PassMed May & June Flashcards
What would appropriate flexion to pain score (GCS)?
4 for movement
What is a differentiating feature of encephalitis from meningitis - how should you treat?
Abnormalities in brain function (e.g. confusion, personality change etc.)
IV Acyclovir
What is most likely to be causing new onset rounding of the face, abdominal weight gain, straiae, easy bruising and low libido in a heavy smoker with new and persistent cough?
Small cell lung carcinoma - will secrete ACTH leading to cushing’s syndrome
What are the characteristic features of rheumatic fever?
Joint pain, fever, erythema marginatum, dyspnoea, Sydenham’s chorea and S/C nodules following strep infection (often tonsillitis)
Mx for rheumatic fever?
Oral penicillin V and NSAIDs
What is the most likely cause of sudden painless vision loss preceded by floaters/dark spots in the vision in a diabetic
Vitrous Haemorrhage
What should you give alongside Allopurinol (when starting treatment to prevent gout)?
NSAIDs or Colchicine (Allopurinol can cause an acute flare up!)
How can you differentiate biochemically between T1DM and T2DM?
C-peptide levels will be raised in T2DM but not in T1DM
Anti-GAD autoantibodies will be present in T1DM but not T2DM
Thiazide like diuretics can cause increased renal reabsorption of calcium. How would you expect this to present?
Hypercalcaemia
Kidney/biliary stones, bone pain, abdo pain, constipation/urinary frequency, muscle weakness/hyporeflexia, depression, anxiety and confusion
In what circumstances should you ALWAYS give antibiotics in otitis media?
<2 years old with bilateral OM or any age with otorrhoea (discharge following ear drum perforation)
What should you suspect in a patient with a new onset heart murmur and infective symptoms? How can you confirm this diagnosis biochemically?
Infective Endocarditis
Conduct 3 sets of separate blood cultures
Sx of IE?
Fever, Roth spots, Oslers nodes, Murmur, Janeway lesions, Anaemia, Nail bed haemorrhages, Emboli
How can you differentiate between oslers nodes and janeway lesions?
Oslers nodes = painless, on pads of fingers/toes
Janeway lesions = painful, on the palms/soles
What is an atrial myxoma? How does it present?
Benign tumour of the left atrium
Mitral valve obstruction, systemic embolisms, breathlessness, fever and weight loss
Describe the NYHA class?
I = no symptoms, no limtation
II = mild symptoms, slight limitation of physical activity
III = moderate symptoms, marked limitation of physical activity but comfortable at rest
IV = severe symptoms even at rest
What may be the cause of raised ferritin WITHOUT iron overload?
Inflammation, alcohol excess, liver disease, CKD and malignancy
What does a bilateral boggy purple swelling of the septum suggest? How should you manage this?
Septal haematoma
Urgent ENT review
Why is Hartman’s better than normal saline when large volumes of fluids are going to be needed?
0.9% NaCl can cause hyperchloremic acidosis
What is the classic triad of symptoms seen in Cardiac Tamponade?
Hypotension, raised JVP, muffled heart sounds
How should you deliver oxygen to a critically ill patient (even if they are a CO2 retaining COPD patient)?
High flow oxygen
Classic Sx of viral labyrinthitis?
Sudden onset vertigo, hearing loss and dizziness preceded by viral infection
When should you 2WW an over 60s patient for bladder cancer?
Unexplained visible haematuria
Unexplained non-visible haematuria with dysuria or raised WCC
How should you treat VTE and for how long?
DOAC
3/12 if provoked
6/12 if unprovoked or active cancer
How long should you give Vareniciline for before the stop date?
Start 1 week before the stop date and use for 12 weeks
How long should Bupropion be given before the smoking stop date?
Start 1-2 weeks before stop date
What is hidradenitis suppurativa?
Chronic and painful skin disorder leading to recurrent skin nodules (commonly develop in the axilla and groin). May cause sinus tracts, fistulas and rope like scarring.
May require Abx or surgical drainage
What is the standard adult maintenance fluids?
25-30ml/kg/day
What should you look for first line in serology when diagnosis coeliac’s diease?
TTG and IgA antibodies
What should you give to prevent ascites formation in patients with chronic liver diease?
Aldosterone antagonists e.g. spironolactone
Which lobe of the brain does HSV encephalitis characteristically affect?
Temporal lobe
In ALS how often should you give adrenaline?
Every 3-5mins
Patient presents with ?SAH but CT head returns normal. What should you do?
Perform a LP 12 hours post symptom onset - looking for xanthochromia
What symptoms would you typically see in and S1 lesion?
Sensory loss of the posterolateral aspect of the leg and lateral aspect of the foot. Decreased plantarflexion, decreased ankle reflex and positive sciatic nerve stretch test
What is the threshold for RBC transfusion in patients with ACS?
80g/L
Under what circumstances should you perform an urgent CT head?
GCS<13 on inital assessment or <15 after 2 hours, ?skull fracture (including base of skull), post-traumatic seizure, focal neurological deficit, >1 episode of vomiting
What vaccination should be offered to any patients with chronic respiratory or heart conditions?
Single pneumococcal and annual influenza vaccines
Sx of Marfan’s syndrome?
Tall stature, high arched palate, pes planus, arachnodactyly, pectus excavatum and aortic issues
How long is the Ebola incubation period
2-21 days
What is seen in antisyntheetase syndrome?
Myositis (progressive muscle weakness and pain), ILD, thickened/cracked skin of the hands, Raynaud’s phenomenon
Management of necrotising fascitits?
Immediate surgical debridement and IV antibiotics
What is the most common genetic cause of CKD? How should you diagnose it?
Autosomal Dominant Polycystic Kidney Disease
Renal USS
Sx of ADPKD?
Enlarged kidneys, HTN, recurrent UTIs, haematuria, flank pain, mitral valve prolapse, aortic regurgitation and intracranial aneurysm
Blood results which indicate T2DM in adults?
Fasting plasma glucose >7mmol/l
Oral glucose tolerance test >11.1mmol/l
HbA1c >48
Blood results which indicate impaired fasting glucose?
FPG 6.1-6.9mmol/l
Blood results which indicate impaired glucose tolerance?
FPG <7 and OGTT 7.8-11.1mmol/l
What are the features of Cushing’s triad?
Bradycardia, wide pulse pressure and irregular breathing. There is also systolic hypertension to maintain cerebral perfusion
If there is global T wave inversion is the cause likely to be cardiac?
NO
Implies non cardiac cause!!
What do FAST scans assess?
Used in trauma they assess for the presence of fluid in the thorax or abdomen
What are the red flag symptoms for lower back pain?
Age <20 or >50
Hx of malignancy
Night pain
Hx of trauma
Systemic illness
What are the rules in regards to fasting before surgery?
Fast from food and non clear fluids for 6 hours before and fast from clear fluids for 2 hours before
Adenosine is most commonly used to terminate SVT. Who should it be avoided in and name 3 adverse effects?
Avoid in asthmatics
Adverse effects = chest pain, bronchospasm and flushing
Name the shockable vs unshockable rhythms?
Shockable = Ventricular fibrillation and pulseless ventricular tachycardia
Unshockable = Asystole and pulseless electrical activity
How long do symptoms need to be present for to diagnose PTSD?
More than 1 month
How can we treat PTSD?
1st line = CBT or EMDR
2nd line = Venlafaxine or SSRIs
Sx of Aortic Regurg?
Early diastolic murmur
Dyspnoea on exertion, chest pain, light headedness or collapse
What Sx would you see in a typical optic neuritis?
Young woman
Unilateral reduced vision and colour vision (red desaturation), RAPD and painful eye movements
How can you confirm that H.pylori has been successfully eradicated?
Urea breath test
What vaccinations should be offered to those with chronic hepatitis?
Annual influenza vaccine
One off pneumococcal vaccine
What should women be offered prior to IOL?
Vaginal examination for membrane sweep
What medications should you give to a patient with angina?
Aspirin, statin, GTN spray
EITHER beta blocker or CCB
What should you do with a patient who presents with sudden onset sensorineural hearing loss?
Urgent ENT refferral
MRI scan (exclude vestibular schwannoma)
High dose oral steroids
When should you call an ambulance for a patient presenting with bronchiolitis?
Observed or reported apnoea
The child looks seriously unwell to a healthcare professional
Severe respiratory distress (grunting, marked chest recessions, RR >70)
Central cyanosis
Sats <92%
What is the most serious complication of pernicious anaemia?
It predisposes to gastric carcinoma
Name the SEs of thyroxine therapy?
Hyperthyroidism, reduced bone mineral density, worsening angina and AF
What is the 1st line investigation for primary hyperaldosteronism?
Aldosterone/renin ratio
How long should you continue anticoagulation after DC cardioversion for AF?
For life!
What should you give to a healthcare professional who suffers a needlestick injury from a HepB positive patient?
Known responder to HepB vaccine = booster dose
In the process of being vaccinated or non-responder = Hep B immunogloulins and the vaccine
Sx of typhoid
Systemic illness, bradycardia, abdo pain/distension, constipation and rose spots on the trunk (these may indicate paratyphoid)
Name the eye positions in a CN III/IV/VI palsy?
CN III = down and out
CN IV = up
CN VI = in
Describe the MRC grading system?
0 = no muscle movement
1 = trace of contraction
2 = movement at the joint with gravity eliminated
3 = movement against gravity but not against added resistance
4 = movement against an external resistance with reduced strength
5 = normal strength
What is the most common cause of death following MI?
Cardiac arrest due to VF
Name 2 rate control drugs which can help with chronic HF?
ACEis and Beta blockers
If you have AV block following an MI what type of MI is most likely to have occurred?
Inferior MI
Describe Dressler’s syndrome?
How do you treat?
Fever, pleuritic pain, pericardial effusion and raised ESR occurring 2-6 weeks following an MI.
Treat with NSAIDs
What may you see in left ventricular aneurysm?
Persistent ST elevation and LV failure
Describe LV free wall rupture?
Seen 1-2 weeks post MI. Patients present with acute HF secondary to cardiac tamponade (raised JVP, pulsus paradoxus and diminished heart sounds)
How should you treat a displaced intrascapular hip fracture?
Total hip replacement or hermiarthroplasty
How should you treat an undisplaced intrascapular hip fracture?
Internal fixation
How should you treat and extrascapular hip fracture?
Intertrochanteric = Dynamic hip screw
Subtrochanteric = intramedullary nail
How can you treat Steroid responsive COPD?
SABA or SAMA -> SABA or SAMA and LABA + ICS regularly -> SABA, LABA, LAMA + ICS
How can you treat Steroid unresponsive COPD?
SABA or SAMA -> SABA and LABA + LAMA regularly -> SABA, LABA, LAMA + ICS
What is tested for on the Guthrie test?
Congenita hypothyroidism, CF, Sickle Cell Disease, Phenylketonuria, MCADD, MSUD, IVA, GA1, HCU
What are the stages of COPD severity?
ALL MUST HAVE FEV1/FVC <0.7
Stage 1 = FEV1 of >80% Symptoms must be present to diagnose patient
Stage 2 = FEV1 50-79%
Stage 3 = FEV1 30-49%
Stage 4 = FEV1 <30%
What will joint aspirate show in rheumatoid arthritis?
Yellow cloudy fluid with absence of crystals
High WBC count and predominantly Polymorphonuclear neutrophils
What are the symptoms of cavernous sinus syndrome?
CN III, IV, V, VI are affected. Ophthalmoplegia (most commonly diplopia), facial sensory loss and Horner’s syndrome (unilateral miosis, ptosis, enopthalmos and anhidrosis)
What is the most common medicine used in the first line treatment of cocaine related issues?
Benzodiazepines
Which type of emergency contraception is contraindicated in severe asthma?
Ulipristal Acetate
What is the threshold for transfusion in patients with ACS?
80g/L - in the general population it is 70g/L
Sx and Tx of ITP?
Sx = petechiae, purpura, bleeding
tx = oral prednisolone
What is the initial Tx of Naloxone?
400 micrograms of Naloxone
Mx of Cranial vs Nephrogenic DI?
Cranial = Vasopressin
Nephrogenic = Thiazide diuretics
Which types of diuretics can cause ototoxicity?
Loop diuretics
How do you screen for ADPKD
Abdominal US
S&S of Buerger’s disease?
Extremity ischaemia (intermittent claudication and ischaemic ulcers), Superficial thrombophlebitits and Raynaud’s syndrome. It is highly associated with smoking
A patient presents with urinary incontinence, gait abnormalities and dementia, what is the likely diagnosis?
Normal Pressure Hydrocephalus
On endoscopy and biopsy you see pseudopolyps and inflammation which doesn’t extend past the submusosa. What is the diagnosis UC or CD?
Ulcerative Collitis
How can you differentiate between sensoineural, conductive and mixed hearing loss on audiogram?
Sensorineural = both air and bone conduction are impaired
Conductive = only air conduction is impaired
Mixed = both impaired but air is worse than bone
What are the 1st and 2nd line management of hepatic encephalopathy?
1st line = Lactulose
2nd line = Rifaximin
What is the most common valvular defect after IE? What does it sound like?
Aortic regurgitation
Early diastolic murmur
You see an obese young woman with headaches and blurred vision. What is the most likely diagnosis?
Idiopathic Intracranial Hypertension
What tests must a patient with GORD undergo before having a Nissen Fundoplication?
pH and manometry studies as well as endoscopy and barium swallow
High output HF can be caused by what blood disorder?
Severe anaemia
What type of blood products come with the highest risk of bacterial contamination and therefore should be used with caution in the immunocompromised?
Platelet transfusions
What are the possible causes of grossly elevated APTT?
Heparin therapy, haemophilia or anti-phospholipid syndrome.
Normal factor VIIIc indicated haemophilia
Which type of pneumonia can cause hyponatraemia and should be treated with macrolides e.g. erythromycin?
Legionella pneumonia
What is the 1st line analgesic for renal colic?
IM Diclofenac
Which type of pneumonia is associated with reactivation of HSV and cold sores?
Strep pneumoniae
When should you refer a perforated TM to ENT?
After 6-8 weeks
What is the 1st line Mx for fibroids which do not distort the uterine cavity and are <3cm?
IUS
What should you do if a man (of any age) presents with Hb<110?
Refer for 2WW upper and lower GI endoscopy
True or false, steroids can cause psychosis?
TRUE
What is the likely cause of an isolated fever in the 1st 24hrs after surgery?
Physiological reaction to surgery
How can you differentiate between papillary and medullary thyroid cancer?
Papillary = associated with young females
Medullary = associated with raised calcitonin
Which of the following drugs should be stopped in AKI: Candesartan for HTN OR Aspirin for IHD?
Candesartan. ARBs should be stopped in AKI but the Aspirin dose used for cardiac purposes is considered safe
True or false, giving heparin can CAUSE PE?
TRUE
Heparin can cause heparin induced thrombocytopenia leading to clots
What should you monitor prior to commencing Amidoarone Tx?
TFTs, LFTs, U&Es and CXR
What is the adrenaline dose in anaphylaxis?
0.5mg/0.5ml 1 in 1000 IM
What is the adrenaline dose in cardiac arrest?
1mg/10ml 1 in 10,000 IV
Why should statins be temporarily stopped when starting macrolide treatment?
There is a risk of rhabdomyolysis
Sx and Ix for Venous Sinus Thrombosis
Sx of raised ICP e.g. headache, nausea and vomiting and reduced consciousness in those with hypercoagulable state
Ix = MR Venogram
Tx for Lymes Disease?
No symptoms = reassurance
Sx (e.g. erythema migrans) = Doxycycline
ELISA will confirm disease presence
S/Es of TB medications?
Rifampicin = orange/yellow secretions
Isoniazid = peripheral neuropathy and hepatitis
Pyrazinamide = gout, hepatitis and arthritis
Ethambutol = optic neuritis
How much insulin should you give in DKA?
0.1 units/kg/hr
How can you manage minor allergic reactions when giving blood transfusions?
Temporarily stopping the transfusion and giving antihistamines
Sx of Ankylosing spondylitis?
Apical Fibrosis, Anterior uveitis, Aortic regurgitation, Achilles tendonitis, AV node block, Amyloidosis
What condition should you suspect in a patient presenting with hemarthrosis but no history of trauma?
Haemophilia A or B
What is Adhesive Capsulitis also known as? How does it present
Frozen Shoulder
Limited movement in all directions and loss of abduction/external rotation
How does supraspinatus tendonitis present?
Painful abduction between 60-120 degrees and tenderness over the anterior acromion
What is the most common reason that a total hip replacement requires revision?
Aseptic loosening
Which population is at increased risk for prostate cancer?
Afro-Caribbean Men
Name the key symptoms which would make you suspect a diagnosis of normal pressure hydrocephalus?
Urinary incontinence, Gait Abnormalities and Dementia
What are the first line treatments for secretions in palliative care?
Hyoscine Hydrobromide or Hyoscine Butylbromide
When should you give LMWH in pregnant women who are at high risk of clotting?
Throughout the pregnancy and for 6 weeks after birth
What is the treatment for Trichomonas Vaginalis?
Oral Metronidazole single dose
What alternative diagnosis should you consider in a patient with ?Parkinson’s Disease but who also has diplopia?
Parkinson’s plus syndrome
What test should be offered to ALL patients with TB?
HIV test
