PassMedicine Flashcards
Urinary incontinence + gait abnormality + dementia =
normal pressure hydrocephalus
This condition presents with dementia as well as psychiatric symptoms, the most common of which are hallucinations.
Lewy body dementia
is a Parkinson’s plus condition. Thus, the condition shares many of the core features of Parkinson’s disease (tremor, rigidity, bradykinesia) as well as additional symptoms
Multiple system atrophy
cardinal features of Parkinson’s disease
(tremor, rigidity and bradykinesia)
Newly diagnosed patient of black African or African–Caribbean origin with hypertension - add a
calcium channel blocker
have reduced efficacy in black patients and are therefore not used first-line
ACE inhibitors
typically causes an early diastolic murmur
Aortic regurgitation
most common valvular defect after infective endocarditis
aortic regurgitation
Intensity of the murmur is increased by the handgrip maneuver
Collapsing pulse
Wide pulse pressure
Aortic regurgitation
is a murmur that occurs with a patent ductus arteriosus, which is a type of congenital heart defect where the ductus arteriosus does not close after birth.
continuous machine-like murmur
An ejection systolic murmur is heard with
aortic stenosis
A low-pitched diastolic murmur, sometimes called a rumbling murmur, is caused by
mitral stenosis
A pansystolic murmur, or holosystolic murmur, is a murmur present throughout all of systole and is typical for
mitral regurgitation
This may cause a small volume pulse, a fourth heart sound and a thrill.
pansystolic murmur, or holosystolic murmur, mitral regurgitation
Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with
dexamethasone
can reduce cerebral oedema, and therefore, reduce intracranial pressure, help alleviate symptoms of headaches and improve associated neurological deficits.
Dexamethasone
would not improve the raised intracranial pressure, and can take up to 72 hours to reach peak serum concentrations.
Fentanyl patch
is preferable to topiramate in women of childbearing age (i.e. the majority of women with migraine)
Propranolol
propranolol is preferable to topiramate, as the latter may be
teratogenic
it can reduce the effectiveness of hormonal contraceptives
topiramate
is a medication which can be used to prevent predictable menstrual migraine.
Frovatriptan
is considered a first-line option for migraine prophylaxis, but it can be teratogenic and it can reduce the effectiveness of hormonal contraceptives
Topiramate
is a medication which can be used to prevent predictable menstrual migraine
Zolmitriptan
are used in the acute treatment of migraine
5-HT receptor agonists
First line management of acute pericarditis involves
combination of NSAID and colchicine
This might be a suitable choice if NSAIDs or colchicine were contraindicated or have failed or when there is a specific indication such as an autoimmune disease.
Prednisolone
Over-replacement with thyroxine increases the risk for
osteoporosis
reduced bone mineral density and osteoporosis
Over-replacement with thyroxine
is seen in thyrotoxicosis associated with Graves’ disease, due to the autoantibody-mediated activation of orbital fibroblasts.
Exophthalmos (proptosis)
is more commonly associated with hyperglycaemia, rather than hypoglycaemia.
Thyrotoxicosis
is a cause of high-output heart failure
Severe anaemia
as it causes cardiac stress through tachycardia and increased stroke volume.
high-output heart failure
This occurs when blood accumulates in the myocardium, usually following trauma.
Cardiac tamponade
It typically presents with Beck’s triad and requires immediate pericardiocentesis.
Cardiac tamponade
It does typically affect patients in this age group but is a genetic condition causing the heart muscle to be thicker, and is a cause of sudden death in young people. It is not related to severe anaemia.
Hypertrophic cardiomyopathy
is an inflammation of the heart muscle which can cause heart failure
Myocarditis
is an inflammation of the pericardium
Pericarditis
Discontinue SAMA (switch to SABA) if commencing LAMA
COPD
Serial peak flow measurements at work and at home are used to detect
occupational asthma
The onset of cough and wheeze after starting a new job coupled with the improvement of symptoms whilst on holiday suggests a diagnosis of
occupational asthma
A baker is a high-risk profession for occupational
asthma
Schistosomiasis is treated with
praziquantel
which commonly causes a ‘swimmer’s itch’, particularly in patients who return from Africa
schistosomiasis
This usually causes an itchy rash to form commonly on the legs due to swimming in infected water.
schistosomiasis
is commonly used in the management of cellulitis.
Flucloxacillin
can be used for the management of nematodes.
Thiabendazole
is a parasitic flatworm infection
Schistosomiasis, or bilharzia
Definitive diagnosis of sickle cell disease is by
haemoglobin electrophoresis
This patient is presenting with a history of thrombotic crises, typical of
sickle cell anemia
the sickle-shaped red blood cells occlude the vessels causing
momentary ischemia
The treatment is supportive, with analgesia and abundant fluids.
sickle-shaped red blood cells occlude the vessels causing momentary ischemia.
Serum-free light chain assay is used to diagnose
multiple myeloma
is a contraindication to statin therapy
Pregnancy
Thymomas are commonly associated with
myasthenia gravis
Lambert-Eaton myasthenic syndrome is commonly associated with
small-cell lung cancer
is a life-threatening medical emergency that requires immediate treatment with pericardiocentesis
Cardiac tamponade
triad consists of muffled heart sounds, raised JVP and hypotension.
Beck’s triad
Cardiac tamponade is an emergency and requires immediate
pericardiocentesis to drain the blood in the pericardium.
is a procedure used to aspirate air from the pleural cavity in patients with a tension pneumothorax.
Thoracocentesis
It is important to remember that strokes can be caused by
hypercoagulable states and hyperviscosity
which usually also presents with bone marrow infiltration, splenomegaly and sometimes lymphadenopathy.
Waldenstrom’s macroglobulinaemia
Pyridostigmine is a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of
myasthenia gravis
are used to treat myasthenic crisis where there is respiratory muscle weakness
Plasmapheresis and IV immunoglobulin
Immunosuppressive agents such as prednisolone can be used to treat relapses however it may take months of treatment to achieve remission.
myasthenia gravis
would be considered if the disease is not easily controlled by pyridostigmine or there was evidence of a thymoma to prevent local invasion.
Thymectomy
Posterior MI typically present on ECG with
tall R waves V1-2
usually occurs due to an occlusion of the posterior descending artery (posterior interventricular artery).
Posterior myocardial infarction
In 80% of people, this artery branches from the right coronary artery.
posterior descending artery (posterior interventricular artery)
In this case there is a high risk wound and symptoms so tetanus ___________would be advised alongside a muscle relaxant such as diazepam, and ventilatory support if needed.
immunuglobulin
Wounds burns needing surgery delayed more than 6 hours
Wounds contaminated with soil
Compound fractures
Wounds containing foreign bodies
Wounds/burns in people with systemic sepsis
High risk wounds
Signs of right-sided heart failure are
raised JVP, ankle oedema and hepatomegaly
describes the hypertrophy of the right ventricle and right heart failure that are caused by pulmonary arterial hypertension.
Cor pulmonale
hypoxia induces pulmonary vasoconstriction, eventually causing
pulmonary hypertension
Shortness of breath on exertion, orthopnoea and paroxysmal nocturnal dyspnoea are more indicative of
left-sided heart failure
Chest pain on exertion is indicative of angina due to
coronary artery disease.
is a sign of right-sided heart failure
Hepatomegaly
sign may be seen in pancreatic cancer
The ‘double duct’
New onset diabetes (HbA1C of 7.3%) in someone of this age should ring alarm bells for
pancreatic cancer and prompt referral.
A raised serum lipase and painless jaundice also add to the case.
pancreatic cancer and prompt referral.
this is seen on brain imaging and can indicate progressive supranuclear palsy (PSP)
Hummingbird sign
Pulmonary stenosis is louder on
inspiration
causes an ejection systolic murmur that is louder on inspiration.
Pulmonary stenosis
An ejection systolic murmur that is louder on expiration is characteristic of
aortic stenosis
A holo-systolic murmur that is louder on expiration is indicative of
mitral regurgitation.
A holo-systolic murmur that is louder on inspiration is indicative of
tricuspid regurgitation
Late systolic murmurs indicate
mitral valve prolapse and coarctation of the aorta
A mid-systolic click is caused by
prolapse of the mitral valve
is the gold standard test for diagnosing venous sinus thrombosis
MR Venogram
slow-onset severe headache, diplopia, nausea and seizures. These are all features of
increased intracranial pressure
past medical history of antiphospholipid syndrome coupled with pregnancy, which induces a
hypercoagulable state, lead to a diagnosis of venous sinus thrombosis.
is defined as a thrombotic obstruction of the cerebral veins and/or dural sinuses.
Venous sinus thrombosis
MR venogram is a form of MRI which is used to diagnose this condition
Venous sinus thrombosis
This is the investigation of choice to diagnose meningitis, which would present with fever, photophobia and neck stiffness
Lumbar puncture - CSF sent for cell counts and gram stain
This is the investigation of choice to diagnose a subdural haematoma when a CT head is negative
Lumbar puncture with CSF sent for xanthochromia
severe, sudden onset thunderclap headache, photophobia and neck stiffness
subdural haematoma
is normal in around 70% of patients affected by venous sinus thrombosis.
Non-contrast CT head scan
describes patients with ischaemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischaemia
Unstable angina
This patient is presenting with chest pain accompanied by deeply inverted T waves in V2-3 and a 0.5mm ST depression in the same leads.
unstable angina
would present with a sharp, tearing pain in the anterior chest or back.
Aortic dissection
It is a type of progressive cellulitis that invades the floor of the mouth and soft tissues of the neck.
Ludwig’s angina
presents with chest pain and ST-segment depression
Non-ST elevation myocardial infarction
needs an ST elevation greater than 1.5 mm in V2-3 in women to be diagnosed and elevated troponin levels.
ST elevation myocardial infarction
classically presents as visible haematuria following a recent URTI
IgA nephropathy
episodes of macroscopic haematuria, typically associated with a recent respiratory tract infection and mild proteinuria.
IgA nephropathy
which is caused by immune complex (IgG, IgM, and C3) deposition in the glomeruli.
post-streptococcal glomerulonephritis
This happens more slowly, typically 7-14 days following a group A beta-hemolytic Streptococcus infection and causes proteinuria.
post-streptococcal glomerulonephritis
is an X-linked dominant disease. It presents with microscopic haematuria, bilateral sensorineural deafness, and lenticonus.
Alport’s syndrome
can present as nephrotic syndrome, haematuria, or proteinuria.
Membranoproliferative glomerulonephritis
disease is very common in children, but nearly always presents as nephrotic syndrome.
Minimal change
causes renal failure by tubular cell necrosis
Myoglobinuria
The history and a very high serum creatine kinase give a diagnosis of
rhabdomyolysis
can cause a restrictive lung defect on spirometry
Kyphoscoliosis (e.g. ankylosing spondylitis)
a normal chest examination along with a normal chest x-ray make clinically significant ILD unlikely
Pulmonary fibrosis
The x-ray may show emphysema, flattened hemidiaphragms and hyperinflation. In obstructive lung disease, the FEV1/FVC ratio is < 0.7.
COPD
should be stopped in AKI as may worsen renal function
ACE inhibitors
is a 5α-reductase inhibitor and treats benign prostatic hyperplasia (BPH) by blocking dihydrotestosterone synthesis.
Finasteride
‘Unprovoked’ pulmonary embolisms are typically treated for
6 months
is used to suppress nausea and vomiting with intracranial tumours
Dexamethasone
can reduce the oedema of CNS tumor can relieve nausea and vomiting.
Dexamethasone
is commonly prescribed in malignant nausea, it is not the best drug for nausea secondary to brain tumours because it does not directly treat the cause of nausea.
histamine H1-receptor antagonist (antihistamine)cyclizine
helps to reduce labyrinth disorders related symptoms.
Prochlorperazine
is analogous to chlorpromazine; both of these agents antagonize dopaminergic D2 receptors in various pathways of the central nervous system.
Prochlorperazine
the antiemetic action of ____________is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone in the central nervous system, it will not reduce the oedema of the tumour which causes the symptoms
metoclopramide
is a type of benzodiazepine which will reduce his agitation
Lorazepam
should be urgently referred for assessment by specialist spinal services (neurosurgery or orthopaedic spinal surgery)
degenerative cervical myelopathy
degenerative cervical myelopathy
Cervical decompressive surgery
SGLT-2 inhibitors have been linked to necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)
Dapagliflozin
is an SGLT-2 inhibitor used in type 2 diabetes. It acts to inhibit sodium glucose co-transporter 2 in the proximal convoluted tubule which reduces glucose reabsorption and increases urinary glucose excretion.
Dapaglifozin
Ileocaecal resection may result in
vitamin B12 deficiency
is absorbed in the terminal ileum, therefore resection of the terminal ileum as part of ileocaecal resection would reduce
vitamin B12
would cause anaemia and glossitis
Iron deficiency
Cortisol: suppressed
ACTH: suppressed
High-dose dexamethasone suppression test with a pituitary adenoma
Suppressed ACTH and cortisol on high-dose dexamethasone suppression
Cushing’s disease (pituitary adenoma)
Suppressed ACTH but unsuppressed cortisol on high-dose dexamethasone
adrenal adenomas
Unsuppressed ACTH and cortisol on high-dose dexamethasone suppression
Ectopic ACTH syndrome
following possible exposure give immunglobulin + vaccination
Rabies
there will be an abnormally large drop in BP during inspiration, known as pulsus paradoxus
In cardiac tamponade
drop in blood pressure on inspiration
pulsus paradoxus
The symptoms three months ago were likely due to optic neuritis, a common presenting feature of ___________.
multiple sclerosis
The combination of low platelet counts and raised FDP in this setting make ________ the most likely diagnosis.
Disseminated intravascular coagulation
is most commonly caused by cavernous sinus tumours.
Cavernous sinus syndrome
the nasopharyngeal malignancy has locally invaded the left cavernous sinus
Cavernous sinus syndrome
Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner’s syndrome.
Cavernous sinus syndrome
Measure of disease activity in rheumatoid arthritis
DAS28
Helps estimate the risk of a patient having a deep vein thrombosis
Wells score
Mini-mental state examination - used to assess cognitive impairment
MMSE
Used in the assessment of suspected obstructive sleep apnoea
Epworth Sleepiness Scale
Indicates prognosis in prostate cancer
Gleason score
is the second most common association of HNPCC after colorectal cancer
Endometrial cancer
are ‘critical’ medicines which should not be stopped on acute admissions and must be delivered on time
Levodopa and other antiparkinsons drugs
presents with the triad of sudden onset abdominal pain, ascites, and tender hepatomegaly
Budd-Chiari syndrome
Gallstones are likely to cause a greater increase in
ALP
causes a rise in bilirubin after an acute stress on the body eg: illness or fasting.
Gilbert’s syndrome
DVT investigation: if the scan is negative, but the D-dimer is positive
→ stop anticoagulation and repeat scan in 1 week
Sexual dysfunction is an important side effect of
thiazide-like diuretics such as indapamide
Due to it’s action as an insulin secretagogue, it can cause hypoglycaemia.
Gliclazide
Hypsarrhythmia on EEG suggests
infantile spasms (West’s syndrome)
typically present with tonic-clonic movements and a loss of consciousness, with a history of fever, most commonly between the ages of 6 months and 3 years.
Febrile seizures
typically presents in adolescence with infrequent generalised seizures.
Juvenile myoclonic epilepsy
Nasogastric tubes are safe to use if
pH <5.5 on aspirate
develops in around 10% of primary sclerosing cholangitis patients
Cholangiocarcinoma
is the most common cause of an exudative pleural effusion
Pneumonia
protein level >35 and the LDH >200 point
exudative effusion
can immediately be ruled out as they are both transudative.
heart failure and renal failure
ITP - give oral
prednisolone
is the first-line treatment for immune thrombocytopenic purpura (ITP) which is defined as an isolated low platelet count
Oral prednisolone
3 sets of blood cultures are recommended in the investigation of
infective endocarditis
is used for symptomatic bradycardia if atropine fails
External pacing
typically presents with haematuria, proteinuria/oedema, hypertension and oliguria
Post-streptococcal glomerulonephritis
periorbital oedema, oliguria, proteinuria and haematuria after impetigo.
Post-streptococcal glomerulonephritis
profuse diarrhoea due to infection with Escherichia coli O157
Haemolytic uraemic syndrome
presents similarly and also occurs after an upper respiratory tract infection, but has a shorter latency period (1-2 days following the infection)
IgA nephropathy
It could result in dark (‘cola coloured’) urine due to myoglobinuria
Rhabdomyolysis
infection is a common cause for non-specific urethritis (dysuria +/- urethral discharge)
Chlamydia trachomatis
most common symptom of Crohn’s disease in children?
Abdominal pain
COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features →
add a LABA + ICS
is used first-line to prevent angina attacks
A beta-blocker or a calcium channel blocker
Newly diagnosed patient with hypertension who has a background of type 2 diabetes mellitus - add
an ACE inhibitor or an angiotensin receptor blocker regardless of age
Motor (6 points) Verbal (5 points) Eye opening (4 points). Can remember as ‘654…MoVE’
GCS
A sudden anemia and a low reticulocute count indicates parvovirus
sickle cell anaemia
It is important to remember that strokes can be caused by
hypercoagulable states and hyperviscosity
UTI in a pregnant woman in the third trimester - use
amoxicillin or cefalexin
is the recommended treatment for symptomatic UTI in pregnant women near term
Cefalexin
is the treatment of choice for some sexually transmitted infections such as Chlamydia in pregnant women
Azithromycin
postural hypotension may be seen in Parkinson’s disease the ataxic gait point towards a diagnosis of
multiple system atrophy
is associated with faecal-oral spread, commonly affecting shellfish and pork products. Blood results show elevated bilirubin and significant transaminitis.
Hepatitis E
Pneumocystis jiroveci penumonia is treated with
co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
are the investigation of choice in genital herpes
Nucleic acid amplification tests (NAAT)
Optic neuritis can be a feature of
multiple sclerosis
should first be investigated with a Holter monitor after initial bloods/ECG
Palpitations
should first be investigated with a Holter monitor after initial bloods/ECG
Palpitations
are best visualized by MRI of the cerebellopontine angle
Acoustic neuromas
Regular opioid medication can lead to
medication overuse headaches
In life-threatening Clostridium difficile infection treatment is with
ORAL vancomycin and IV metronidazole
are generally used first-line in the management of patients with warm autoimmune haemolytic anaemia
Steroids (+/- rituximab)
Lying/standing blood pressure is a very important investigation in the elderly who present with
falls
often presents with raised CK and leukocytosis
Neuroleptic malignant syndrome
accounts for the majority of lung cancer cases in non-smokers
Adenocarcinoma
is an X linked disorder affecting red cell enzymes.
Glucose-6-phosphate dehydrogenase deficiency
PPI + amoxicillin + clarithromycin, or
PPI + metronidazole + clarithromycin
H. pylori eradication:
is associated with Takayasu’s arteritis
Renal artery stenosis
Patients with a suspected pulmonary embolism should be initially managed with a
direct oral anticoagulant (DOAC)
There is no need for prophylactic antibiotics for Lyme disease in
asymptomatic patients bitten by a tick
causes peripheral neuropathy
Isoniazid
are first-line in benign prostatic hyperplasia if the patient has troublesome symptoms
Alpha-1 antagonists
pseudopolyps seen on endoscopy
Ulcerative colitis
should be prescribed in all patients with suspected hepatic encephalopathy
Lactulose
Obese, young female with headaches / blurred vision think
idiopathic intracranial hypertension
painless bright red vaginal bleeding
Placenta praevia
Right upper quadrant tenderness and bilious fluid in the intra-abdominal drain would suggest
bile leak following the cholecystectomy
Patients with GORD being considered for fundoplication surgery require
oesophageal pH and manometry studies
disease is a cause of hypoglycaemia
Addison’s
