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passmed recall Flashcards

1
Q

CUSHINGS

what are the urea and electrolytes most likely to show?

A

hypokalaemic metabolic alkalosis

excess of cortisol production from adrenal glands or exogenous glucocorticoid use.

Excess cortisol can lead to sodium and water retention –> HTN and hypokalaemic metablolic acidosis

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2
Q

Prolactinoma management

A

1st line - dopamine agonists (cabergoline or bromocriptine)

GH secreting adenoma:
Somatostatin analogues (octreotide)

ATH secretomg adenoma
–> ketoconazole (inhibit cortisol synthesis)

TRANSPHENOID SURGERY

Non-functioning adenoma - compressive symptoms or hormone deficiences therefore surgery if first line treatment

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3
Q

NECROTIZING FASCIITIS: A culture of the wound grows gram-positive cocci in chains.

A

Streptococcus pyogenes is the most common cause of type 2 necrotising fasciitis

STRIPTOCOCUS

Staph aureus - clusters
E.COLI - gram negative rod
P.aeruginosa - gram negative rod
C.perfringens - gram positive rod (T1 nec fasc)

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4
Q

Hypokalaemia causes

A

Hypokalaemia: DIRE

Drugs (loop and thiazide diuretics)
Intestinal loss or inadequate intake
Renal tubular acidosis
Endocrine (Conn’s, Cushings)

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5
Q

Hyperkalaemia causes

A

Drugs (K+ sparing anti-diuretics, ACEi)
Renal failure
Endocrine (Addison’s)
Artifact (clotted sample)
DKA

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6
Q

typical biochemical pattern for primary hyperparathyroidism.

A
  • excessive autonomous secretion of PTH from parathyroid gland
  • results in mild hypercalcaemia
  • low serum phosphate
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7
Q

**corneal abrasion **

features

Investigation

management

A

Features
- eye pain
- lacrimation
- photophobia
- foreign body sensation and conjunctival injection
- decreased visual acuity in affected eye

Investigation
- fluorescein staining

Management
- topical ABx to prevent 2ndary bacterial infection (topical chloramphenicol)

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8
Q

Addison’s patient with intercurrent illness: dose increase

A

double the glucocorticoids, keep fludrocortisone dose the same

e.g. hydrocortisone

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9
Q

reversal agent for dabigatran

A

Idarucizumab

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10
Q

This is an agent used to reverse rivaroxaban and apixaban, two other direct oral anticoagulants which work as direct factor Xa inhibitors.

A

Andexanet alfa

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11
Q

Massive PE + hypotension MX

A

THROMBOLYSE

Thrombolysis indicated when there is haemodynamic instability.

PE 1st line
–> DOAC
or LMWH followed by another DOAC (dabigatran or edoxaban)
OR LMWH followed by vit k antagonist (warfarin)

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12
Q

Features of Guillain Barree syndrome

A

Features
- history of gastroenteritis
- respiratory muscle weakness
- cranial nerve involvement:
–> diplopia
–> bilateral facial nerve palsy
–> oropharyngeal weakness
- autonomic involvement
–> urinary retention
–> diarrhoea

Less common: papilloedema (2ndary to reduced CSF absorption)

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13
Q

Invetigations for Guillain Barre

A
  1. LP
    –> rise in protein w/ normal WBC (ALBUMINOCYTOLOGIC DISSOCIATION)
  2. Nerve conduction studies
    –> decreased motor nerve conduction velocity
    –> prolonged distal motor latency

Weakness typically ascending. Reflexes reduced or absent. Sensory symptoms mild

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14
Q

THIS should be co-administered with isoniazid to prevent peripheral neuropathy

A

VITAMIN B6 (PYRIDOXINE)

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15
Q

Helicobacter pylori infection can lead to what malignancy

A

GASTRIC LYMPHOMA (MALT)
–> antrum of stomach
–> systemic features (fever + night sweats)

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16
Q

Criteria to distinguish between exudate and transudate pleural effusion

A

LIGHTS CRITIERA
Exudates > 30g , transudate <30
if between 25-35 –> USE LIGHTS

pleural aspiration first then drainage

Send sample for pH, protein, lactate dehydrogenase, cytology and microbiology

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17
Q

8 MALE
pc: losing weight, lethargic, night sweats, RHS non tender lymphadenopathy and mild abdominal tenderness upon palpation.

Histology: starry sky pattern

What organism if indicated in patients condition:

A

BURKITT LYMPHOMA

EPSTEIN BARR VIRUS!

B-cell high grade neoplasm

Mx = chemo
Rapid response but may lead to tumour lysis syndrome. (RASBURICASE given before chemo to reduce risk of TLS)

18
Q

paraesthesiae in limbs on neck flexion

A

Lhermitte’s syndrom

19
Q

Dysphagia, aspiration pneumonia, halitosis →

A

pharyngeal pouch

IX - barium swallow combined with dynamic video fluroscopy

Management: surgery

20
Q

Glasgow Coma Scale: adults

A
21
Q

A 50-year-old man presents with right-sided ear pain and facial weakness. He had flu-like symptoms of fever and headache for three days before the rash appeared.

On examination, there is a right-sided facial nerve palsy. A vesicular rash is seen on otoscopy.

A

Treatment of Ramsay Hunt syndrome consists of
1. oral aciclovir
2. corticosteroids

herpes zoster oticus

Full recovery likely if antiviral tx started w/i 72 hours of onset of symptoms.
1st line = 800mg aciclovir 5 times daily for 7 days and prednisolone 60mg 5 days

22
Q

acute management of DKA: insulin regime

A

START fixed rate insulin

Continue regular long acting insulin

STOP regular short acting insulin

0.1 unit/kg/hour

DKA mx
1. FLUID replacment - isotonic saline first
2. start fixed rate insulin infusion
3. once glucose >14 start 10% dextrose infusion 125mls/hr in addition to 0.9 NaCl regime
4. Correct electrolyte disturbances

DKA resolution is defined as:
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

23
Q

Polymorphic ventricular tachycardia,

A

torsades de pointes

macrolides can prolong QT! e.g. azithromycin

24
Q

When should a child presenting with glue ear be urgently referred to ENT

A
  • DOWNS SYNDROME
  • CLEFT PALATE

Tx usually:
- active observation for 3 months
- GROMMET INSERTION
- Adenoidectomy

25
Q

TONSILLECTOMY

NICE recommend that surgery should be considered only if the person meets all of the following criteria

A
  1. sore throats are due to tonsillitis
  2. 5 or more episodes per year
  3. symptoms atleast year
  4. episodes are disabling

Complications of tonsillitis include:
otitis media
quinsy - peritonsillar abscess
rheumatic fever and glomerulonephritis very rarely

26
Q

suppressed TSH levels (below normal range) and normal serum thyroxine (T4) levels

indicate

A

Subclinical hyperthyroidism is associated with:
atrial fibrillation, osteoporosis and possibly dementia

27
Q

dry AMD mx

A

High dose of beta-carotene, vitamins C and E, and zinc can be given to slow deterioration of visual loss

28
Q

An ECG shows absent T waves, large U waves and a prolonged PR interval

A

HYPOKALAEMIA

IV potassium infusion can be given at MAX **10mmol/hour **without cardiac monitoring!

29
Q

Alcoholic ketoacidosis is managed

A

infusion of saline and thiamine

Rehydration - with IV fluids such as saline
Thiamine - to prevent the development of Wernicke’s encephalopathy

30
Q

Pheochromocytoma investigation

A

Tests
24 hr urinary collection of metanephrines (sensitivity 97%*)

31
Q

Management of phaeochromocytoma

A
  1. SURGERY
  2. alpha-blocker (e.g. phenoxybenzamine)
  3. beta-blocker (e.g. propranolol)

Features are typically episodic
hypertension (around 90% of cases, may be sustained)
headaches
palpitations
sweating
anxiety

32
Q

Visual hallucinations with dementia :

A

Lewy body dementia

Mx: ACH i (Donepezil, rivastigimine) and memantine

33
Q

Anterior uveitis management

A

URGENT OPTHAL REVIEW

  1. CYCLOPLEGICS (dilate the pupil to help relieve pain and photophobia) –> ATROPINE, CYCLOPENTOLATE
  2. Steroid eye drops

HLAB27 associated

**Features **
- blurred vision
- photophobia
- miosis (ciliary muscle spasm)
- pain (ciliary muscle spasm and raised IOP)
- CILIARY FLUSH
- IRREGULAR PUPIL!

34
Q

Patient w/ pmh IHD & HTN pc: abdo pain , rectal bleeding and diarrhoea. after eating large meal.

CXR - no pneumoperitoneum or signs of obstruction

what is likely diagnosis and part of the colon affected:

A

ISHCAEMIC COLITIS
- bowel requires more blood flow for increased energy demands for digestion –> ischaemic colitis

SPLENIC FLEXURE

35
Q

Thiazide diuretics can cause what biochemical picture

A

HYPERCALCAEMIA and hypocalciuria

36
Q

65 MALE

PC: sudden onset painless vision loss in LEFT eye
FLASHES and floaters, reddish blurred vision in affected eye.
PMH: diabetics

Likely diagnosis

A

VIRTEOUS HAEMORRHAGE

37
Q

Patient presents w/ rapid onset eye pain, watering of eye. photophobia, cotnact lens wearer , poor hygience, no fever headaches.

likely diagnosis

A

BACTERIAL KERATITIS

Acanthamoeba keratitis: associated with contact lens use

viral keratitis: herpes simplex, herpes zoster - may lead to a dendritic ulcer

38
Q

notable decrease in systolic blood pressure during inspiration.

A

pulsus paradoxus

SEEN IN CARDIAC TAMPONADE
becks triad
- hypotension
- raised JVP
- muffled heart sounds

39
Q

Flashes + floaters are most commonly caused by a

A

posterior vitreous detachment

conversely retinal detachement can be a complication of PVD and present with: sudden vision loss, veil covering visual field

40
Q

Trick to remember complications of correcting sodium too fast:

A

Trick to remember complications of correcting sodium too fast:
‘if you go too high, the brain will die’ - central pontine myelinolysis

‘if you go too low, the brain will blow’ - cerebral oedema (hypernatraemia)

41
Q

postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

A

Progressive supranuclear palsy:

Management
poor response to L-dopa

42
Q
A

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