retina: detachment
Optic nerve: neuritis

81
Q

How does latanoprost work in primary open angle glaucoma

A

Increases uveoscleral outflow

82
Q

Which type of glaucoma is associated with myopia

A

Primary open angle glaucoma

83
Q

Which type of glaucoma is associated with hypermetropia

A

Acute angle closure glaucoma

84
Q

What infection can you get after an eye surgery

A

Endophthalmitis

85
Q

What is the karyotype of Klinefelter’s syndrome

A

XXY

86
Q

What are the features of Klinefelter’s syndrome

A

Tall
Lack secondary sexual characteristics
Small firm testes
Infertility
High LH, low testosterone

87
Q

What is the mechanism of action of gliptins/DPP4 inhibitors

A

Reduces the peripheral breakdown of GLP-1 (an incretin)

88
Q

How do you treat hypertension in black patients with diabetes

A

ARB (eg valsartan, losartan)

89
Q

What can cause a painful goitre

A

De Quervain’s thyroiditis

90
Q

What is the HbA1c target in patients with T2DM diet controlled

A

48

91
Q

What is the HbA1c target in patients with T2DM controlled with metformin

A

48

92
Q

What is the HbA1c target for patients with T2DM controlled with drugs which may cause hypoglycaemia

A

53

93
Q

What is first line management of T2DM in patients with stable angina

A

Metformin and then SGLT-2

94
Q

How do you give insulin in DKA

A

Fixed rate 0.1 units/kg/hr + continue long acting insulin

Stop any short acting insulin

95
Q

What is the first line treatment for symptoms of thyrotoxicosis

A

Beta blocker

96
Q

Where are anti-thyroid peroxidase antibodies elevated

A

Hashimoto’s thyroiditis

97
Q

What is the definition of impaired glucose tolerance on a OGTT

A

Fasting <7
OGTT 2hr 7.8-11

98
Q

How do you stabilise a patient with a phaeochromocytoma

A

Alpha blocker first (phenoxybenzamine) then a beta blocker

99
Q

How do you differentiate between Kallmans and Klinefelter’s syndrome

A

Kallman’s hypo-hypo
Klinefelter (XXY) hi hyper-hypo
Testosterone low in both - trophins high in Klinefelter

100
Q

How does treatment for hypothyroidism change in pregnancy

A

Thyroid replacement dose may need to be increased by 50%

101
Q

How do you treat T1DM in patients with a BMI >25

A

Insulin
Consider metformin

102
Q

In DKA when do you give dextrose

A

When glucose falls below 14

10% dextrose at 125 mls/hr

103
Q

What is the most common form of thyroid cancer

A

Papillary (70%) usually in young females

104
Q

What is the first line management for painful diabetic neuropathy

A

Amitriptyline, duloxetine

Gabapentin, pregabalin

105
Q

How do you choose which anti-platelet to give after an NSTEMI

A

Aspirin + either
Ticagrelor if not high bleeding risk
Clopidogrel if high bleeding risk

106
Q

How do you treat ventricular fibrillation

A

Shockable rhythm

Amiodarone 300mg after 3 shocks

Amiodarone 150mg after 5 shocks

107
Q

What statin should be started first

A

Atorvastatin is best
Simvastatin if not tolerated

108
Q

How do you treat AF onset <48 hours

A

Heparinise the patient
Electrical DC cardioversion or medical: amiodarone if structural heart disease; flecainide or amiodarone if not

Continued anticoagulation

109
Q

How do you treat AF onset >48 hours

A

Anticoagulate for 3 weeks prior to cardioversion

Electrical cardioversion DC

Continued anticoagulation

110
Q

How do you treat aortic dissection

A

Surgical management if in ascending aorta; control BP with beta blocker

If in descending aorta control BP with beta blocker

111
Q

You suspect PE, but D-dimer is negative; what do you do?

A

Consider alternative diagnosis, stop anticoagulation

112
Q

How do you manage a major bleed for people on warfarin

A

Stop warfarin, give vit K, prothrombin complex concentrate

113
Q

What findings are found on ECG in pericarditis

A

Widespread
ST elevation, PR depression
PR depression is the most specific

114
Q

How do you treat acute pericarditis

A

NSAIDs and colchicine

115
Q

What is the likely causative organism for infective endocarditis in IVDU

A

Staph aureus

116
Q

What anticoagulation is given after prosthetic heart valve replacement

A

Bioprosthetic - aspirin
Mechanical - warfarin + aspirin

117
Q

What causes a broad complex tachycardia

A

VT

118
Q

How do you treat VT

A

Amiodarone 300mg over 10-60 mins

119
Q

How do you treat tachyarrhythmias in patients in shock (bp<90) or with signs of ischaemia (troponin raised)

A

DC cardioversion

120
Q

What are the rate limiting CCBs

A

Dilitazem
Verapamil

121
Q

What antibiotics cause TDP

A

Macrolides (erythromycin)

122
Q

What effect does hypercalcaemia have on ECG

A

Short QT

123
Q

What is Dressler’s syndrome

A

2-6 weeks after MI

Fever, pleuritic chest pain, pericaridal effusion, raised ESR

124
Q

How do you treat Dressler’s syndrome

A

NSAIDs

125
Q

How does a posterior MI present on ECG

A

Tall R waves in V1 and V2

126
Q

What medication do you give to treat a massive PE

A

Thrombolyse with with alteplase

127
Q

What electrolyte disturbance can cause long QT

A

Hypo Ca, K, Mg

128
Q

What artery supplies the atrioventricular node and why is it relevant

A

RCA
Inferior MI may be associated with arrhythmias

129
Q

How do you investigate PE

A

CTPA
If renal impaired then VQ

130
Q

What do you see on a blood test for haemochromotosis

A

Low transferrin

High ferritin, iron, transferin saturation

131
Q

What supplement should be given to alcoholic patients

A

Thiamine (B1)

132
Q

What is the first second and thirdline antibiotics to give in C Diff infection

A

10 days oral vancomycin

Oral fidaxomicin

Oral vanc + IV metronidazole

133
Q

How do you treat a life threatening C diff infection

A

oral vancomycin + IV metronidazole

134
Q

What are the antibodies associated with primary biliary cholangitis and primary sclerosing cholangitis

A

PBC: anti mitochondrial antibodies (AMA)
PSC: p-ANCA

135
Q

What LFTs suggest alcoholic liver disease

A

AST:ALT ratio 2:1

136
Q

What cancer is associated with Coeliac disease

A

T-cell lymphoma of small intestine

137
Q

What are the features of scurvy

A

Poor diet - no vit C intake
Bleeding/receeding gums
easy bruising
arthralgia

138
Q

What is the most common causative organism in spontaneous bacterial peritonitis

A

E. coli

139
Q

What antibiotic do you give for spontaneous bacterial peritonitis

A

Cefotaxime

140
Q

What is the first line treatment for primary biliary cirrhosis

A

Ursodeoxycholic acid

141
Q

What is the first-line treatment for autoimmune hepatitis

A

Steroids/immunosuppression

142
Q

What anti-bodies are associated with autoimmune hepatitis

A

Anti nuclear (ANA)
Smooth muscle (SMA)

143
Q

What are the features of acute liver failure

A

Jaundice
Encephalopathy
INR >1.5

144
Q

How do you treat Wilson’s disease

A

Penicillamine

145
Q

How do you tell the difference between acute and chronic hep B infection based on antibodies

A

IgM - initially produced therefore acute
IgG - comes later, chronic

146
Q

In patients with Barret’s oesophagus, with dysplasia on biopsy, what is the next step in management

A

Endoscopic intervention

This may be radiofrequency ablation, or endoscopic mucosal resection

147
Q

What is the medical prophylaxis for oesophageal bleeding

A

Propanolol

or other non selective beta blocker

148
Q

What is the first line medication to be used in maintaining remission in Crohn’s disease

A

Azathioprine or mercaptopurine

149
Q

What happens in a (transjugular intraheptaic portosystemic shunt) TIPS procedure

A

Shunt to connect hepatic vein and portal vein

150
Q

What are the side effects of the tuberculosis medications

A

‘RIPE’
RifamPEEcin - orange urine
IsoNERVEzid - B6 deficiency (peripheral neuropathy)
PyraLIVERmid - hepatoxic
EYEthambol - optic neuritis

151
Q

What is the mode of transmission of haemochromotosis

A

Autosomal recessive

152
Q

How does hepatocellular disease present in LFTs

A

ALT raised
ALP normal
ALT/ALP high

153
Q

How does cholestatic disease present in LFTs

A

ALT normal
ALP raised
ALT/ALP low

154
Q

How do urea levels indicate the location of a GI bleed

A

High urea levels indicate upper (high) GI bleed vs lower GI bleed

155
Q

How do you treat B12 deficiency

A

3 injections per week for 2 weeks (regular)
Then every 3 months (maintenance)

156
Q

What is the investigation of choice for pancreatic cancer

A

CT

157
Q

What is Budd-Chiari syndrome

A

Hepatic vein thrombosis

158
Q

What are the symptoms of intestinal angina

A

Colicky abdominal pain after eating
Weight loss
Abdominal bruit

159
Q

How do you do pharmacological cardioversion on an AF patient with structural heart disease

A

Amiodarone

160
Q

How do you do pharmacological cardioversion on an AF patient without structural heart disease

A

Flecainide or amiodarone

161
Q

What does Cushing’s syndrome show on ABG

A

Fluid retention causes hypokalaemic metabolic alkalosis

162
Q

When do you give fondaparinux in NSTEMI

A

If not a high bleeding risk and no PCI planned

163
Q

What anticoagulant should be given to STEMI patient

A

Aspirin
+ prasugrel if not on anticoagulant
/clopidogrel if they are

164
Q

Where is the site of action of furosemide

A

Ascending loop of Henle

165
Q

What do you see on ECG in hypokalaemia

A

small/absent T wave
U wave (small wave after T)
long PR

166
Q

How should long term steroid dose be adjusted in intercurrent illness

A

Long term steroids should have doses doubled during intercurrent illness

167
Q

What does bifasicular block look like on ECG

A

RBBB + left axis deviation

168
Q

What are the options for treatment of bradycardia

A

Atropine (max 3mg)
Transcutaneous pacing
Adrenaline infusion titrated to response

169
Q

What diuretics are ototoxic

A

Loop diuretic (furosemide)

170
Q

What are the shockable rhythms?

A

VF
Pulseless VT

171
Q

What are the non-shockable rhythms

A

PEA
Asystole

172
Q

How do you treat SVT

A

Vagal manoeuvres
IV adenosine (verapamil if asthmatic)
Cardioversion

173
Q

How do you treat patients on warfarin who have to have emergency surgery

A

If urgent: four factor prothrombin complex concentrate

If they can wait 8 hrs: give vit K

174
Q

What is the most common cause of primary hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia

175
Q

What are delta waves and what are they associated with

A

Slurred upstroke in R wave

WPW

176
Q

At what age should those with a family history get screened annually for glaucoma

A

40 years

177
Q

What is the first line treatment for hear failure with reduced ejection fraction

A

beta blocker and ace inhibitor

178
Q

What is the first line management for acute closed angle glaucoma

A

Pilocarpine
Alpha and beta blockers

179
Q

What is a Dieulafoy lesion

A

AV malformation which can cause GI bleed

180
Q

What are the features of autoimmune hepatitis

A

Young female
Amenorrhoea (liver metabolism of oestrogens affected)
Hepatitis symptoms (fever, jaundice, etc)

181
Q

What do you see in blood tests for Wilson’s disease

A

Decreased serum copper (absorbed into cells)
Increased free (unbound) ceruloplasmin

182
Q

What is the potassium requirement in maintenance fluids

A

1 mmol/kg/day

183
Q

What do you measure to monitor haemachromotosis

A

Ferritin
Transferrin saturation

184
Q

What medication could be useful in treating Raynauds

A

CCB eg nifedipine

185
Q

What is the difference between acute stress disorder and post traumatic stress disorder

A

Acute stress disorder < 4 weeks
PTSD > 4 weeks

186
Q
A

Finals (2 decks)

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