PassMed September Flashcards
What should you do with a patient found to have unilateral nasal polyps?
Urgent ENT referal - this is a RF for cancer
Which hand joints are most typically affected by the OA?
Osteoarthritis typically affects the DIP joints and carpometacarpal joints. PIP joints are typically sparred
What is the most common symptoms of acute open angle glaucoma? What is the primary treatment?
Peripheral visual field defects (most common), severe eye pain, redness of the eye and halos around lights
Timolol - reduces aqueous production
What is the management for primary hyperaldosteronism?
Potassium sparring diuretics (aldosterone antagonists) e.g. spironolactone
Name 4 symptoms of hypocalcaemia?
Perioral paraesthesia, tetany, cramps and convulsions
What is acute intermittent porphyria?
Can be triggered by nitrofurantoin
Causes severe abdo pain, HTN, tachycardia, hallucinations, anxiety and muscle weakness
What is the 1st line management of thrush?
Oral fluconazole
What is the 1st line Tx for low severity CAP?
Oral Amoxicillin
What should you suspect in a patient presenting with severe chest pain and shock after acute vomiting?
Boerhaave Syndrome (oesophageal rupture)
What will be seen in sick euthyroid syndrome?
Low T3/T4 with normal TSH and an acute illness
How should you treat urgency urinary incontinence?
Bladder training then oxybutanin
How frequently should you screen for glaucoma in someone with a positive family history?
Annually from 40 years
What should you do if you clinically suspect tension pneumothorax (no x-ray confirmation)
Immediate needle decompression in the 2nd intercostal space. Do not wait for imaging
What is the most common cause of nephrotic syndrome in adults?
Membranous nephropathy - frequently due to malignancy
Which medication used in psych is associated with nephrogenic DI?
Lithium
What should you suspect in a patient presenting with subacute productive cough, foul smelling sputum and night sweats?
A lung abscess
What is the 1st line Ix for prostate cancer?
Multiparametric MRI
How may an acute mitral regurg (secondary to MI) present?
Pulmonary oedema and sudden breathlessness
Which antibiotic should you use for UTI in the 3rd trimester?
Amoxicillin
Nitro is teratogenic in 3rd trimester and Trimethoprim should be avoided completley
Are short or long sited people more at risk of acute close angle glaucoma?
Long sited
Are short or long sited people more at risk of acute open angle glaucoma?
Short sited
What are we worried about in a patient with persistent ST elevation following and MI?
Left ventricle aneurysm - this increases the risk of emboli
What should with give to a patient who is started on an NSAID and SSRI?
PPI
Name 3 viral infections that should be routinely screened for antenatally?
HepB, HIV and Syphillis
Is conn’s sydrome associated with metabolic acidosis or alkalosis?
Alkalosis
How long do mania and hypomania last respectivley?
Mania = at least 7 days
Hypomania = less than 7 days
What is chvostek’s sign and trousseu’s sign?
Seen in hypocalcaemia
Chvosteks sign = twitching of the facial muscles when tapping on the facial nerve
Trousseus sign = carpopaedal spasm when inflating the BP cough
What will sodium look like in the urine and blood in SIADH?
High in the urine and low in the blood
Which carcinoma is SIADH associated with?
Small cell lung cancer
What is the 1st line Tx for Grave’s Disease?
Carbimazole
What is the 1st line Tx for Grave’s Disease?
Carbimazole
How can we manage Thyrotoxicosis which occurs without hyperthyroidism?
Propanolol
How quickly should endoscopy be done in patients presenting with an upper GI bleed?
Within 24 hours
A patient presents with tenderness in the anatomical snuff box but no X-ray changes are seen. What should you do?
?Scaphoid fracture
Splint and re-scan in 1-2 weeks
An alcoholic presents to A&E with facial flushing, nausea, vomiting, palpitations and low BP. What antibiotic may have caused this?
Metronidazole
Sx and Mx of Seborrheic Dermatitis?
Scaly red patches in the hair and eyebrows
Topical ketoconazole
What does crescent sign seen on x-ray/MRI of the hip imply?
Avascular necrosis
Name one risk factor for avascular necrosis?
Long term steroid use
Which diabetes drug would most benefit an overweight patient?
SGLT-2 inhibitors e.g. canagliflozin or dapagliflozin
What is Takotsubo Cardiomyopathy?
Acute/sub-acute chest pain occurring after a stressful event in post-menopausal women
Sx of Brown-Sequard syndrome?
Same sided weakness and proprioception/vibration loss
Opposite sided pain and temperature loss
True or false, sarcoidosis is associated with DI?
True
Which type of drug should be avoided in patients with Myasthenia Gravis?
Beta-blockers
When should all pregnant women receive an OGTT?
24-28 weeks.
Those with previous GD should be screened earlier
What surgical procedure is generally executed in bowel emergencies such as perforation or obstruction?
Hartmann’s procedure
A young person presents with small bowel obstruction and has had dark spots in the mouth since birth. What should you suspect?
Peutz-Jeghers Syndrome
Which antibiotic can cause prolonged QT interval?
Erythromycin
What will the serum:creatinine ratio be in pre-renal disease?
High
How can you differentiate clinically between cellulitis and PE?
Fever present = think cellulitis
A patient has metabolic alkalosis and hypokalaemia. What should you suspect?
?Prolonged vomiting
How can you differentiate between an ACL/PCL injury and a meniscal injury based on the history?
ACL/PCL injury = rapid joint swelling after trauma
Meniscal injury = gradual joint swelling after trauma
What will the osmolarity of the plasma and urine be in DI?
Plasma = borderline or high osmolarity
Urine = low osmolarity
What should be used in the 1st line management of a Tone PPH?
IV Syntocinon
Maternal labetolol is a risk factor for what?
Neonatal hypogylcaemia
A patient has had an MI 1 week ago. They now present with a systolic murmur, hypotension and pulmonary oedema. What has happened?
Acute mitral regurgitation due to rupture of the papillary muscles
What is seen with acute tubular necrosis?
No response to fluid challenge
Urea:Creatinine <1:100
Hyperkalaemia
High urine sodium but low osmolality
What may be seen in acute angle closure glaucoma?
Severe eye pain, reduced visual acuity, redness of the eye, corneal haziness and a semi-dilated non-reactive pupil
Where does furosemide act?
On the ascending limb of the loop of Henle
A patient with known HIV presents with odonophagia and dyspahgia. What should you suspect?
Oesophageal candidaisis
What may be seen on an ECG in hypocalcaemia?
QT prolognation
A patient with endometriosis is not responsive to NSAIDs or the COCP. What is the 2nd line management?
GnRH analogues
Do you see hyper or hypo kalaemia in diarrhoea?
Hypokalaemia
How should you treat a patient in cardiac arrest with a shockable rhythm differently depending on if the arrest was witnessed on cardiac monitoring or not?
Witnessed = 3 successive shocks then CPR
Unwitnessed = 1 shock then CPR
What lung condition can be caused by amioadarone?
Pulmonary fibrosis
What is the classical triad of signs in primary hyperaldosteronism?
Hypertension, hypernatraemia and hypokalaemia
What is the most common form of melenoma seen in those with dark skin? Sx?
Acral Lentiginous Melanoma.
Pigmentation of the nail bed affecting the proximal nail folds
HNPCC is the most common congenital risk factor for bowel cancer. What else is it a risk factor for?
Endometrial cancer
When can the IUD/IUS be inserted after birth?
Within 48 hours OR after 4 weeks
How long should you observe for signs of life following an in-hospital failed resuscitation attempt?
5 Mins
What does PTH do to your biochemistry?
Increases blood calcium and decreases phosphate
What is and Argyll Robertson pupil?
Seen in neurosyphilis.
Irregular, constricted pupil which doesn’t react to light but does react to accommodation
What is Holmes-Adie Syndrome?
Unilateral pupil dilation with absent light reflexes and slow accommodation. There will also be absent ankle reflexes
How can we confirm a diagnosis of gout?
2 weeks after the inflammation settles we should measure serum urate levels
What type of drugs should you always withhold in AKI?
Nephrotoxic drugs (e.g. ACEis, ARBs and NSAIDs), Metformin and diuretics
What is the normal size of a kidney? How will the differ in CKD?
10-12cm
In CKD they will appear smaller
What is the treatment pathway in paediatric asthma?
SABA -> SABA + Low dose ICS -> SABA + Low dose ICS + LTRA -> SABA + LABA + Low dose ICS
What should you suspect in a patient who wears contact lenses and swims a lot presenting with eye pain, reduced visual acuity and photophobia?
Acanthamoeba keratitis
What should you do if placenta praevia is noted in early scans?
Rescan at 32 weeks - if it is still there plan for early delivery at 38 weeks
In placenta praevia minor you can wait till 36 weeks to rescan
In what circumstances should beta blockers be stopped in a patient presenting with acute heart failure?
If HR <50, 2nd/3rd degree AV block or if the patient is shocked
Which methods of contraception work by inhibiting ovulation?
Implant, Injection, COCP and Desogestrel only POP
How do the POP, the IUS and the IUD work?
POP = thickens cervical mucous
IUS = prevents endometrial proliferation
IUD = reduces sperm motility
How can we use peak flow to stage the severity of an asthma attack?
Moderate = 50-75%
Severe = 33-50%
Life threatening = <33%
What is Bumetanide?
A loop diuretic
How should you handle any progressively worsening headache with higher cognitive function impairment?
Urgent CT head
What should you suspect in any red/black skin lump which oozes or bleeds?
Nodular Melanoma
What should you suspect in teenage girls presenting with knee pain on walking down the stairs?
Chondromalacia Patellae
What is a Marjolin’s Ulcer?
Squamous cell carcinoma occurring at sites of chronic inflammation or previous injury
What is a Pyoderma Gangrenosum?
Ulcers which occur at stoma sites
What is the most common cause of occupational asthma?
Isocyanates
Which metabolic abnormalities can be caused by loop diuretics?
Hyponatraemia or hypokalaemia or hypocalcaemia
What is a T-score and a Z-score?
T-score = average bone mineral density compared to that of a healthy 30 year old of the same gender
Z-score = T-score but incorporating Age, gender and ethnicity
What does HepA cause, who does it commonly affect?
Acute hepatomegaly and obstructive jaundice
Commonly seen in travellers who have recently returned to the UK
What should you suspect in people with recurrent epistaxis and telangiectases?
Hereditary Haemorrhagic Telanglectasia
What is Wellen’s Syndrome?
Critical LAD artery stenosis.
Patients present with chest pain. ECG will show deeply inverted or biphasic T waves in V2-3.
Troponin will be mildly raised
There is ST elevation in V1-V4. Where is the clot?
LAD artery
What can we use as an alternative medication to Atropine?
Isoprenaline/Adrenaline Infusion
Name 2 drugs which can be used in pharmacological cardioversion
Amiodarone and Flecainide (only if a structurally normal heart)
Where should you measure QT interval from?
Start of the Q wave to the end of the T wave
Is hyper or hypo thyroidism associated with heavy menstrual bleeding?
Hypothyroidism
Hyperthyroidism is associated with oligomenorrhoea
True or false, opioids cause urinary frequency.
False. The can cause urinary retention
What should you do is a semen sample comes back abnormal?
Repeat in 3 months
True or false Hereditary Haemochromatosis can cause cranial DI?
True!
How does acute closure angle glaucoma present?
Severe pain, decreased visual acuity, semi-dilated non-reactive pupil, haloes around the light and a red eye.
What metabolic abnormality can be caused by omeprazole?
Hypomagnesia - this can then lead to hypocalcaemia and hypokalaemia
What X-ray finding is often seen in bronchiectasis?
Parallel line shadows (aka tram lines)
What is seen in cardiogenic shock? Should you do a fluid challenge in these patients?
Systolic BP <90, low urine output, high lactate and cold peripheries
NO!
True or false, glucocorticoids can cause neutrophilia?
True!
What is a trifasicular block? Why is it important?
RBBB, 1st degree heart block and Left axis deviation.
This is an important cause of falls in the elderly
What ECG changes are seen in Wolff-Parkinson-White Syndrome?
Short PR interval, broad QRS and a delta wave
What is Brugada syndrome?
ST elevation in V1-V3. It can cause sudden nocturnal death!
What are the symptoms of normal pressure hydrocephalus? What distinctive findings will you see on CT scan?
Urinary incontince, cognitive impairment and gait disturbance.
Ventriculomegaly out of proportion with sulcal enlargement
A teenage boy presents with progressive muscle weakness and having to use his arms to stand up from sitting on the floor. What is the diagnosis?
Becker muscular dystrophy.
Similar to DMD but occurs in older boys (>10 years)
What are the components of CHA2DS2VASc? Above what score should you definitely anticoagulate?
Congestive HF (1)
HTN (1)
Age >= 75 (2), 65-74 (1)
Diabetes (1)
Previous TIA, stroke or thromboembolism (2)
Vascular disease (1)
Female (1)
>= 2 you should anticoagulate
Which are the best anti-emetics to use for different causes of nausea?
Ondansetron = oncology causes
Haloperidol = causes in your head
Prochlorperazine = Peculiar (dizziness)
Metoclopromide = Mesentery (GI)
Who should you give steroids to in bacterial meningitis?
Children over 3 months. This helps to reduce the risk of hearing loss!
Name 5 poor prognostic indicators in schizophrenia?
Strong family history, gradual onset, low IQ, prodromal social withdrawal and lack of obvious precipitant
A patient presents with reduced foetal movement at 30 weeks. On doppler US there is no foetal heart beat. What should you do next?
Past 28 weeks and no foetal heart beat on doppler US - urgent USS
Which drugs can affect the absorption of levothyroxine? How can you correct this?
Iron and Calcium carbonate. These should be taken at least 4 hours before/after levothyroxine
How should you interpret the Wells score for PE?
> = 4 requires urgent CTPA and thrombolysis whilst waiting
<4 requires D-dimer, if positive do a urgent CTPA
Sx, Ix and Mx for lumbar spinal stenosis?
Pain in the lower limbs which is relieved by lumbar flexion, sitting is better than standing and walking uphill is better than downhill.
Ix = MRI
Mx = laminectomy
A patient just had bowel surgery and is now complaining of abdominal pain, bloating and vomiting. What should you suspect?
Post-operative ileus
Which metabolic abnormality can acute pancreatitis cause?
Hypocalcaemia
What are the 3 Ms of primary biliary cirrhosis? What is the management?
IgM, Anti-Mitochondrial antibodies, Middle aged women
Ursodeoxycholic acid
Which cranial nerve palsy leads to ptosis?
CN III
When can the COCP be restarted after birth?
After 3 weeks if not breast feeding, after 6 weeks if breast feeding
What test may be used to help diagnose age related macular degeneration?
Amsler grid testing
True or false, LH and FSH are low in Turner’s syndrome?
False, they will be raised!
Name 4 Parkinson’s drugs which are likely to cause disinhibition?
Dopamine receptor agonists:
Bromocriptine, Ropinirole, Cabergoline and Apomorphine
Which syndrome can be caused by with-holding parkinsons medications?
Neuroleptic Malignant Syndrome
What are the ECG changes noted in hypokalaemia?
Tall p waves, flattened/inverted T waves, ST depression, prominent U waves
What should you suspect in any patient presenting with persistent ST elevation but no chest pain post MI?
Left ventricular aneurysm
Which type of arrhythmia is commonly associated with pneumothorax?
PEA
How can you differentiate between infantile spasms and infantile colic?
Infantile spasms = child is distressed between spasms
Infantile colic = child is distressed during spasms
What is the key symptom to warn patients about before starting them on levodopa?
Large variations in motor function due to on-off phenomenon
What is the most sensitive and specific lab result which identifies cirrhosis in those with chronic liver disease?
What scan can you do to confirm this?
Thrombocytopenia
Transient Elastography
How quickly do you need to refer ?parkinsons disease patients to neuro?
URGENTLY
What test should you perform in all patients with new AF?
Transthoracic echo
Which hepatitis vaccine should be offered to men who have sex with men?
Hep A
What is the pattern of Haemophilia inheritance?
X-linked recessive
What can we use instead of amiodarone if it is not available?
Lidocaine
Name the signs of cerebellar damage?
Dysdiadochokineaseia and Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
What are the most common and most aggressive types of melanoma
Most common = superficial spreading
Most aggressive = nodular
How does chronic venous insufficiently often present visually?
Brown pigmented skin, legs which are wider at the knee than the ankle and eczema
Define PPH?
The loss of >=500mls of blood from the genital tract within 24 hours of birth of the baby
If thrombosis is suspected as the cause of cardiac arrest what should you do?
Thrombolyse with alteplase and then continue CPR for 60-90 mins
True or False, a LUTI can precipitate urinary retention?
True
When should you give adrenaline and amiodarone in shockable rhythms?
After 3 shocks
How does MG affect sensitivity to anaesthetic agents?
People with MG are more sensitive to Rocuronium but resistant to suxamethonium
Below what BM should neonates be admitted for IV 10% dextrose even if they are asymptomatic?
<1
What should you suspect in a patient with recent MI who presents with sudden HF, raised JVP and pulsus paradoxus?
Left ventricular free wall rupture
You hear a new pansystolic murmur in a patient who had an MI 5 days ago. What do you suspect?
Ventricular Septal Defect
How can we assess bowel anastomoses after bowel surgery?
Gastrografin enema
How do you manage latent TB?
3/12 of isoniazid (+pyridoxine) AND rifampicin
OR
6/12 of isoniazid (+pyridoxine)
Which nerve and nerve root control the triceps reflex?
Radial nerve
C7
What is the 1st line management of absence seizures?
Sodium valproate or ethosuximide
How do you manage amiodarone induced hypothyroidism?
Continue amiodarone but add levothyroxine
How do we manage infantile colic?
Reassurance and support, this is a benign condition!
