Passmed Questions 2.0 Flashcards
when should you give prophylactic abx for spontaneous bacterial peritonitis? what antibiotic would this be?
oral ciprofloxacin
if previous SPB infection
ascitic tap protein 15 or less
child pugh 9 or more
hepatorenal syndrome
what condition would over estimate HbA1c?
splenectomy due to long half life of RBC
treatment for hiccups in palliative care
chlorpromazine or haloperidol
pathophysiology of primary biliary cholangitis
interlobula bile ducts become inflammed –> cholangitis –> cirrhosis
ovarian tumour associated with Meig’s syndrome
fibroma
(benign tumour)
most common ovarian tumour found in women of reproductive age?
follicular cyst
most common ovarian tumour found in young women < 25 years
dermoid cyst (teratoma)
precipitating factors for digoxin toxicity
hypokalaemia, hypomagnaesaemia
hypercalcaemia, hypernatraemia
low albumin
hypothermia, hypothyroidism
amiodarone, verapamil, diltiazem, ciclosporin, spironolactone, thiazide and loop diuretics
increasing age, renal failure,
HF medications which may precipitate digoxin toxicity
spironolactone
loop diuretics
thiazide like diuretics
verapapmil, diltizem
electrolyte abnormalities which could precipitate digoxin toxicity
low K, Mg, temp, albumin, thyroid
high Na, Ca
at what fasting glucose should insulin be started immediately in pregnant patients
if fast glucose 7 or higher then start insulin
if > 5.6 but < 7 - lifestyle advice + metformin
cancer with raised AFP and bHCG
non-seminoma testicular cancer
cancer with raised 15-3
breast cancer
bombesin tumour marker
gatsric cancer, neuroblastoma, small cell lung cancer
S-100 tumour marker
schwannoma, melanoma
treatment for genital warts
multiple, non-keratinized: topical popdophyllum
solitary, keatinized: cryotherapy
what is the target time for thrombectomy and thrombolysis in stroke patients
thrombolysis - 4.5 hours
thrombectomy - 6 hours
when should bells palsy have urgent referral to ENT
no improvement within 3 weeks
features of herpes simplex encephalitis on CT
bilateral temporal lobe hypodensities
features of temporal lobe involvement
aphasia
hemiparesis
memory impairment
antiemetic used in parkinsons
domperidone
acts as dopamine antagonist but doesnt cross BBB so can safely be used in parkinsons
dose of rectal diazepam in seizure emergency
< 1 year - 5mg
2-11 years - 5-10mg
11-17 years - 10mg
adult - 10-20mg
elderly - 10mg
does cushings reflex cause wide or narrow pulse pressure
wide pulse pressure
what blood test is used to check response to treatment in hashimotos
TSH
tear drop poikilocytes on blood film
myelofibrosis
megaloblastic anaemia
thalassaemia
fist line treatment for ITP
oral prednisolone
blood film feature of DIC
schistocytes
what type of cancers are at increased risk with the COCP?
breast and cervical
Monomorphic rash with punched out erosions - diagnosis? causative organism? treatment?
eczema herpeticum
HSV 1 or 2
admit for IV aciclovir
indications for high dose folic acid in pregnancy
taken 3 months prior to conception to 12 weeks pregnancy
either partner has NTD, previous pregnancy with NTD or family history of NTD
diabetes, thalassaemia, coeliac, antiepileptic medications
obsese (BMI 30 or higher)
features on fundoscopy and condition they are found in;
- drusen
- cotton wool spoots
- flame haemorrhages
- AV nicking
- cupping of optic disc
drusen - age related macular degeneration
cotton wool spots - HTN, diabetic retinopathy
flame haemorhages - HTN
AV nicking - HTN
- cupping of optic disc - glaucoma
cancers associated with dermatomyositis
ovarian and lung cancer
cancer associated with
- migratory thrombophlebitis
- necrolytic migratory erythema
- pyoderma gangrenosum
- tylosis
pancreatic
glucaganoma
myeloproliferative disorders
oesophageal
live attenuated vaccines
BCG
MMR
oral polio
yellow fever
oral typhoid
treatment for heart block post MI
no treatmet if asymptomatic
transcutaneous pacing if symptomatic +/or elderly
drugs that can induce erythema nodosum
penicillin
sulphonadmides
COCP
good prognostic factors for SCC
well circumscribed lesion
< 20mm diameter
<2mm deep
no associated disease
surgical margins for excision of SCC
if < 20mm then 4mm margin
if > 20mm then 6mm margin
what cancer are renal transplant patients at risk of
SCC
treatment for antiphospholipid syndrome during pregnancy
aspirin + LMWH
(LMWH usually continued 6 weeks post partum or until oral anticoagulant can be restarted)
whats the most common cardiac abnormality found in downs syndrome
AVSD
(endocardial cushion defect)
wells score criteria
bed bound >3 days or recent major surgery in past 12 weeks
leg swelling >3cm
previous DVT/PE
tachycardia (HR > 100)
active cancer
collateral superficial veins
entire leg swollen
pitting oedema
tenderness along deep venous system
differential diagnosis unlikely
if > 2 then USS
if < 2 then d-dimer
medication used to prevent;
- calcium stones
- urate stones
- oxalate
calcium stones - thiazide like diuretics
urate stones - allopurinol oral bisophosphonate
oxalate - pyridoxine, cholestyramine
1st line treatment for renal stones
<5mm and asymptomatic - watch and wait
5-10mm - shockwave lithotripsy
10-20mm - SWLT or ureteroscopy
> 20mm - percutaneous nephrolithotomy
if pregnant –> SWLT contraindicated
1st line treatment for ureteric stones
<10mm - SWLT +/- alpha blockers
10-20mm - ureteroscopy
acute heart failure with hypotension management
1st line - HDU for inotropic support
2nd line - vasopressors
3rd line - mechanical circulatory assistance i.e. intra aortic balloon counterpulsation or LVAD
treatment for magnesium sulphate induced respiratory depression
calcium gluconate
most common congenital heart disease in new born and at 1-2 months age
new born - transportation of great arteries
if 1-2 months of age - tetralogy of fallot
mode of action of bupropion
used for smoking cessation
norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist
mode of action of varenicline
used for smoking cessation
partial nicotinic receptor agonist
colorectal screening
FIT test every 2 years people aged 50-74 in scotland ,60-74 years in england
when do you refer patients with sciatica +/- known disc prolapse to neurosurgery
after 4-6 weeks of conservative management
most common infective organism in bronchiectasis
H. influenzae
indications for surgery in bronchiectasis
uncontrollable haemoptysis
localised disease
rules for pregnancy women unvaccinated against Rubella during pregnancy
MMR live attenuated so not given during pregnancy
can be given in post-natal period
advise to keep away from people who may have rubella
breast lump with green discharge
mammary duct ectasia
irregular breast lump in obese lady with skin tethering
fat necrosis
discrete, non-tender lump in breast of 20 year old
fibroadenoma
lumpy tender breasts which may become painful during menstruation
fibroadenosis (fibrocystic disease)
breast lump associated with bloody stained nipple discharge
ductal pappiloma
night blindness and tunnel vision?
retinitis pigmentosa
how should you alter long acting insulin on the day of surgery
reduce dose by 20%
what is an acceptable level of PSA post prostatectomy?
undetectable
any level of PSA should require urgent referral to oncology
1st line management in paediatrics with constipation?
advice on diet and exercise + movicol paediatric plain
drug causes of lung fibrosis
amiodarone
bleomycin, busulphan
sulfasalazine, MTX
cabergoline, bromocriptine, pergolide
nitrofurantoin
whats the most appropriate test to confirm h.pylori eradication after completing treatment
urea breath test
main indication for placing chest drain in pleural infections
purulent discharge
growth of organisms
PH < 7.2
1st, 2nd and 3rd line treatment for anal fissure
1st: increase dietary fiber, bulk forming laxatives or lactulose if not tolerated
2nd: topical GTN, topical diltiazem if GTN not tolerated
3rd: if fails after 8 weeks of treatment the consideration of referral for surgical management - sphincterectomy or botulinum toxin
pregnant and exposed to chickenpox. Not symptomatic. Dont know if they have previously had chickenpox. What do you do?
check varicella IgG Ab
pregnant and exposed to chickenpox. Symptomatic. What do you do?
discuss with Obs and Gynae
pregnant and exposed to chickenpox. Asymptomatic. Previously had chickenpox. What do you do?
Reassure
1st, 2nd, 3rd and 4th degree perineal tears
1st degree: superficial no muscle involvement
2nd degree: injury to perineal muscle
3rd degree: tear of the anal sphincter complex
4th degree: tear of anal sphincter complex and rectal mucosa
WHO categories of obese on BMI ranges
BMI 30 - 34.9 obese type I
BMI 35-39.9 obese type II
BMI 40 and above obese type III
what type metabolic abnormality does cushings cause
hypokalaemia metabolic alkalosis
XR features of perthes disease
early: widened joint space
late: flattening of the femoral head
firm painless lump in the eyelid and management
chalazion (meiboman cyst)
resolve spontaneously but sometimes require surgical drainage
treatment for stye
hot compress
antibiotics if there is associated conjunctivitis
treatment for gatsroenteritis in severe cases +/or immunocompromised patients
ciprofloxacin
causative organism of keratitis found in contact lens wearers?
pseudomonas
staph aureus if not contact lens wearer
treatment for keratitis
stop wearing contacts until resolves
topical quinolone
what is the antidepressant of choice in a breast feeding woman?
sertraline or paroxetine
what medication should be given in patient with subarachnoid haemorrhage
nimodipine to prevent vasospasm
features of pesticide poisoning
increase in parasympathetic acitivity i.e. drooling
bradycardia
small pupils (miosis)
whats the earliest time external cephalic version can be offered in nuliparous and multiparous women?
nuliparious - 36 weeks
multiparous - 37 weeks
what chromosomes are BRCA 1 and BRCA 2 located on?
BRCA 1 - chromosome 17
BRCA 2 - chromosome 13
what cancers does BRCA 2 put men at risk of
breast and prostate
when is the anomaly scan done
18-20 weeks
pigmented laded macrophages suggestive of melanosis coli. what is the cause of this
laxative abuse
what antiemetic is recommended in patients with mirgaine
prokinetic such as metoclopramide
what type of laxative is first line in patients with IBS
bulk forming laxative such as isphagula husk
what type of hearing test is done at the newborn screening
otoaccoustic emission test
what type of hearing test is done at school entry age
pure tone audiometry
treatment for recurrent c.diff infection within 12 weeks of prev infection
oral fidaxomicin
