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REVISION > PASSMED MARCH > Flashcards

PASSMED MARCH Flashcards

1
Q

Causes of post-splenectomy sepsis?

A

remember NHS (encapsulated bacteria)
Neisseria meningitis
H. Influenza
S. Pneumonia

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2
Q

Whats the causative organism of syphilis?

A

A spirochete called treponema pallidum

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3
Q

Outline the 3 steps of the surgical safety checklist and when they occur?

A

Sign in - before induction of anaesthesia
Time out - before incision of skin
Sign out - before pt leaves operating room

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4
Q

What is a bisferiens pulse?

A

A double pulse noticed during systole in the peripheral pulse

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5
Q

What causes a bisferiens pulse?

A

Aortic valve regurgitation - think of it as back flow of blood causing the double systolic waveform

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6
Q

Causes of finger clubbing?

A

Congenital cyanotic heart disease & CF
Lung cancer & absess
UC
Bronchiectasis
Benign mesothelioma
Iidippathic pulmonary fibrosis or IE
Neurogenic tumours
Granulomas e.g. sarcoidosis

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7
Q

What antibodies are raised in Hashimoto’s thyroiditis?

A

Anti-TPO and anti-thyroglobulin antibodies

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8
Q

What antibodies are raised in Graves’ disease?

A

Anti-TSH in 90%
Anti-TPO in 75%

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9
Q

What do we measure thyroglobulin antibodies for?

A

For part of thyroid cancer follow up - measured yearly to detect early recurrent disease

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10
Q

Which type of thyroid cancer causes raised serum calcitonin?

A

Medullary carcinoma

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11
Q

First and second-line treatment for episodic viral wheeze?

A

SABA or anticholinergic via a spacer
Intermittent LTRA or ICS or both

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12
Q

Most likely cause for proximal muscle weakness, respiratory symptoms and an elevated CK?

A

Polymyositis

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13
Q

Symptoms of PMR?

A

aching morning stiffness in proximal limb muscles but NOT weakness

mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

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14
Q

What can cause a vascular necrosis of the hip?

A

long-term steroid use
chemotherapy
alcohol excess
trauma

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15
Q

How does GCA affect the eyes?

A

It causes inflammation of the posterior ciliary arteries = anterior ischaemic optic neuropathy

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16
Q

Fundoscopy signs of anterior ischaemic optic neuropathy?

A

Pale swollen optic disc with blurry margins

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17
Q

What % of pts with ankylosing spondylitis are HLA B27 positive?

A

90%

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18
Q

Outline stepwise treatment of ankylosing spondylitis?

A

NSAIDs and PT
If peripheral joint involvement -> DMARDs
If severe - anti-TNF

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19
Q

Contraindications to bisphosphonates?

A

Abnormalities of oesophagus
hypocalcaemia
factors which delay emptying (e.g. stricture or achalasia)
EGFR <35

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20
Q

What % of patients with dermatomyositis have malignancy?

A

20-25%

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21
Q

What is the triad for feltys syndrome?

A

RA
Splenomegaly
Low WCC

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22
Q

Blood test results (ca, vit D, PTH etc) in osteoporosis?

A

All normal

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23
Q

What drugs can cause drug-induced SLE?

A

Procainamid
Hydralazine
Quinidine

Lower risk:
Isoniazid
Phenytoin
Minocycline

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24
Q

First line treatment for RA?

A

DMARD +/- a short course of bridging prednisolone

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25
Q

Presentation of left ventricular aneurysm as a complication of an MI?

A

Signs of left ventricular failure - bibasal crckles, SOB, loud S3 and S4
Persisting ST elevation

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26
Q

How do we manage ascites secondary to liver cirrhosis?

A

Spironolactone

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27
Q

Early symptoms of haemochromatosis?

A

Fatigue
ED
Arthralgia

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28
Q

At what point in pregnancy can a diagnosis of pre-eclampsia be made?

A

new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria
other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

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29
Q

What type of renal stone is most likely in a pt undergoing chemotherapy for ALL?

A

Uric acid

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30
Q

Which type of renal stones are associated with an inherited metabolic disorder?

A

Cystine

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31
Q

Which renal stones are radio-lucent?

A

Uric acid

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32
Q

Signs in right posterior inferior cerebellar artery stroke (lateral medullary syndrome)?

A

Cerebellar signs - ataxia, nystagmus
Contralateral limb sensory loss
Ipsilateral horners, facial numbness and dysphagia

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33
Q

How is TRALI differentiated from TACO?

A

TACO - hypertension
TRALI - hypotension

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34
Q

Blood results for calcium, ALP, PTH and phosphate in osteoegenesis imperfecta?

A

All normal

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35
Q

Presenting features of osteogenesis imperfecta?

A

Fractures following minor trauma
Blue sclera
Deafness secondary to otosclerosis
Dental imperfections

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36
Q

What is placenta accreta?

A

Attachment of the placenta to the myometrium due to a defective decidua basalis

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37
Q

What is placenta increta?

A

When chorionic villi of placenta invade into the myometrium

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38
Q

What is placenta percreta?

A

When chorionic villi of placenta invade into the perimetrium

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39
Q

Whats the definition of a primary postpartum haemorrhage?

A

The loss of 500ml or more of blood from the genital tract within 24 hours of the birth of a baby

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40
Q

What factors determine if an IV glycoprotein 1B/2a receptor antagonists should be given for NSTEMIs?

A

High GRACE risk score and whether a percutaneous coronary intervtjopn is to be performed

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41
Q

Triad for Wernickes encephalopathy?

A

Confusion
Ataxia
Nystagmus/opthalmoplegia

42
Q

Presentation of degenerative cervical myelopathy?

A

Neck pain and stiffness
Tingling or numbness in limbs
Clumsiness in hands/change in dexterity
Imbalance -> falls
Difficulty mobilising
Disturbance of bladder or bowel function
Pain in limbs or trunks
Fatigu

43
Q

What organism causes necrotising fasciitis?

A

Group A strep

44
Q

Do you get hearing loss in vestibular neuronitis?

45
Q

Long term anticoagulant drug and target for metallic valve for aortic stenosis?

A

Warfarin with an INR target of 3

46
Q

What organism that can cause pneumonia causes hyponatraemia?

A

Legionella pneumophilia

47
Q

Why when you start a synthetic GnRH drug should you use an anti-androgen alongside at the start?

A

As GnRH agonists can cause an initial rise in testosterone for 2-3 weeks - this is a tumour flare = can cause bone pain, bladder obstruction

48
Q

Tumour markers for Seminomas?

49
Q

Tumour markers for non-seminomas?

A

AFP
Beta-hCG

50
Q

Whats the most Ilkley intracranial haemorrhage when the pt experiences a lucid interval and then briefly regains consciousness before progressing to a coma?

A

Extradural haematoma

51
Q

Likely cause of ongoing loin pain, haematuria and pyrexia of unknown origin?

52
Q

Incubation period of impetigo?

53
Q

What % of primary renal neoplasms do renal cell cancers make up?

54
Q

What is the most common histological subtype of renal cell cancer?

A

Clear cell - up to 85%

55
Q

Features of renal cell carcinoma?

A

Haematuria
Loin pain
Abdominal mass
Pyrexia of unknown origin
Left-sided varicocele

56
Q

What are the possible endocrine effects of renal cell carcinoma?

A

Polycthemia - may secrete EPO
Hypercalcaemia - may secrete PTHrp
Cushing - can produce ACTH

57
Q

What is the pathophysiology of ITP

A

IgG antibodies directed against glycoprotein 2b-3a or 1B complex on platelets

58
Q

Investigations for ITP?

A

Bone marrow aspiration should be done before starting steroids to rule out leukaemia

59
Q

What would be seen on bone marrow aspiration in ITP?

A

Normal-increased number of megakaryocytes in the bone marrow

60
Q

What are contraindications for platelet transfusions?

A

Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopemia
Thrombotic thrombocytopenic purpura

61
Q

What is Samter’s triad?

A

asthma + aspirin sensitivity + nasal polyposis

62
Q

What is a normal fundal height growth per week after 24/40?

A

1cm per week

63
Q

When would you expect the fundus to be palpable at the umbilicus?

64
Q

When would you expect the fundus to be palpable at the xiphoid sternum?

65
Q

PH in trichomonas vaginalis?

66
Q

What causes scarlet fever?

A

A reaction to erythrogenic toxins produced by group A haemolytic streptococci usually strep pyogenes

67
Q

Peak age of incidence for scarlet fever?

A

4 years (2-6)

68
Q

What are features of myelofibrosis?

A

Anaemia symptoms
Massive splenomegaly which may cause pain or loss of appetite
Hypermetabolic symptoms e.g. weight loss, night sweats

With progression:
Bleeding due to thrombocytopenia
Bone pain
Hyperuricaemia and gout

69
Q

What causes urge incontinence?

A

Overactive detrusor activity in the bladder

70
Q

Features of papilloedema during fundoscopy?

A

venous engorgement: usually the first sign
blurring of the optic disc margin
elevation of optic disc
loss of the optic cup
Paton’s lines: concentric/radial retinal lines cascading from the optic disc

71
Q

What is a Stanford type A aortic dissection? How does this relate to the DeBakey classification?

A

involves the ascending aorta and can propagate to the aortic arch and descending aorta
I.e. deBakey type 1 and 2

72
Q

What is a Stanford type B aortic dissection? How does this relate to the DeBakey classification?

A

When the dissection affects the descending aorta and the origin is distal to the left subclavian artery
This is a type 3 DeBakey classification

73
Q

What investigations are needed for an aortic dissection?

A

ECG as pt has chest pain so excludes MI
CXR - widened mediastinum
CT angiography of CAP is investigation of choice
If pt is unstable and CT is too risk a transoeseophageal echocardiography may be done

74
Q

Abdominal XR findings in NEC?

A

Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis
Portal venous gas
Pneumoperitoneum
Rigler and football sign

75
Q

What is rigler sign on AXR?

A

Air inside and outside of the bowel wall - a sign of pneumoperitoneum

76
Q

What is the football sign on AXR?

A

Air outlining the falciform ligament and creating a radiolucent oval contour similar to a football - caused by massive pneumoperitoneum

77
Q

What is the strongest risk factor for anal cancer?

A

HPV infection

78
Q

Age of cystic hygroma vs branchial cyst?

A

Cystic hygroma. Present before 2
Branchial cyst - presents in early adulthood

79
Q

What is the main cause of mitral stenosis?

A

Rheunatici fever

80
Q

Symptoms of vestibular neuronitis?

A

Recent viral infection
Recurrent vertigo attacks lasting hoursdays
N&V
Horizontal nystagmus

(No hearing loss of tinnitus!)

81
Q

How can vestibular neuronitis be differentiated from a posterior circulation stroke?

A

HiNTs exam

82
Q

Outline how we can use the HiNTs exam to distinguish between peripheral and central causes of vertigo?

A

If head impulse test shows corrective saccade - peripheral cause
If head impulse test is normal - central cause

If no nystagmus or its unidirectional -peripheral cause
If nystagmus is bidirectional or vertical - central case

Test of skew: if no vertical skew = peripheral cause. If vertical skew = central cause

83
Q

What are the 2 most common valvular heart diseases in order?

84
Q

Which valve is most commonly affected by infective endocarditis?

A

Mitral valve

85
Q

Most common causes of aortic regurgitation?

A

Acute - IE or aortic dissection
Chronic - RF, age related calcification, biscuspud valve, CTD or rheumatological conditions

86
Q

Most common causes of aortic stenosis?

A

Age related degeneration and calcification or a bicuspid valve

87
Q

Most common causes of mitral regurgitation?

A

Post-MI - rupture of chordae tendinae and papillary muscle
Mitral valve prolapse
IE
RF

88
Q

What organism is the most common cause of infective endocarditis?

A

Staph aureus

89
Q

Which cause of infective endocarditis is associated with poor dental hygeiene?

A

Streptococcus viridans

90
Q

Which cause of infective endocarditis is associated with recent prosthetic valve surgery (<2 months)?

A

Coagulate-negative staph e.g. Staphylococcus epidermidis

91
Q

Which cause of infective endocarditis is associated with colorectal cancer?

A

Strep bovis

92
Q

What are the culture negative causes of infective endocarditis?

A

HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
Coxiella burnetii
Bartonella
Brucella

93
Q

What are the pathological criteria for the modified duke criteria?

A

Positive histology or microbiology of pathological material obtained in cardiac surgery or autopsy

94
Q

What are the major criteria for the modified duke criteria?

A

2 positive blood cultures showing typical organisms for IE
Persistent bacteraemia from 2 blood cultures taken >12 hours apart or 3 or more positive blood cultures where pathogen is less specific
Positive molecular assays for specific gene targets
Positive echocardiogram
New valvular regurgitation

95
Q

What are the minor criteria for the modified duke criteria?

A

Predisposing heart condition or IVDU
Microbiological evidence that does not meet major criteria
Fever >38
Vascular phenomena e.g. petechia, splinter haemorrhages, emboli, clubbing, janeway lesions
Immunological phenomena e.g. oslers nodes, Roth spots, glomerulonephritis

96
Q

How can you diagnose infective endocarditis with modified duke criteria?

A

One of the following:
- pathological criteria positive
- 2 major criteria
- 1 major and 3 minor criteria
- 5 minor criteria

97
Q

What causes radio-radial delay?

A

Subclavian artery stenosis
Aortic dissection
Aortic coarctation

98
Q

What causes a collapsing pulse?

A

Cardiac - AR or PDA

Normal physiological states e..g fever, pregnancy
High output states - anaemia, AV fistula, thyrotoxicosis

99
Q

What is a collapsing pulse also known as?

A

Water hammer pulse

100
Q

Symptoms of infective endocarditis?

A

FROM JANE

Fever
Roth spots
Osler nodes
Murmur

Janeway lesions
Anaemia
Nail bed haemorrhage
Emboli (not PE)

101
Q

How can infective endocarditis cause splenic infarction?

A

A septic emboli can result in this

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