Passmed Questions Flashcards
Values of impaired glucose toleranve test
After 2 hours it increases to 7.8 or higher but below 11.1
Prophylaxis treatment for cluster headache
Verapamil
Are c-peptide levels high in type 1 or type 2 diabetes
T2DM
1st and second line treatment for muscle rigidity and spasms in MA
First line baclofen
Second line gabapentin
What supplements can affect levothyroxine
Iron or calcium tablets can affect absorption levothyroxine resulting in low T4 and high TSH
Tamoxifen action
Selective oestrogen receptor modulator
what would affect PSA levels and how long should you wait before performing the test ?
prostate biopsy - 6 weeks
UTI - 4 weeks
DRE - 1 week
ejaculation and vigorous exercise - 2 weeks
TREATMENT FOR LYME DISEASE IF DISSEMINATED INFECTION
Ceftriaxone
single most important indicator for liver transplant in paracetamol overdose
PH < 7.3
USS screening in AAA
< 4.5 = 12 monthly
4.5 - 5.5 = 3 monthly
>5.4 or rapidly growing aneurysm = rapid referral to vascular
difference in anaemia of chronic disease and iron deficiency anaemia on blood results
both low iron and transferrin
iron deficiency has high TIBC
anaemia of chronic disease has low TIBC
what drugs are contraindicated with concurrent use of sidenifil
nitrates or nicorandil
what heart condition is associated with turners syndrome?
bicuspid aortic valve (ejection systolic murmur)
coarctation of aorta (late systolic)
what’s the most serious long term complications associated with turners syndrome?
aortic dilatation and aortic dissection
in what condition should donepezil be avoided?
(also what is donepexzil’s action and what is it used for?)
cholinesterase inhibitor
used in alzheimers
increases vagal tone thereby causing bradycardia.
avoided in sick sinus syndrome and other heart conditions
adverse effects of donepezil
insomnia
bradycardia
indomethacin or prostaglandin E1 for treatment of PDA
indomethacin to close duct
prostaglandin E1 to keep duct open if there is a concurrent congenital heart defect that requires repair
what is the theoretical risk associated with giving the rotavirus too late?
intussusception
at how many weeks should the first and second doses of rotavirus be given by
1st dose by 14 weeks
2nd dose by 25 weeks (6 months)
what condition is found in 50% of patients with degenerative cervical myelopathy
carpal tunnel syndrome
Hg, MCV and reticulocyte count found in sickle cell patients
Hg low
MCV normal
reticulocyte high
drugs that can cause pancreatitis
azathioprine, mecaptopurine, sodium valproate, furosemide, bendroflumethiazide, pentamidine, steroids
pancreatitis makes anyone furious because its so sore
been abroad recently and presented with constipation and fever
typhoid fever (salmonella typhii)
What rise in creatinine and drop in eGFr is acceptable when starting ACE inhibitors
20% drop in eGFR
30% rise in creatinine
at what size is a breast fibroadenoma for surgical excision
> 3cm
most common causative organism of epididymo-orchitis
chalmydia
if antibiotics are required for campylobacter what is abx of choice
clarithromycin
1st line imagine for suspected stroke
head CT non-contrast
what type of collagen makes up the vitreous humor of the eye
type II
what type of collagen makes up the lens of the eye
type III
causative organisms of chest infection post influenza infection
staph aueus
how to test for the main adverse effect of kawasaki
aortic aneurysms - echo
criteria for expectant management in ectopic pregnancy
size < 35mm
no symptoms
no foetal heart beat
bHCG < 1000
unruptured
criteria for medical management in ectopic pregnancy
size < 35mm
pain
no foetal heart beat
bHCG < 1500
unruptured
criteria for surgical management in ectopic pregnancy
size >35mm
pain
foetal heart beat
ruptured
bHCG >5000
intrauterine pregnancy
surgical management for ectopic pregnancy
salpingectomy
salpingotomy if risks of infertility such as contralateral tubal damage
pathophysiology of subcortical vascular dementia
small vessel disease
CURB scoring
confusion (abbreviated mental score 8 or more)
urea >= 7
RR >= 30
BP <= 90 systolic +/or <= 60 diastolic
mode of action of rifampicin
inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA
prophylactic medication given in people with varices
propanolol is given to prevent variceal bleeding
hydroxychloroquine side effects
corneal deposits
‘bulls-eye retinopathy’
what DMARD can cause demyelination
etanercept
drugs that should be avoided whilst breast feeding
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
management for gestational diabetes and glucose values associated with treatment options
if fasting glucose < 7 then trial of diet and exercise for 1-2 weeks. If this fails then start metformin
if fasting glucose >=7 then start insulin
contraindications to sildenafil
hypotension
recent stroke or MI
nitrates or or nicorandil
treatment for croup
emergency treatment - high flow 02 + nebulised adrenaline
management - single dose oral dex regardless of severity
treatment for latent TB
isoniazid and pyridoxine for 6 months
treatment for toxoplasmosis
treatment not required in immunocompetent patients
if immunocompromised or complications then treat with pyrimethamine and sulphadiazine for 6 weeks
class III vs class IV haemorrhagic shock
class III 30-40% blood loss, BP drops, confused, urine 5-15ml, HR > 120
class IV >40% blood loss, BP drops, lethargic, urine < 5ml, HR > 140ml
first line treatment for gestational hypertension in a patient with asthma
nifedipine
prophylactic treatment for household members of a patients with neisseria meningitidis
oral ciprofloxacin
when can copper IUD be used for emergency contraception
5 days after unprotected sex
5 days after first day of ovulation
causative organism for measles
RNA paramyxovirus
normal value of anion gap ?
causes of raised anion gap metabolic acidosis
8-14
Lactate: shock, hypoxia
Ketones: DKA, alcohol
urea: CKD
acid: salicyclates, methanol
5-oxoproline: chronic paracetamol use
neurotransmitter effects of alcohol withdrawal
decreased inhibitory GABA and increased excitatory glutamate
extra-articular manifestations of crohns that is related to disease activity
arthritis
erythema nodosum
episcleritis
osteoporosis
exposure to chickenpox < 20 weeks pregnant. Course of action?
if not vaccinated = IVIG
if vacciated = no action
if unsure = immediately arrange for varicella Ab testing
exposure to chicken pox >20 weeks pregnant. Course of action?
if not vaccinated = IVIG or aciclovir
if vaccinated = no action
if unsure = immediately arrange for varicella Ab testing
1st line investigation for suspected prostate cancer
multiparametric MRI
1st lin emanagement if suspected cows milk protein intolerance
switch to extensive hydrolysed formula
if this fails then try amino-acid based formula
ramsey hunt syndrome treatmentn
steroids + aciclovir
monitoring of LFTs when starting a statin
at baseline, 3 months, then 12 months
first line antihypertensive treatment if < 55
ACE inhibitor / ARB
first line antihypertensive if diabetic?
ACE or ARB
first line antihypertensive if > 55
CCB
first line anti-hypertensive if afro carribean?
CCB
first line antihypertensive if > 55 with diabetes
ACE inhibitor
wolf parkinson white features
accessory pathway in conduction leading to atrio-ventricular re entry tachycardia. Can lead to VF.
right axis deviation if left sided accessory pathway and vice versa
short PR interval, wide QRS with slurred upstroke ‘delta wave’
associations with Wolf-parkinson white syndrome
hocm
ebsteins anomaly
mitral valve prolpase
thyrotoxicosis
secundum ASD
1st line treatment for capillary haemangioma
propranolol
1ts, 2nd, 3rd and 4th line treatment for psoriasis
1st line - once daily topical steroid and vit D analogue
2nd line - twice daily vit D analogue
3rd line - twice daily topical steroid or coal tar
4th line - phototherapy or MTX
treatment in heart failure to improve mortality after all medical options have been optimised
cardiac resynchronised therapy (if qrs > 120 OR ejection fraction < 35%)
LVAD or transplant if young
treatment for moderate-severe pustular acne rosasea?
ivermectin + doycycline
treatment for otitis externa
mild - topical acetic acid 2% spray
modera/severe (discharge, hearing loss, lymphadenopathy, debris) = topical antibiotic + topical steroid
drugs that can cause galactorrhoea
metoclopramide
domperidone
phenothiazines (i.e. chlorpromazine)
haloperidol
very rare: SSRIs, opioids
treatment for lichen planus
topical clobetasone
congenital condition with rocker bottom feet and overlapping fingers
edward syndrome (trisomy 18)
small eyes and polydactyly
patau syndrome
learning difficulties and macrocephaly
fragile X
micrognathia, posterior displacement of tongue, cleft palate
pierre-robin syndrome
supravalvular aortic stenosis, hypercalcaemia, short stature, learning difficulties
williams syndrome
when is the OCP, POP, IUD, mirena and nexplanon effective
IUD - immediately
POP - 2 days
COCP, implant, injection and mirena (IUS) - 7 days
with diagnosis of chlamydia, what partners should you notify?
symptomatic men - all partners past 4 weeks
women + asymptomatic men - past 6 months
what condition should ullipristal be used with caution in
asthma
antiphospholipid findings on blood test
prolonged APTT
thrombocytopenia
what artery is affected if there is complete heart block after an MI
right coronary artery
induction of labour if bishop score < 6
vaginal prostaglandin or oral misoprostol
(cervical balloon may be inserted if previous c-section or risk of hyperstimulation)
induction of labour if bishop score < 6
amniotomy or iV oxytocin infusion
red, painful eye with small pupil, ciliary flush
anterior uveitis
red, painful eye with mid-dilated pupil, haloes
acute angle closure glaucoma
abx of choice for dental abscess
amoxicillin
abx of choice for mastitis whilst breast feeding
flucloxacillin
chocolate ovarian cyst
endometriotic cyst
criteria for stage 1, 2, and 3 AKI
stage 1
- rise in creatining >26 in 24 hours or > 1.5x baseline in 7 days. or < 0.5ml/kg/hr for 6 hours
stage 2
- creatinine 2-2.5x baseline
- urine < 0.5ml/kg/hr > 12 hours
stage 3
- creatinine > 3.5x baseline or > 354
- urine < 0.3ml/kg/hr 24 hours or anuric for 12 hours
calcium and phosphate in rhabdomylysis
hypocalcaemia
hyperphosphataemia
(calcium binds to myoglobin)
cervical cancer screening
25-49 -> every 3 years
50-64 -> every 5 years
first line treatment for syphillis
IM benzathine penicillin
decreases BNP levels
Beta blockers
Obesity
ACE inhibitors
ARB
Aldosterone inhibitors
what anti-diabetic medication is contraindicated in heart failure
pioglitazone
causes fluid retension and worsens HF
what medication is given to someone post-MI with reduced LVEF
aldosterone antagonist e.g. spironolactone
biochemical effects of tumour lysis syndrome
high potassium and phosphate
low calcium
glucose levels in fasting glucose and 2 hours post glucose challenge which is diagnostic for gestational diabetes
fasting - 5.6 mmol
2 hours post - 7.8 mmol
enzyme inducing drugs
st johns wart
phenytoin
enzyme inhibiting drugs
erythromycin
isoniazid
describe the missed pills rules for COCP
if missed 1 pill then take 1 active pill even if its 2 in a day and continue as usual
if missed 2 in week 1 then emergency contraception needed
if in week 2 then take active pill + extra precautions
if in week 3 then take active pill + omit pill free interval
what medication can lead to hypoglycaemic unawareness in diabetic patients
betablockers as they mimic hypoglycaemia
treatment in hospital for suspected meningitis in child < 3 months and > 3 months
IV ceftriaxone
if < 3 months add IV amox for listeria cover
most common causatie organisms in meningitis in < 3 months
neonate (up to 3 months);
group B strep
Neissieria meningitidis
listeria
most common causative organisms meningitis 1month -6 years
neissiseria meningitidis
strep pneumoniae
hamophillus influenzae
most common causative organisms meningitis > 6 years
neissiseria meningitidis
strep pneumoniae
non-sedating antihistamines
loratadine and cetirizine
what PH9-Q score would you start anti-depressants and/or CBT only
PH9-Q score < 16 = CBT
> 16 add in anti-depressants
