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