PassMed Qs Flashcards by Charley Frew

What is the antibiotic prophylaxis of choice for COPD patients who continue to have exacerbations?

Azithromycin

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How can a posterior MI present on a normal 12 lead ECG?

Tall R waves in V1-V2

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What is the first line anti-anginal for stable angina with patients with HF?

Bisoprolol

(Aspirin + statins are appropriate but aren’t anti-anginals)

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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

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When are nitrates contraindicated?

Hypotension (<90mmHg)

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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)

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What drug is contraindicated in V Tachycardia and why?

Verapamil - cause hypotension, VFib, Cardiac arrest

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How would a left ventricular aneurysm present?

ST Elevation 4 weeks after MI
Bibasal crackles
3rd and 4th heart sounds

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What antibiotic should you avoid in long QT syndrome?

Erythromycin

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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

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How do you treat vancomycin-resistant C diff?

Oral Fidaxomicin

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What common drug can causes drug induced-cholestasis?

COCP

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What is the ratio of AST:ALT in alcoholic hepatitis?

2:1

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What microorganism can cause rose spots on the abdomen?

Salmonella typhi (typhoid fever)

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How will conn’s syndrome present on ECG?

Hypokalaemia

U waves w/ shallow T waves + prolonged PR interval

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What tests are helpful to distinguish between DM1 + DM2?

C-peptide levels
Anti-GAD Ab

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How does acute interstitial nephritis appear on urine dip?

High WCC + eisonophills w/ reduced renal function

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What drug would you use in penicillin allergic pregnant cellulitis?

Erythromycin

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What is the first step in the management of cardiac tamponade?

Pericardial Needle Aspiration

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What are the features of multiple myeloma?

CRAB

hyperCalcaemia
Renal failure
Anaemia
Bone fractures/lytic lesions

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What is the treatment while awaiting for transfer to hospital with mengicoccoal sepsis?

IM benzylpenicillin

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How does mesenteric ischaemia present?

Abdo Pain
Bloody diarrhoea
High WCC
Metabolic Acidosis

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What is the best anti-emetic to prescribe in Parkinson’s?

Domperidone

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What common cardiac drug can cause cold peripheries?

B blockers

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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?

1. B blocker/Ca channel blocker 2. amlodipine/modified-release nifedipine 3. 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