Passmed Knowledge 2 Flashcards
What drug/dose do you give for anaphylaxis
500 micrograms, 1 in 1000 adrenaline
What blood test is useful to determine if someone has had a true episode of anaphylaxis
Tryptase - can remain elevated for 12 hours
What chemo drug causes peripheral neuropathy
Vincristine
How do you differentiate between a pseudo-seizure and a seizure
Serum prolactin will be raised in a seizure
What is the first line antibiotics for bacterial meningitis in someone
Cefotaxime
add amoxicillin if over 50 years old
What are the causes of primary postpartum haemorrhage
Tone (uterine atony) most common
Trauma (perineal tear)
Tissues (retained placenta)
Thrombin (bleeding)
What are the steps in management for a postpartum haemorrhage
Medical: Oxytocin, ergometrine, carboprost
Surgical: intrauterine balloon tamponade (Bakri catheter); ligate uterine, internal iliac artery; hysterectomy last line
Why is adrenaline added to local anaesthetic
To prolong its affect
What is the treatment for adrenaline induced ischaemia
Phentolamine
What is the treatment for anaesthetic toxicity
Lipid emulsion
Where is the lesion of a patient who has a loss of vision in the RUQ of the visual field in both eyes
Inferior optic radiations in left temporal lobe (PITS)
Where is the lesion of a patient who has a loss of vision in the RLQ of the visual field in both eyes
Inferior optic ration in left parietal lobe (PITS)
What investigations need to be done on people with TIA
CT head
Carotid doppler
What is the pathophysiology of Gullian-Barre syndrome
Immune-mediated demyelination of the PNS triggered by infection usually with Campylobacter jejuni
What bacteria is associated with Gullain-Barre syndrome
Campylobacter jejuni
What are the features of Guillain-Barre syndrome
Back pain/leg pain
Progressive, ascending, symmetrical weakness in the limbs
Reduced reflexes
What are the findings on lumbar puncture for Guillain-Barre syndrome
Rise in protein with a normal white blood cell count
Albuminocytologic dissociation
What are Osler’s nodes
Painful red raised lesions associated with autoimmune complexes (oSLEr’s nodes)
What are Bouchard’s nodes
Proximal interphalangeal joint outgrowth (osteoarthritis)
What are Heberden’s nodes
Distal interphalangeal joint swelling, bony outgrowth that leaves the fingertip skewed (Heberedens = outer hebrides = far away = DIP)
What is a ganglion on the hand
Soft swelling associate with tendon sheath near a joint - asymptomatic usually
What does the ‘target sign’ indicate on ultrasound
Intussusception
What is the pattern of distribution of seborrhoeic dermatitis
Areas of sebum production: nasolabal folds, neck, behind ears
What is first line management of organophosphate poisoning
Atropine
What are the features of orbital compartment syndrome
Eye pain/swelling
Rock hard eyelids
RAPD = relative afferent pupillary defect
What is the treatment for orbital compartment syndrome
Urgent lateral canthotomy to decompress orbit
What do you see on fundoscopy for retinal vein occlusion
Severe retinal haemorrhages (stormy sunset)
What are the symptoms of retinal vein occlusion
Sudden painless vision loss in one eye
What are the risk factors for retinal vein occlusion
Age
HTN
CVD
Glaucoma
Polycythaemia
What sort of anaemia does Crohn’s disease cause
B12 Deficiency (macro) + Iron deficiency (micro) = mixed
Red blood cell width distribution will be raised
If a patient is suspected to have a PE, CTPA is negative; what is the next investigative step
Proximal leg vein ultrasound
What is the first line investigation for a PE
If Well’s score is > 4 (likely): CTPA, then leg ultrasound if negative
If Well’s score < 4 (unlikely): D-dimer
What is the first line option for management of achalasia
Pneumatic dilation
What is the option for managing achalasia in patients who are high surgical risk
Botox injection in to the oesophageal sphincter
What are the features of Lewy body dementia
Progressive cognitive impairment which may fluctuate
Impairments in attention and exeuctive function
Hallucinations
What is the management of Lewy body dementia
Aceylcholinesterase inhibitors (donepezil, rivastigmine,)
Memantine
Give examples of acetylcholinesterase inhibitors used in Lewy body dementia
Donepezil
Rivastigmine
What kind of dementia can present with fluctuating mental state
Lewy body dementia
How do you prevent a stroke in someone with AF; how long after a stroke should you initiate management
Warfarin/DOAC
in TIA - anticoag immediately
In stroke - antiplatelet immediately; anticoag after 2 weeks
What is the definition of prediabetes
HbA1c of 42-47 (6-6.4%)
What dose of adrenaline is given to children over 12 and adults for anaphylaxis
500mcg 1:1000
What dose of adrenaline is given to children 6months to 6 years for anaphylaxis
150mcg 1:1000
What dose of adrenaline is given to children <6 months for anaphylaxis
100-150mcg 1:1000
What dose of adrenaline is given to children between 6 years and 12 years for anaphylaxis
300mcg 1:1000
How does the dose of adrenaline change (for anaphylaxis) by age
<6 months: 100-150 mcg
6m-6y: 150mcg
6y-12y: 300mcg
12y + adults: 500mcg
all 1:1000
How often can adrenaline be given in anaphylaxis
Every 5 minutes
What is the definition of refractory anaphylaxis
Anaphylaxis not responding to 2 doses of IM adrenaline
How do you treat refractory anaphylaxis
Expert: IV adrenaline infusion
What are the stages of AKI
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
What is Hutchinson’s sign
Shingles rash extending to the tip of the nose - indicated nasociliary involvement and is a risk factor for ocular involvement
How do you treat herpes zoster ophthalmicus
Antiviral treatment for 7-10 days
What are the risk factors for age related macular degeneration
Age
Smoking
Family history
What is the most common type of macular degeneration
Dry - 90% of ccases (aka atrophic)
What characteristics can be used to differentiate between dry and wet age related macular degeneration
Dry - drusen = yellow round spots
Wet - choroidal neovascularisation = red patches
What are the features of macular degeneration
Reduction in visual acuity
Glare around objects, difficulty in dark adaptation
Distortion of line perception on Amsler grid testing
How do you investigate age related macular degeneration
Slit lamp microscopy
What are the types of diabetic retinopathy
Proliferative or non-proliferative; maculopathy
What are the signs of non-proliferative diabetic retinopathy
Cotton wool spots , microaneurysms
What are the features of proliferative diabetic retinopathy
Neovascularisation - haemorrhage
How do you manage diabetic retinopathy
Optimise glycaemic control
Panretinal laster photocoagulation if proliferative or very severe non
Intravitreal vascular endothelial growth factor (VEGF) inhibitors
What are the features of acute angle closure glaucoma
Severe pain
decreased visual acuity
hard red eye, haloes around lights
semi-dilated non reactive pupil
What investigations should be done for acute angle closure glaucoma
Tonometry - IOP
Gonioscopy - slit lamp to measure angle
What may cause optic neuritis
MS
diabetes
syphilis
What are the features of optic neuritis
Decreasing visual acuity
Colour vision loss
Pain on eye movement
RAPD
How do you investigate optic neuritis
MRI with contrast brain and orbits
What is Horner’s syndrome
Miosis
Ptosis
anhidrosis on one side
enopthalmos
What are the causes of anhidrosis of the face arm and trunk
Central lesion
Stroke, syringomyelia, MS, tumour, encephalitis
What are the causes of anhidrosis of the face
Pancoast tumour (tumour at top of lung)
Thyroidectomy
Trauma
cervical rib
What is the first line management of primary open angle glaucoma
360* selective laser trabeculoplasty (SLT)
In the treatment of open angle glaucoma, how does latanoprost help
Increases uveoscleral outflow
What medication causes brown pigmentation of the iris
Latanoprost (prostaglandin analogue)
What drugs can be given to to reduce aqueous production in open angle glaucoma
Beta-blockers, brimodine
How do you treat open angle glaucoma
Latanoprost (prostaglandin analogue) or beta-blocker
Dorzolamide (carbonic anhydrase inhibitor)
Brimodine
How does pilocarpine work in treatment of open angle glaucoma
Increase uveoscleral outflow
What are the side effects of pilocarpine
Constricted pupil
Headache
Blurred vision
What are the features of keratitis
Inflammation of the cornea
Red painful eye
photophobia
foreign body/gritty sensation
hypopyon
Associated with contact lens use
How do you treat keratitis
Antibiotics (quinolones)
Cycloplegics - pain relief eg cyclopentolate
How do you tell the difference between Horner’s syndrome and CNIII palsy
Both give ptosis
Constricted pupil in Horner’s
Dilated pupil in CNIII
How do you treat infective conjunctivitis
Topical chloramphenicol
What are the causes of relative afferent pupillary defect
Retina: detachment
Optic nerve: neuritis
How does latanoprost work in primary open angle glaucoma
Increases uveoscleral outflow
Which type of glaucoma is associated with myopia
Primary open angle glaucoma
Which type of glaucoma is associated with hypermetropia
Acute angle closure glaucoma
What infection can you get after an eye surgery
Endophthalmitis
What is the karyotype of Klinefelter’s syndrome
XXY
What are the features of Klinefelter’s syndrome
Tall
Lack secondary sexual characteristics
Small firm testes
Infertility
High LH, low testosterone
What is the mechanism of action of gliptins/DPP4 inhibitors
Reduces the peripheral breakdown of GLP-1 (an incretin)
How do you treat hypertension in black patients with diabetes
ARB (eg valsartan, losartan)
What can cause a painful goitre
De Quervain’s thyroiditis
What is the HbA1c target in patients with T2DM diet controlled
48
What is the HbA1c target in patients with T2DM controlled with metformin
48
What is the HbA1c target for patients with T2DM controlled with drugs which may cause hypoglycaemia
53
What is first line management of T2DM in patients with stable angina
Metformin and then SGLT-2
How do you give insulin in DKA
Fixed rate 0.1 units/kg/hr + continue long acting insulin
Stop any short acting insulin
What is the first line treatment for symptoms of thyrotoxicosis
Beta blocker
Where are anti-thyroid peroxidase antibodies elevated
Hashimoto’s thyroiditis
What is the definition of impaired glucose tolerance on a OGTT
Fasting <7
OGTT 2hr 7.8-11
How do you stabilise a patient with a phaeochromocytoma
Alpha blocker first (phenoxybenzamine) then a beta blocker
How do you differentiate between Kallmans and Klinefelter’s syndrome
Kallman’s hypo-hypo
Klinefelter (XXY) hi hyper-hypo
Testosterone low in both - trophins high in Klinefelter
How does treatment for hypothyroidism change in pregnancy
Thyroid replacement dose may need to be increased by 50%
How do you treat T1DM in patients with a BMI >25
Insulin
Consider metformin
In DKA when do you give dextrose
When glucose falls below 14
10% dextrose at 125 mls/hr
What is the most common form of thyroid cancer
Papillary (70%) usually in young females
What is the first line management for painful diabetic neuropathy
Amitriptyline, duloxetine
Gabapentin, pregabalin
How do you choose which anti-platelet to give after an NSTEMI
Aspirin + either
Ticagrelor if not high bleeding risk
Clopidogrel if high bleeding risk
How do you treat ventricular fibrillation
Shockable rhythm
Amiodarone 300mg after 3 shocks
Amiodarone 150mg after 5 shocks
What statin should be started first
Atorvastatin is best
Simvastatin if not tolerated
How do you treat AF onset <48 hours
Heparinise the patient
Electrical DC cardioversion or medical: amiodarone if structural heart disease; flecainide or amiodarone if not
Continued anticoagulation
How do you treat AF onset >48 hours
Anticoagulate for 3 weeks prior to cardioversion
Electrical cardioversion DC
Continued anticoagulation
How do you treat aortic dissection
Surgical management if in ascending aorta; control BP with beta blocker
If in descending aorta control BP with beta blocker
You suspect PE, but D-dimer is negative; what do you do?
Consider alternative diagnosis, stop anticoagulation
How do you manage a major bleed for people on warfarin
Stop warfarin, give vit K, prothrombin complex concentrate
What findings are found on ECG in pericarditis
Widespread
ST elevation, PR depression
PR depression is the most specific
How do you treat acute pericarditis
NSAIDs and colchicine
What is the likely causative organism for infective endocarditis in IVDU
Staph aureus
What anticoagulation is given after prosthetic heart valve replacement
Bioprosthetic - aspirin
Mechanical - warfarin + aspirin
What causes a broad complex tachycardia
VT
How do you treat VT
Amiodarone 300mg over 10-60 mins
How do you treat tachyarrhythmias in patients in shock (bp<90) or with signs of ischaemia (troponin raised)
DC cardioversion
What are the rate limiting CCBs
Dilitazem
Verapamil
What antibiotics cause TDP
Macrolides (erythromycin)
What effect does hypercalcaemia have on ECG
Short QT
What is Dressler’s syndrome
2-6 weeks after MI
Fever, pleuritic chest pain, pericaridal effusion, raised ESR
How do you treat Dressler’s syndrome
NSAIDs
How does a posterior MI present on ECG
Tall R waves in V1 and V2
What medication do you give to treat a massive PE
Thrombolyse with with alteplase
What electrolyte disturbance can cause long QT
Hypo Ca, K, Mg
What artery supplies the atrioventricular node and why is it relevant
RCA
Inferior MI may be associated with arrhythmias
How do you investigate PE
CTPA
If renal impaired then VQ
What do you see on a blood test for haemochromotosis
Low transferrin
High ferritin, iron, transferin saturation
What supplement should be given to alcoholic patients
Thiamine (B1)
What is the first second and thirdline antibiotics to give in C Diff infection
10 days oral vancomycin
Oral fidaxomicin
Oral vanc + IV metronidazole
How do you treat a life threatening C diff infection
oral vancomycin + IV metronidazole
What are the antibodies associated with primary biliary cholangitis and primary sclerosing cholangitis
PBC: anti mitochondrial antibodies (AMA)
PSC: p-ANCA
What LFTs suggest alcoholic liver disease
AST:ALT ratio 2:1
What cancer is associated with Coeliac disease
T-cell lymphoma of small intestine
What are the features of scurvy
Poor diet - no vit C intake
Bleeding/receeding gums
easy bruising
arthralgia
What is the most common causative organism in spontaneous bacterial peritonitis
E. coli
What antibiotic do you give for spontaneous bacterial peritonitis
Cefotaxime
What is the first line treatment for primary biliary cirrhosis
Ursodeoxycholic acid
What is the first-line treatment for autoimmune hepatitis
Steroids/immunosuppression
What anti-bodies are associated with autoimmune hepatitis
Anti nuclear (ANA)
Smooth muscle (SMA)
What are the features of acute liver failure
Jaundice
Encephalopathy
INR >1.5
How do you treat Wilson’s disease
Penicillamine
How do you tell the difference between acute and chronic hep B infection based on antibodies
IgM - initially produced therefore acute
IgG - comes later, chronic
In patients with Barret’s oesophagus, with dysplasia on biopsy, what is the next step in management
Endoscopic intervention
This may be radiofrequency ablation, or endoscopic mucosal resection
What is the medical prophylaxis for oesophageal bleeding
Propanolol
or other non selective beta blocker
What is the first line medication to be used in maintaining remission in Crohn’s disease
Azathioprine or mercaptopurine
What happens in a (transjugular intraheptaic portosystemic shunt) TIPS procedure
Shunt to connect hepatic vein and portal vein
What are the side effects of the tuberculosis medications
‘RIPE’
RifamPEEcin - orange urine
IsoNERVEzid - B6 deficiency (peripheral neuropathy)
PyraLIVERmid - hepatoxic
EYEthambol - optic neuritis
What is the mode of transmission of haemochromotosis
Autosomal recessive
How does hepatocellular disease present in LFTs
ALT raised
ALP normal
ALT/ALP high
How does cholestatic disease present in LFTs
ALT normal
ALP raised
ALT/ALP low
How do urea levels indicate the location of a GI bleed
High urea levels indicate upper (high) GI bleed vs lower GI bleed
How do you treat B12 deficiency
3 injections per week for 2 weeks (regular)
Then every 3 months (maintenance)
What is the investigation of choice for pancreatic cancer
CT
What is Budd-Chiari syndrome
Hepatic vein thrombosis
What are the symptoms of intestinal angina
Colicky abdominal pain after eating
Weight loss
Abdominal bruit
How do you do pharmacological cardioversion on an AF patient with structural heart disease
Amiodarone
How do you do pharmacological cardioversion on an AF patient without structural heart disease
Flecainide or amiodarone
What does Cushing’s syndrome show on ABG
Fluid retention causes hypokalaemic metabolic alkalosis
When do you give fondaparinux in NSTEMI
If not a high bleeding risk and no PCI planned
What anticoagulant should be given to STEMI patient
Aspirin
+ prasugrel if not on anticoagulant
/clopidogrel if they are
Where is the site of action of furosemide
Ascending loop of Henle
What do you see on ECG in hypokalaemia
small/absent T wave
U wave (small wave after T)
long PR
How should long term steroid dose be adjusted in intercurrent illness
Long term steroids should have doses doubled during intercurrent illness
What does bifasicular block look like on ECG
RBBB + left axis deviation
What are the options for treatment of bradycardia
Atropine (max 3mg)
Transcutaneous pacing
Adrenaline infusion titrated to response
What diuretics are ototoxic
Loop diuretic (furosemide)
What are the shockable rhythms?
VF
Pulseless VT
What are the non-shockable rhythms
PEA
Asystole
How do you treat SVT
Vagal manoeuvres
IV adenosine (verapamil if asthmatic)
Cardioversion
How do you treat patients on warfarin who have to have emergency surgery
If urgent: four factor prothrombin complex concentrate
If they can wait 8 hrs: give vit K
What is the most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
What are delta waves and what are they associated with
Slurred upstroke in R wave
WPW
At what age should those with a family history get screened annually for glaucoma
40 years
What is the first line treatment for hear failure with reduced ejection fraction
beta blocker and ace inhibitor
What is the first line management for acute closed angle glaucoma
Pilocarpine
Alpha and beta blockers
What is a Dieulafoy lesion
AV malformation which can cause GI bleed
What are the features of autoimmune hepatitis
Young female
Amenorrhoea (liver metabolism of oestrogens affected)
Hepatitis symptoms (fever, jaundice, etc)
What do you see in blood tests for Wilson’s disease
Decreased serum copper (absorbed into cells)
Increased free (unbound) ceruloplasmin
What is the potassium requirement in maintenance fluids
1 mmol/kg/day
What do you measure to monitor haemachromotosis
Ferritin
Transferrin saturation
What medication could be useful in treating Raynauds
CCB eg nifedipine
What is the difference between acute stress disorder and post traumatic stress disorder
Acute stress disorder < 4 weeks
PTSD > 4 weeks
