PassMed Qs Flashcards
What is the antibiotic prophylaxis of choice for COPD patients who continue to have exacerbations?
Azithromycin
How can a posterior MI present on a normal 12 lead ECG?
Tall R waves in V1-V2
What is the first line anti-anginal for stable angina with patients with HF?
Bisoprolol
(Aspirin + statins are appropriate but aren’t anti-anginals)
How do we diagnose Brugada Syndrome and how is it treated?
ECG: ST elevation followed by T wave inversion in V1-V3
Tx: Implantable cardioverter-defibrilator
When are nitrates contraindicated?
Hypotension (<90mmHg)
A patient presents to you with severe SOB + LOC, he suffered a MI recently.
What is the diagnosis and what murmur would you here?
Widespread systolic murmur
Mitral Regurgitation (secondary to papillary muscle rupture)
What drug is contraindicated in V Tachycardia and why?
Verapamil - cause hypotension, VFib, Cardiac arrest
How would a left ventricular aneurysm present?
ST Elevation 4 weeks after MI
Bibasal crackles
3rd and 4th heart sounds
What antibiotic should you avoid in long QT syndrome?
Erythromycin
What is the difference between mild and severe exacerbation of UC?
Mild - bloody diarrhoea
Severe - severe abdo pain, loss of appetite, fever, tachycardia, hypotensive, 6+ bloody stools daily
How do you treat vancomycin-resistant C diff?
Oral Fidaxomicin
What common drug can causes drug induced-cholestasis?
COCP
What is the ratio of AST:ALT in alcoholic hepatitis?
2:1
What microorganism can cause rose spots on the abdomen?
Salmonella typhi (typhoid fever)
How will conn’s syndrome present on ECG?
Hypokalaemia
U waves w/ shallow T waves + prolonged PR interval
What tests are helpful to distinguish between DM1 + DM2?
C-peptide levels
Anti-GAD Ab
How does acute interstitial nephritis appear on urine dip?
High WCC + eisonophills w/ reduced renal function
What drug would you use in penicillin allergic pregnant cellulitis?
Erythromycin
What is the first step in the management of cardiac tamponade?
Pericardial Needle Aspiration
What are the features of multiple myeloma?
CRAB
hyperCalcaemia
Renal failure
Anaemia
Bone fractures/lytic lesions
What is the treatment while awaiting for transfer to hospital with mengicoccoal sepsis?
IM benzylpenicillin
How does mesenteric ischaemia present?
Abdo Pain
Bloody diarrhoea
High WCC
Metabolic Acidosis
What is the best anti-emetic to prescribe in Parkinson’s?
Domperidone
What common cardiac drug can cause cold peripheries?
B blockers
How does ALD present on a FBC?
Macrocytic anaemia
Thrombocytopenia
What is the HbA1c target in DMII?
48 mmol/mol
What cancer are hashimotos patients more likely to suffer with?
MALT lymphoma
What treatment is first line for HFwRLVEF (LV)?
Bisoprolol + Ramipril
What antibiotic for MRSA?
Vancomycin
What microorganism can cause a cavitation lesion pneumonia?
Staph aureus
How does pulmonary stenosis sound?
Ejection systolic - louder on inspiration
What is the target BP for DMII?
Same as normal
<140/90mmHg
How does gastroparesis present? (paralysis of stomach)
Erratic blood glucose control
Bloating
Vomiting
What action should you undertake if an older woman is going to be on steroids for 3 months+?
Immediate co-prescription of alendronate
A middle aged man presents with sudden onset headache and jaw claudication. You suspect GCA and prescribe steroids and take a biopsy. The biopsy comes back normal, what is your next step of management?
Continue prednisolone
(GCA has skip lesions so may show a normal biopsy)
What drug class can reduce hypoglycaemiac awareness and make hypos less obvious?
Beta-blockers
Suppress adrenaline/fight or flight response
How does wernicke’s encephalophaty appear and what is the management?
Confusion
Ataxia
Yellow sclera
Involuntary rhythmic motion of the eyes (nystagmus)
Pabrinex (IV Vitamin B/C)
What effect does metronidazole have on warfarin?
Increases the anticoagulant effect of warfarin
(increases INR)
How does Anti-glomerular basement membrane disease present?
Haemoptysis
AKI
Proteinuria
Haematuria
(a pulmonary-renal syndrome)
How does typhoid fever present? (salmonella typhi)
Fever
Abdo pain
Constipation
Small rose spots over abdomen
What are heparins (enoxaparin) effect on potassium levels?
Hyperkalaemia
How do you manage a RA flare in GP?
IM methylprednisolone and refer to rheum
How does yellow fever present and what is it’s incubation period?
Incubation period: 2-14 days
Diffuse pain in legs
Lethargy
Jaundice
High fever
Vomiting
What vaccine should people with coeliac disease receive and why?
Pneumocococcal due to hyposlenism
How does a patient present with ANCA associated vasculitis?
Weight loss
Fatigue
Joint pain
Blood in urine
SOB
CXR - bilateral perihilar cavitating nodules
cANCA +ve
What is the risk of over treating hypothyroidism?
osteopersosis
What is the first line treatment for Immune Thrombocytopenic Purpura (ITP)?
PO Prednisolone
What type of dementia is associated with motor neurone disease?
Frontotemporal Dementia
What is the most common microorganism to cause peritonitis secondary to peritoneal dialysis?
Stphylococcus epidermidis
How does sarcoidosis present?
Young Female
SOB
Fatigue on exertion
Facial rash (lupus pernio)
Lymphadenopathy
Elevated serum Caclcium
On histology what does UC show?
Crypt Abscesses
What should you do if triple therapy (metformin, flozin, glitazone) doesn’t control DM II?
Switch one of the meds to liraglutide
What should you advise a patient that is due to have anti-transglutimase test?
Ensure they eat gluten 6 weeks prior
(no inflammation otherwise)
What is the M rule for PBC?
(primary biliary cholangitis)
igM
anti-Mitochondrial antibodies
Middle aged woman
What is the main complication with correction of hypernatraemia with fluids?
Cerebral Oedema (especially in young patients
What can be the first sign of myocardial ischaemia on an ECG?
Large/hyperacute T waves
What is the first line anti-hypertensive for a black DMII patient?
Losartan (ARB)
How does a patient with a posterior MI present appear on ECG?
Tall R waves in V1-V2
What is the management for a suspected PE?
DOAC for 3 months
What is the triad for Budd-chiari syndrome?
Sudden onset abdo pain
Ascites
Tender Hepatomegaly
Which cardiac drug is contraindicated in VT and why?
Verapamil as can precipitate MI
How does sarcoidosis present?
Bilateral hilar lymphadenopathy (CXR)
Cough
Low grade fever
Erythema Nodosum
More common in afro-caribbeans
How does dengue fever present?
Retro-orbital headache
Fever
Facail flushing
Eash
Theombocytopenia
What disturbance to a blood gas can prolonged vomiting cause?
Metabolic alkalosis
Hypokalaemia
How does dilated cardiomyopathy present?
Increasing SOB on exertion
3rd heart sound
How would an MI affecting the AV node present?
RCA involved
STEMI on II,III,aVF
1st degree heart block
Bradycardia
What abx is used to treat MRSA?
Vancomycin
What drug is used to treat PBC?
Cholestyramine
What could a high Total Iron Binding Capacity indicate on bloods?
INFLAMMATION
What would a high urinary sodium indicate?
Acute tubular necrosis
How does gastroperesis present?
Erratic blood glucose
Bloating
Vomiting
What is the initial management for Bell’s palsy?
PO Prednisolone
A patient presents with fatigue, osteomalacia and diarrhoea. What could be the cause?
Undiagnosed Coeliac Disease
What diet changes should be made in patients with ascites?
Restrict sodium/salt intake
What condition is medullary thyroid cancer associated with?
Phaeochromocytoma
What drug reduces mortality in HF?
B blockers
What drug can be used in the management of severe alcoholic hepatitis?
Predinsolone
Why would a patient on long term PPI present with muscle aches?
Low magnesium
What drug is given to diarrhoea predominant IBS?
Loperamide
(sertraline/amitryptiline 2nd line)
What bacterial pneumonia would cause:
dry cough
erythema multiforme
CXR - reticular nodular shadowing
Mycoplasma pneumoniae
What anti-hypertensives are contraindicated in renovascular disease?
ACE-i
Which diuretic causes hypercalcaemia?
Thiazide like1
What is the treatment for an unstable patient in VT?
DC Cardioversion
(I.v amiodarone in stable)
Where are inhaled foreign objects most like to sit?
Right main bronchus
What common condition can cause postural hypotension?
Diabetes
How does coarctation of the aorta present?
Weak femoral pulses
systolic murmur heard loudest at the left sternal edge
How quickly should fibrinolysis be administered after semi?
No longer then 12 hours post symptoms
What is the relevance to the length of symptoms of ACUTE AF with regards to treatment?
< 48 hours: rate or rhythm control
≥ 48 hours or uncertain: rate control
(delay cardioversion until they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks)
Unstable: cardioversion
What is the most specific ECG finding for acute pericarditis?
PR DEPRESSION
What is an ADR of Nicorandil?
Ulceration (Gi tract or oral cavity)
What ECG change do you see with hypercalcaemia?
shortening of the QT interval
What cardiac drug should be temporarily stopped when on co-amoxiclav, erythromycin or clarithromycin?
statins
What do you do in asystole?
Give adrenaline every 3-5 mins
CPR and check rhythm every 2 mins
Atropine no longer used
Which valve are IVDU most likely to get endocartitis?
Tricuspid valve
What is the angina management cascade?
- B blocker/Ca channel blocker
- amlodipine/modified-release nifedipine
- ivabradine
nicorandil
ranolazine
How does a ventricular septal defect sound?
Pansystolic murmur
How does pulmonary fibrosis from asbestos and coal differ?
Asbestos - CXR lower zone changes
Coal - CXR upper zone changes
How would a lung abscess present?
Night Sweats
Foul smelling sputum
Productive Cough
Previous pneumonia
How does Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis) present?
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis/nasal polyps
mononeuritis multiplex
pANCA positive in 60%
What should you give if you are draining a large ascites?
Human albumin solution (reduced mortality)
How does vomiting appear on ABG/VBG?
Metabolic alkalosis
What cancers are Lynch syndrome (HNPCC) sufferers likely to get?
Colorectal
endometrial
