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#passmed 2023 > PASSPORT FINALE > Flashcards

PASSPORT FINALE Flashcards

1
Q

What does Complete Heart block look like in ECG?

A

(complete disassoc between P n QRS)

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2
Q

Where are the Purkinje fibre / Bundle of His in diagram of heart cut in half?

A
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3
Q

Where are Myocardium, Endocardium, and Purkinje fibres in Histology?

A
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4
Q

Where are Myocardium, Endocardium, and Purkinje fibres in Histology, again?

A
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5
Q

What is the definition of Orthostatic hypotension? (2 options)

A
  • Drop in Systolic by 20 // OR
  • Drop in Diastolic by 10
    (within 2-5 mins of standing)
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6
Q

What medications can cause Heart Block? (7 things)

A

HF meds + more
1. Amiodarone
2. Beta blockers
3. CCB
4. Digoxin
5. TC antidepressants
6. Opioids
7. Antihistamines (bc drowsiness)

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7
Q

Apart from Orthostatic hypotension, what can cause LOC? (9 things)

A
  1. Dehydration / No food
  2. Standing for long time
  3. Vasovagal
  4. Hypoglycaemia
  5. Anaemia
  6. Arrhythmias
  7. Valvular HD
  8. Infection
  9. Anaphylaxis
    (Dear Sam, Very Happy After A Vacation In Australia)
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8
Q

List malignant causes of cervical lymphadenopathy? (6 things)

A
  1. Lymphoma
  2. Leukaemia
  3. Thyroid cancer
  4. Nasopharyngeal cancer
  5. Squamous cell carcinoma (skin cancer)
  6. Metastatic cancer (spread to lymph nodes)
    (Listen, Lumps in The Neck Signal Malignancy)
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9
Q

Give 4 causes of lumps in the neck apart from Lymphoma?

A
  1. Thyroid nodule
  2. Lipoma
  3. Salivary gland tumour
  4. Metastatic cancer (spread to lymph nodes)
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10
Q

What are 2 B symptoms associated with hodgkins lymphoma? (3 things)

A
  1. Fever
  2. Night sweats
  3. WL
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11
Q

Give a description of Reed Sternberg cells and then the name (reed sternberg cells)?

A

LARGE MULTINUCLEATED CELL, nucleus bilobed? prominent nucleolus?

B lymphocytes mutate into 2 types of cell:
1. Reed-Sternberg cells (large multi-nucleated cells)
2. Hodgkin cells (large mono-nucleated)
(I think question asking to describe unnamed cell, and then next part is to name the cell which is Reed-Sternberg)

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12
Q

How do you stage and assess what cancer it is? (2 things)

A
  1. Gold standard investigation for Dx = Lymph node biopsy
  2. Staging for HL = Ann Arbor Staging system (do CT)
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13
Q

What are the Ann Arbor Stages that you will see on CT? (not a q but write it just so they kno u kno)

A
  • Stage 1: Confined to 1 region of lymph nodes
  • Stage 2: In 2+ regions but on same side of diaphragm (above / below)
  • Stage 3: In regions above AND below diaphragm
  • Stage 4: Spread to NON-lymphatic organs e.g liver / lungs
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14
Q

What do you need to consider before special tests (ct / core needle biopsy)?

A
  1. Biopsy = risk of bleeding / inf
  2. CT scan is ionizing radiation = can increase risk of cancer over time
  3. Maybe do bloods before to check (low everything in FBC)
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15
Q

Interpret Odds ratio:

A
  • If Odds ratio = 1, then no assoc between exposure + disease
  • If Odds ratio more than 1, means positive association, so means exposure causes the disease defo
  • If Odds ratio less than 1, means negative association, so means exposure protects against disease
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16
Q

Give 2 immediate + 2 delayed reactions of blood transfusion?

A

Immediate
1. Acute Haemolytic Transfusion Reaction (AHTR)
2. TRALI (Transfusion Related Acute Lung Injury)
Delayed:
1. Delayed Haemolytic Transfusion Reaction (DHTR)
2. Iron overload

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17
Q

What are 4 types of prolapses?

A
  1. Bladder prolapse (cyctocele)
  2. Uterine prolapse
  3. Vaginal prolapse
  4. Rectal prolapse (rectocele)
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18
Q

What are 3 conservative and 3 surgical treatments for prolapses?

A

Conservative
1. Pelvic floor exercise
2. Pessary (that white ring you saw them put in)
3. Lifestyle: WL, no heavy lifting, treat constipation
Surgical
1. Hysterectomy (uterus)
2. Sacrocolpoplexy (uterus / vagina) (mesh)
3. Ant / Post repair (repairs vagina walls –> treats bladder / rectum prolapse)
4. Rectopexy

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19
Q

What are 2 examinations you need to perform in prolapse and why? (3 things)

A
  1. Pelvic exam, including bimanual, and ask pt to cough / squeeze, to see strength of pelvic muslces and ligaments
  2. Urodynamic studies – to check bladder function + any incontinence
  3. Rectal exam – n ask pt to cough / squeeze
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20
Q

What are 4 symptoms of prolapses?

A
  1. Bulge + feeling pressure in vagina / rectum
  2. Dyspareunia
  3. Incontinence
  4. Frequency / urgency / can’t empty bladder
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21
Q

What investigations should you do for someone presenting with incontinence? (4 things)

A
  1. Bladder diary
  2. Urodynamic testing
  3. Urinalysis (UTI?)
  4. Cystoscopy (structural abn?)
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22
Q

What are 4 signs of parkinsons?

A
  1. Tremor
  2. Rigidity (cogwheel)
  3. Akinesia / Bradykinesia
  4. Postural instability
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23
Q

What are the MOA of the different Parkinsons meds? (5 things) (M list, not sure if acc q or relation to levodopa / carbidopa q from R list)

A
  1. Levodopa = precursor to dopamine, converted to dopamine in brain
  2. Carbidopa = peripheral decarboxylase inhibitor, stops levodopa being broken down peripherally
  3. Pramipexole = dopamine agonist, reduce levodopa dose needed
  4. Rasagiline = MAO-B inhibitor, stop dopamine breakdown in brain
  5. Entacapone = COMT inhibitor, stops dopamine breakdown peripherally
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24
Q

Why are levidopa and carbidopa used instead of just dopamine for Parkinsons? (4 points)

A
  1. Because dopamine can’t cross BBB
  2. Parkinsons is shortage of dopamine inside brain, so you need to get dopamine to brain
  3. Levidopa can cross BBB
  4. But need to give Carbidopa to stop levodopa from being broken down before it reaches brain
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25
Q

Why do Parkinsons pt get choreiform movements? (3 things)

A
  1. Bc Levodopa
  2. Meds taken several times per day
  3. Fluctuating levels of dopamine throughout day causes chorea, aka levodopa-induced-dyskinesia (invol brief movements)
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26
Q

What is the pathophysiology of Parkinsons? (it’s a fill in gap question) (4 points)

A
  1. Parkins is neurodegenerative disorder
  2. Substantia nigra (in basal ganglia) degenerate
  3. So no more dopamine produced
  4. Dopamine controls movement and coordination
    (not the acc one in exam but basic pathophys to remember)
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27
Q

down’s
Name 2 tests used for screening other than down’s screening and name the diseases they test for

A
  1. AFP (Alpha-fetoprotein) screening = tests for Neural Tube Defects (spinda bifida / anencephaly)
  2. NIPT (non-invasive prenatal testing) = tests for trisomy 18 and 13 (aka Edwards and Patau syndromes)
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28
Q

What are 4 features of a good screening test? (6 things)

A
  1. High sensitivity
  2. High specificity
  3. High PPV (positive predicted value)
  4. High NPV (negative predicted value)
  5. Reliability (aka can be repeated to give consistent results)
  6. Cost-effective
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29
Q

What is the difference between Sensitivity and specificity? (M list)

A
  • Sensitivity = ability of a test to correctly identify ppl who have the disease
  • Specificity = ability of a test to correctly identify ppl who DON’T have the disease
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30
Q

What are 2 features of Downs syndrome on the picture?

A
  1. Slanted upturned eyes
  2. Flat nose bridge
  3. Small ears
  4. Short neck
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31
Q

How does VSD cause tachycpnoea? (4 steps)

A
  1. L-R shunt
  2. Increased blood flow to lungs
  3. Increases workload on lungs
  4. RR increases (tachypnoea)
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32
Q

Label the main arteries and veins from the heart?

A
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33
Q

What are the branches of the aorta? (3 things, from L to R) (not a q, but helping with labelling one above)

A
  1. Brachiocephalic artery
  2. Left Common Carotid artery
  3. Left subclavian artery
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34
Q

What are the Coronary Arteries? not a q, but helping with labelling one above)

A
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35
Q

Label the coronary veins? (3 things) (not a q, but helping with labelling one above)

A
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36
Q

Work out how much maintenance fluids a kid who is 14kg needs?

A
  • 100ml / kg for first 10kg = 1000ml
  • 50ml / kg for next 4kg = 200ml
  • So = 1200ml
    (rule is 100 for first 10, 50 for next 10, 20 after that)
37
Q

What dose does the child (14kg) need of Dexamethasone?

A
  • 150mcg / kg / day for croup
  • 14 x 150mcg = 2.1mg / day
38
Q

What are 2 viruses that cause Croup?

A
  1. Parainfluenza
  2. RSV
39
Q

How can you assess for the severity of Croup?

A

Westley Croup Score

40
Q

What does the Westley Croup Score takes into account? (5 things) (not a separate q, just completion for one above)

A
  1. Level of consciousness
  2. Stridor (how loud)
  3. Retractions (intrercostal / subcostal)
  4. Air entry
  5. Cyanosis
41
Q

What are 2 symptoms (I think they mean of severe) croup?

A

If they mean severe:
1. Stridor @ rest
2. Cyanosis
If they mean normal croup:
1. Barking cough
2. Stridor @ exertion

42
Q

What are 2 medications that are used in severe croup?

A
  1. Epinephrine (aka Adrenaline)
  2. Dexamethasone
  3. Nebulised salbutamol
43
Q

What is BiPap? (M list, “Ventilation – Bipap”)

A

Non invasive ventilation technique for pt in Resp failure

44
Q

What are 3 findings on MRI of metastatic spinal cord compression? (not acc MRI from exam)

A
  1. Visible tumour / lesion compressing on spinal cord
  2. Loss of normal spinal cord shape
  3. Narrowing of spinal canal bc of tumour
  4. Increased signal intensity bc inflammation
45
Q

what plane is the MRI?

A

Sagittal

46
Q

What are 2 symptoms of metastatic spinal cord compression? (4 things)

A
  1. Pain in back / neck
  2. Weakness in arms / legs
  3. Difficulty walking
  4. Loss of sensation to bowels / bladder
47
Q

What are 4 findings on examination of Metastatic spinal cord compression?

A
  1. Spasticity / stiffness in limbs
  2. Sensory loss (pins n needles / numbness)
  3. Motor loss (weakness in arms / legs)
  4. Hyperreflexia
48
Q

What is the immediate management of metastatic spinal cord compression? (3 things)

A
  1. Dexamethasone (to reduce swelling n compression)
  2. Analgesia
  3. Urgent surgical decompression
49
Q

What are 2 non pharmacological managements for metastatic spinal cord compression?

A
  1. Surgical decompression
  2. Radiotherapy (shrinks tumour so reduces pressure)
50
Q

What are 2 non medical teams you would a patient with metastatic spinal cord compression to? (3 things)

A
  1. Physio
  2. Occupational health
  3. Palliative
51
Q

What are 4 questions in the history you would ask to a pregnant woman who presents with abdominal pain?

A
  1. How many weeks pregnant
  2. When did you first experience pain?
  3. Any vaginal bleeding / discharge?
  4. Any other symptoms, N+V / Fever?
52
Q

What are 4 differential diagnosis that present similarly to Pre term labour?

A
  1. Placental abruption (pain + bleeding)
  2. Braxton Hicks contractions (contractions)
  3. UTI (pain)
  4. Fibroids (pain + bleeding)
53
Q

What are 4 steps you would consider in managing pre term labour? (5 things)

A
  1. Steroids (for lung maturation)
  2. Tocolytics (Nifedipine) (to suppress contractions n delay labour)
  3. MgS (protects against CP + also tocolytic)
  4. Abx
  5. Consider C section
54
Q

e.g CTG / urinary dip or amnisure (not sure if answer if part of Q)
What are 2 ways to monitor a pregnant woman after all of the basic tests?

A
  1. CTG / urinary dip / Amnisure (here in case not part of Q)
  2. Maternal BP monitoring
  3. Non-stress test (NST)
55
Q

What are immediate management options of airway? (3 things)

A
  1. Head tilt, chin lift, jaw thrust
  2. Suctioning any secretions / obstructions
  3. Assisted ventilation with bag-valve-mask device
56
Q

How is Dx of Tension pneumothorax made? (7 things)

A
  1. SOB
  2. Chest pain
  3. Reduced breath sounds @ affected side
  4. Hyperresonance to percussion @ affected side
  5. Tracheal deviation away from affected side
  6. Distended neck veins
  7. No need for imaging bc emergency
57
Q

what is the immediate management of tension pneumothorax? (2 steps)

A
  1. Insert large bore cannula into 2nd intercostal space, mid-clavicular line
  2. Aspirate air out
58
Q

What do you need to do after a chest drain for Tension pneumothorax? (2 things)

A
  1. CXR to check insertion is correct and not hitting neurovasc bundles below ribs
  2. CXR also tells you if pneumothorax resolved
59
Q

What are 4 structures a chest drain (done for tension pneumothorax) goes through?

A
  1. Skin
  2. Subcut tissue
  3. External, internal, innermost intercostal muscles
  4. Parietal pleura
60
Q

What are 4 risk factors for epistaxis? (5 things)

A
  1. Aspirin / warfarin
  2. HTN
  3. Infections (sinusitis)
  4. Trauma (fall)
  5. Dry air
61
Q

What are 4 local management options for epistaxis? (5 things)

A
  1. Pressure (pinch nostrils for 10 mins)
  2. Ice pack (cold compress)
  3. Packing
  4. Cauterization (seals bleeding vessels)
  5. Topical vasoconstrictors (over the counter nasal sprays)
62
Q

What are 2 ways to reverse high INR from vitamin k (I think they mean vit K antagonist aka warfarin) (or apart from vit K maybe)?

A
  1. vit K (if they don’t mean apart from vit K)
  2. Prothrombin complex concentrate (PCC)
  3. Fresh frozen plasma (FPP)
63
Q

What are 2 indications for warfarin use?

A
  1. AF
  2. DVT
64
Q

What is the MOA of warfarin?

A

Inhibits vit K dependant synthesis of clotting factors in liver

65
Q

What are the arteries in Littles Area? (M list “Nose bleeds - Little’s area”)

A
  1. Ant + Post ethmoidal arteries
  2. Sup labial artery
66
Q

Describe the complete geriatric assessment (chatgtp said aka Comprehensive Geri Assessment aka CGA) (7 things)

A
  1. Medical history
  2. Medication review
  3. Physical exam
  4. Cogn assessment
  5. Psychosocial wellbeing
  6. Functional assessment
  7. Nutritional assessment
    Medicine Makes People Crazy, Please Feed Now
67
Q

Label the hip anatomy (20 things) (q = interpret graph + pubic rami fracture + hip anatomy)

A
68
Q

What are 4 frailty syndromes apart from falls?

A
  1. Delirium / Dementia
  2. Incontinence
  3. Immobility
  4. Polypharmacy
    DIIP
69
Q

What are 4 causes of falls from the pt history? (5 things)

A

Idk history but check for:
1. Vision problems (e.g cataracts)
2. CVS disease
3. Balance / gait disorders: Parkinsons / MS etc
4. Meds: sedatives / antiHTN / antidepressants
5. Weakness (e.g muscles / arthritis)

70
Q

What is an Advanced Directive?

A

AD = legal document allows person to make decisions about their healthcare in Advance, in case they become unable to communicate their wishes in future (aka LOC / lose capacity)

71
Q

What makes an Advanced Directive legal? (3 things)

A
  1. Must be in writing + signed by person making it
  2. Must be competent and understand everything at time of writing
  3. Must be witnessed / authorized by someone not related to them
72
Q

What are 2 things that a Lasting power of attorney can do in terms of a patients health and welfare?

A
  1. Make decisions about pt tx, including life-sustaining tx
  2. Make decisions about pt diet
  3. Make decisions about where pt lives
  4. Make decisions abt daily routine (aka social + leisure activity)
73
Q

What are 2 pathogens causing otitis externa?

A
  1. Pseudomonas aeruginosa
  2. Staph aureus
74
Q

What are 2 treatments for otitis externa other than antibiotics? (3 things)

A
  1. Ear cleaning (with cotton swab)
  2. Analgesia
  3. Topical ear drops (steroids)
75
Q

What are 4 important things for antibiotic stewardship?

A
  1. Only prescribed when necessary
  2. Prescribe for right dose and duration
  3. Select based on culture + susceptibility testing
  4. Education + communication between Dr + pt on appropriate use
76
Q

What is Malignant Otitis Externa? (2 things) (M list)

A
  1. Complication of OE
  2. Spread to skull base + temporal bone
77
Q

Who is more at risk of Malignant OE? (2 things) (M list)

A
  1. Elderly
  2. Immunocompromised
78
Q

What are the CF of Malignant Otitis Externa? (4 things) (M list)

A
  1. Fever
  2. Pain (severe)
  3. HL
  4. Facial nerve paralysis (which leads on to next q abt facial nerve from R list)
79
Q

What is the Mx for Malignant Otitis Externa? (2 things) (M list)

A
  1. Long term abx (ciprofloxacin)
  2. Surgical debridement
80
Q

What is a rare complication of Otitis externa involving a structure that runs nearby? (not sure but q = facial nerve palsy complication asked about umn vs lmn)

A

Facial nerve palsy

81
Q

How do you differentiate between UMN vs LMN Facial nerve palsy?

A

UMN:
1. Lesion in CNS (central)
2. Only lower half face affected, forehead spaired (so can wrinkle it)
3. Hyperreflexia + increased tone on affected side of face
4. NO loss of taste (on ant 2/3 of tongue)
LMN:
1. Lesion in PNS (peripheral)
2. Entire face affected (forehead affected, CAN’T wrinkle it)
3. Loss of taste (on ant 2/3 of tongue)
4. Hyporeflexia + reduced tone on affected side of face

82
Q

How do you interpret Rinnes test? (M list)

A
  • AC better than BC = Positive Rinne = Normal / Sensorineural HL
  • BC better than AC = Negative Rinne = Conductive HL
83
Q

How do you interpret Webers test? (M list)

A
  • Conductive: Lateralises to affected ear
  • Sensorineural: Lateralised to normal ear
84
Q

What are the side fx of Lithium? (5 things) (M list)

A
  1. Neuro fx = Confusion / tremor
  2. Thyroid = Hypo / Hyperthyroidism
  3. CVS = Arrhytmias / Low HR
  4. Renal toxicity
  5. GI = N + V + D
85
Q

What are some differentials of a breast lump? (7 things) (M list)

A
  1. Breast cancer (invasive ductal carcinoma)
  2. Fibroadenoma
  3. Fat necrosis
  4. Breast cyst
  5. Duct ectasia
  6. Mastitis / abscess
  7. Lipoma
86
Q

What is MAP? (M list)

A

Mean Arterial Pressure
(measure of average pressure in pt arteries)

87
Q

How do you calculate MAP? (M list)

A

((2 x Diastolic BP) + Systolic BP) / 3

88
Q

When is MAP used? (M list)

A

To guide Mx of Hypotension in rly ill pt

#passmed 2023 (39 decks)

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