Passmed medicine Flashcards
Which conditions are each diuretics used for?
Ascites - Aldosterone antagonists (spironolactone).
Heart Failure - Furosemide.
HyperTension - Thiazides
What mnemonic is used to remember first line drugs for diabetic neuropathy?
‘All Diabetics Get Peripheral (neuropathy)’ - ADGP:
-Amitriptyline
-Duloxetine
-Gabapentin
-Pregabalin
Which non-invasive ventilation is used for type 1 and type 2 respiratory failure?
Type 1 - CPAP
Type 2 - BiPAP
What are hba1c diabetic targets for each management?
<48 - diet/lifestyle controlled.
<53 - hypoglycaemic medication (not metformin).
On metformin:
>58 - add another medication.
What can differentiate an upper and lower GI bleed?
High urea levels can indicate an upper GI bleed vs lower GI bleed.
Which antibiotics are used for each STI?
Syphilis - Benzathine benzylpenicillin.
Chlamydia - Doxycycline.
Gonorrhoea - Ceftriaxone.
What is the mnemonic to remember symptoms of normal pressure hydrocephalus (NPH)?
Wet, wacky, wobbly:
-Incontinence, cognitive symptoms, abnormal gait.
Which drug removes potassium from the body rather than shifting it into cells?
Calcium resonium (calcium polystyrene sulphonate).
What is a way to remember the difference between Lambert Eaton syndrome and Myasthenia Gravis?
LA*mbert Eaton - Mainly affects LEgs and has Autonomic symptoms.
How long to keep eating gluten for before coeliac tests?
6 weeks.
How long to stop PPI for before testing for H. Pylori?
2 weeks.
What is a mnemonic to remember motor innervation to the hand?
Rock, paper, scissors -> median, radial, ulnar (alphabetical).
Rock - clenching fist (median - finger flexion).
Paper - stretching hand (radial - finger extension).
Scissors - make scissors (ulnar - dinger abduction and adduction).
Which type of dementia has visual hallucinations associated?
Lewy body dementia
What is the mnemonic to remember the causes of hypokalaemia?
DIRE:
Drugs (loop and thiazide diuretics).
Intestinal loss/inadequate intake.
Renal tubular acidosis.
Endocrine (Conn’s, Cushing’s).
What is the mnemonic to remember the causes of of hyperkalaemia?
DREAD:
Drugs (K+ sparing diuretics, ACEi).
Renal failure.
Endocrine (Addison’s).
Artifact (clotted sample).
DKA.
What are the reversible causes of cardiac arrest?
4 H’s:
Hypoxia, hypovolaemia, hypothermia, hyper/hypo (-kalaemia, -glycaemia).
4 T’s:
Thrombosis (cardiac/pulmonary), tension pneumothorax, tamponade (cardiac), toxins.
Which cancer are patients on long term immunosuppressants for organ transplantation more at risk for?
Skin cancer:
SCC, BCC, melanoma.
What is a mnemonic to remember the origin of breast metastases?
2L’s and 2B’s:
Lungs, liver, bones and brain.
What causes U waves on an ECG?
Hypokalaemia.
Which lung cancers secrete which hormones?
Small cell: ACTH, ADH.
Squamous cell: PTH.
What is a mnemonic to remember murmurs and when they’re heard louder?
RILE:
Right sided - Inspiration.
Left sided - Expiration.
Which diuretics can cause ototoxicity?
Loop diuretics.
What is a thyroid storm?
Complication of thyrotoxicosis - fever, hypertension, tachycardia, N+V, agitation/confusion.
Which cancer does pernicious anaemia predispose patients to?
Gastric cancer.
What are the mnemonics to remember the causes of the types of anaemia?
Microcytic - TAILS.
Normocytic - 3As and 2Hs.
Macrocytic - FAT RBC.
Why do patients with coeliac disease require regular immunisations?
Functional hyposplenism.
Mnemonic to remember anti-emetic mechanisms of action?
Anti emetics are 1, 2, 3:
1: Cyclizine H1 receptor.
2: Metoclopramide D2 receptor.
3: Ondansetron 5HT-3 receptor.
Mnemonic to differentiate between IgA nephropathy and post-strep glomerulonephritis?
IgA (3 letters) = 3 days.
Post-streptococcal (17 letters) = 2-3 weeks.
(Presenting after initial symptoms).
What is the diagnosis when cardiac tamponade signs are present post MI?
Left ventricular free wall rupture.
What is the diagnosis when there is pulmonary oedema post MI?
Papillary muscle rupture.
What is an indication that kidney disease is chronic and not acute?
Hypoglycaemia.
What is the community management of hypoglycaemia?
Oral glucose liquid/gel/tablet.
Glucogel or dextrogel.
Glucagon IM/SC.
What is the hospital management of hypoglycaemia?
Alert: Quick acting carb (gel/liquid/tablet).
Unconsious or unable to swallow: IM/SC glucagon.
-If IV access - IV glucose 20%.
How does a retinal/ophthalmic artery occlusion present?
Amaurosis fugax.
How does a basilar artery stroke present?
Locked in syndrome.
What reduced the incidence of contrast-induced AKI?
IV hydration with 0.9% NaCl before and after infusion.
What are four normal ECG variants in athletes?
Sinus bradycardia, junctional rhythm, first degree heart block, Mobitz type 1.
What is the most modifiable risk factor in thyroid eye disease?
Smoking.
Describe the lung fibrosis patterns for asbestosis and coal/silicosis?
Asbestosis - lower lobes.
Coal/silicosis - upper lobes.
What is the mnemonic to remember causes of delirium?
PINCHME:
Pain, infection, nutrition, constipation, hydration, medication, environment.
What is sick euthyroid syndrome?
Low TSH, T4 and T3 due to systemic illness - reversible and no treatment is needed.
What is a mnemonic to remember drugs that cause a long QT interval?
METHCATS:
Methadone.
Erythromycin.
Terfenadien.
Haloperidol.
Citalopram/chloroquine.
Amiodarone.
Tricyclics.
Sotalol.
Describe the spirometry findings of pulmonary fibrosis?
Restrictive:
FEV:FVC >70%, decreased FVC, reduced TLCO.
What is the characteristic organism responsible for food poisoning after reheating rice?
Bacillus Cereus.
What is a mnemonic to remember drugs to stop during AKI?
CANADA:
Contrast media
ACE inhibitors
NSAIDS - apart from cardioprotective aspirin.
Aminoglycosides
Diuretics
ARBs
What is the management of a myasthenic crisis?
Immunoglobulins and plasmapheresis.
What is given to to patients with a CD4 count less than 200/mm3 and why?
Co-trimoxazole for prophylaxis against PCP.
What is a key difference of Lambert Eaton syndrome to Myasthenia Gravis?
Lambert Eaton normally affects the legs worse.
What is the difference between lateral medullary syndrome and lateral pontine syndrome?
LMS - PICA, ipsilateral facial pain and temperature loss.
LPS - AICA, ipsilateral facial paralysis and deafness.
Which type of dementia presents with fluctuating cognition compared to other types of dementia?
Lewy body dementia.
Describe the differences between CN III, IV and VI nerve palsy.
CNIII - Ptosis, ‘down and out’ eye, dilated, fixed pupil.
CNIV - Defective downward gaze, vertical diplopia.
CNVI - Defective abduction, horizontal diplopia.
What are the blood transfusion thresholds of patients with and without ACS?
What temperature are RBCs stored at and what is the non-urgent transfusion time?
Without ACS - 70 g/L.
With ACS - 80 g/L.
4 degrees celcius.
90-120 minutes.
What is an essential tremor associated with?
Tremor present with sustained muscle tone in hands.
Can also affect vocal chords.
What is klebsiella pneumonia associated with?
Alcoholics.
What is the most common cause of community acquired pneumonia?
Strep pneumoniae.
Describe what mycoplasma pnuemoniae is associated with.
How is it diagnosed?
Atypical - erythema multiforme, haemolytic anaemia, ITP.
-Serology.
Describe what legionella pnuemophilia is associated with.
How is it diagnosed?
Atypical - lymphopenia, hyponatraemia, recent holiday (aircon).
-Urinary antigen.
Who is staph aureus pneumonia most common in?
In people after recent influenza infection.
What are the three main bacteria responsible for infective endocarditis?
Strep viridans
Staph aureus - IVDU and prosthetic valves
Staph epidermidis - prosthetic valves
When IM adrenaline is administered, where is it given?
Anterolateral aspect of the middle third of the thigh.
What is the acute management of hypercalcaemia and hypocalcemia?
Hyper - IV fluids (saline).
Hypo - IV calcium gluconate.
Which HPV strains cause 90% of genital warts?
HPV 6 and 11.
What should all TIA patients be offered if they’re not a candidate for endarterectomy?
Urgent carotid doppler ultrasound.
Mnemonic for furosemide side effects?
OH DANG:
Ototoxicity
Hypokalaemia
Dehydration
Allergy
Nephritis
Gout
Why is there no forehead sparing in Bell’s palsy?
LMN condition - affects entire side of the face
Mnemonic for Wernicke’s encephalopathy?
WE CAN:
(Wernicke’s encephalopathy)
Confusion
Ataxia
Nystagmus
What is the most likely diagnosis in a ill patient with decreased pO2 and a non-cardiorespiratory problem?
Acute respiratory distress syndrome
What is the secondary prevention for MI patients with AF?
Aspirin 300mg - 2 weeks
Then DOAC/warfarin
What is acute tubular necrosis?
Most common cause of renal AKI:
Occurs when there is damage to tubular cells from prolonged ischaemia or presence of toxins (NSAIDs).
Kidneys no longer to can concentrate urine or retain sodium leading to high urinary sodium and low urine osmolality.
How can ATN be shown on urinalysis?
Urine sodium >40 mmol/L
How do sulfonylurea drugs work?
Increase pancreatic insulin secretion - only effective if function pancreatic beta cells are.
-Bind to ATP dependent channel on beta cell membranes.
What are two side effects of sulfonylurea drugs?
Hypoglycaemia
Weight gain
Describe the pathophysiology of HOCM.
mc - mutations in the gene encoding beta-myosin heavy chain protein or myosin-binding protein C
-results in predominantly diastolic dysfunction (decreased compliance and cardiac output due to LVH)
-characterised by myofibrillar hypertrophy with chaotic and disorganised fashion myocyte and fibrosis on biopsy
Which drugs are to be avoided in Lewy body dementia?
Avoid HARM drugs:
Haloperidol
Antipsychotics
pRochloperazine
Metoclopramide
What are the most common causes of bone metastases?
Five B’s in order of frequency:
Breast
Bronchus
Brostate
Bidney
Byroid
What is a campylobacter infection characterised by?
Prodrome, abdominal pain and bloody diarrhoea
Can ACE inhibitors be prescribed in renovascular disease?
No
Describe sodium levels in pre-renal AKI and ATN (renal AKI).
Pre-renal - kidneys work hard to keep sodium in the body
ATN - tubular kidney cells dead, can’t keep sodium in so you also get hypokalaemia and hypotension
Why does Addison’s disease cause hyperpigmentation?
ACTH derived from POMC.
When POMC is cleaved to form ACTH, other melanocyte-simulating hormones (MSH) are produced.
MSH affect melanocytes in skin to produce melanin.
What is cataplexy?
Sudden transient episode of muscle weakness typically triggered by strong emotions such as laughter, anger or surprise.
Often associated with narcolepsy.
What are Stokes-Adams attacks?
Refers to syncopal episodes that occur from cardiac arrhythmia.
mc bradycardia in the form of:
-2nd degree type II AV block
-complete heart block
-sick sinus syndrome
What initial tests are needed before commencing amiodarone?
TFT, LFT, U+Es, CXR
CXR - pulmonary fibrosis
U+Es - to detect hypokalaemia
TFTs - thyrotoxic
What is the most common cause of diarrhoea in patients with HIV?
Cryptosporidium and other protozoa
How often should type 1 diabetics check their blood glucose levels?
Blood glucose at least 4 times a day:
-including before each meal and before bed
What is a big clue to typhoid fever?
Constipation
What is an ECG characteristic of a posterior MI?
Causes ST depression on 12-lead ECG
-Tall R waves in anterior leads (V1-V2)
Which medications should a patient receive after PCI for a STEMI?
CRABS (clopidogrel, rampiril, aspirin, beta-blocker, statin).
Dual antiplatelet therapy (aspirin and clopidogrel/ticagrelor), beta blocker, ACEi, statin.
Where do you get hepatitis E from?
Faceo-oral route - the sea
In a patient with Crohn’s after an ileo-caecal resection with a normal CRP, what is given and why?
Cholestyramine due to bile acid malabsoprtion.
Which heart rhythm does a tension pneumothorax cause?
PEA - pulseless electrical activity
What are the eGFR variables?
CAGE:
Creatinine, age, gender, ethnicity
Describe spirometry in obstructive lung disease.
Give examples of obstructive lung disease.
FEV1 - significantly reduced
FVC - reduced or normal
FEV1/FVC - reduced
Asthma, COPD, bronchiectasis
Describe spirometry in restrictive lung disease.
Give examples of restrictive lung disease.
FEV1 - reduced
FVC - significantly reduced
FEV1/FVC - normal or increased
Pulmonary fibrosis, asbestosis, sarcoidosis, ARDS, obesity, neuromuscular disorders
Explain the types of diabetes insipidus and their medications.
DI - ADH not effective, no anti-diuresis so polyuria (ADH retains water).
-Cranial DI - ADH not produced. DESMOPRESSIN
-Nephrogenic DI - Kidneys don’t respond to ADH - THIAZIDE DIURETIC
What is the difference between acute and chronic subdural haematomas on CT scan?
Acute - hyperdense
Chronic - hypodense
What reverses rivaroxaban and apixaban?
Andexanet alfa
What is the treatment for medication overuse headache?
Simple analgesia and triptans - stop abruptly
Opioid analgesia - withdraw gradually
Classic history of acoustic neuroma?
Vertigo, hearing loss, tinnitus and absent corneal reflex
Which medication class is beneficial in proteinuria CKD?
SGLT-2 inhibitor - regardless of diabetic status
ACEi in AKI and CKD?
Stop in AKI
Beneficial in ACEi
What causes dysphagia when on steroid therapy?
Oesophageal candidiasis
Most common cause of infective COPD exacerbation?
H. influenzae
Which blood cancer does coeliac disease put you at risk of?
T cell lymphoma
What are the first line treatment for spasticity for MS?
Baclofen and gabapentin
Treatment of gonorrhoea vs chlamydia?
Gonorrhoea - IM ceftriaxone
Chlamydia - Doxycycline
What is the treatment of Addison’s disease?
Hydrocortisone and fludrocortisone
Describe Hep B serology.
HBsAg - surface antigen (acute or chronic infection)
IgG - chronic
IgM - acute
Most common cause of SVC obstruction?
Small cell lung cancer
Describe klebsiella in the lungs.
Causes cavitating pneumonia in upper lobes
Mainly in diabetics and alcoholics
Two most common causes of bilateral hilar lymphadenopathy?
Sarcoidosis and TB
Electrolyte abnormality seen in prolonged diarrhoea?
Metabolic acidosis with hypokalaemia
How can diabetic patients sometimes present with MI?
Without chest pain
What anion gap does diarrhoea cause?
Normal anion gap acidosis
What is a high-stepping gait a sign of?
Peripheral neuropathy
Three EBV related malignancies?
Burkitt’s lymphoma
Hodgkin’s lymphoma
Nasopharyngeal carcinoma
Treatment for Wernicke’s encephalopathy?
Pabrinex - IV B/C vitamins
Diabetic sick day rules for patients of insulin?
Not stop insulin due to DKA risk
Continue normal insulin regime but check blood sugars frequently
ECG features of ECG?
Small/absent or inverted T waves
Prolonged PR
ST depression
Long QT
U waves
First thing to do when a cardiac arrest is witnessed on a monitor?
Maximum of three successive shocks
When is cardiac endarterectomy indicated?
In a patient who has had a TIA with carotid artery stenosis exceeding 70% on side contralateral to symptoms
Mnemonic for quadrantanopia?
PITS:
Parietal - Inferior quadrantanopia
Temporal - Superior quadrantanopia
What is the 1-2-12 rule for STEMI?
1 - Primary PCI is #1 choice for STEMI
2 - Transport to PCI centre if within 2h (if not - thrombolysis)
12 - Symptoms start within 12h - PCI
Side effects of TB antibiotics?
Isoniazide - peripheral neuropathy
Ethambutol - Uveitis
Rifampicin - Orange/red tears/urine
Which electrolyte abnormality does chronic alcoholism cause?
Hypomagnesaemia
