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A final year of medicine > Pastest > Flashcards

Pastest Flashcards

1
Q

Asked to see a 41y/o man with stoma in RLQ; has spout and produces liquid, light brown fluid. What is it likely to be?

A

Ileostomy. These have looser stool with more acid therefore more likely to leak and cause caustic damage to skin therefore are fashioned with a spout for better delivery (colostomy are flat and usually LLQ)

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2
Q

2 year old boy with 2 day cough, non-productive, no accessory muscle usage and afebrile. R sided wheeze?

A

Likely to be inhaled foreign body. Causes audible wheeze, airway irritation and cough. Bronchiolitis likely to follow coryzal period, and cause resp. distress e.g. accessory muscle usage, nasal flare, tachypnoea and have widespread inspiratory creps. Asthma would have acute onset with widespread wheeze and resp. distress; croup would cause barking cough and possibly stridor.

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3
Q

What is Apo C-II?

A

Essential cofactor of LPL which hydrolyses triglyceride in VLDL and chylomicrons therefore deficiency in Apo C-II causes elevated chylomicrons and VLDLs

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4
Q

55 year old woman with vaginal bleeding, small ulcer on genitals; ulcer is on vulva with indurated base and everted margins; can palpate inguinal lymphadenopathy.

A

Vulval carcinoma (characteristic lesion with lymphadenopathy)

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5
Q

30-year-old, 7 months pregnant woman with bluish lump that she has noticed in the vulva; has increased in size but remained painless

A

Varicose veins (vulval varicosity worsened in pregnancy due to the pressure of the gravid uterus obstructing venous drainage from the lower extremities

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6
Q

28-year-old woman with itchy white patches on her vulva; OE the vulva skin is thickened in these areas

A

Lichen sclerosis. Only differentiated from leukoplakia with biopsy, but leukoplakia is usually confined to the mouth and not typically itchy. This also suggests a more chronic lichen sclerosis picture as the skin has become thickened

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7
Q

20 y/o patient who is six months pregnant notices warty lesions on vulva; in stable relationship and no STI history

A

= vulval wart. Caused by HPV. Pregnancy = immunosuppression so become more florid. As some HPV strains cause CIN, this may need treatment

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8
Q

32 y/o with painful vulval swelling, becomes larger and burst. Has lump in labia majora with a punctum and foul-smelling pus

A

= Bartholin’s abscess

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9
Q

10% rule of phaeo?

A

10% extramedullary, 10% malignant, 10% familial, 10% bilateral

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10
Q

Features of phaeo?

A

Hypertension, headache, sweating, anxiety, “feeling of impending doom”; may get postural hypotension, constipation, weight loss, abdominal pain and glucose intolerance

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11
Q

Features in history indicating renal artery stenosis?

A

Atherosclerosis, dyslipidaemia, smoking, HTN refractory to medication

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12
Q

Triad of features in Conn’s?

A

HTN, hypokalaemia and metabolic alkalosis

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13
Q

Two main causes of Conn’s?

A

Aldosterone-producing adenomas and bilateral adrenal hyperplasia

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14
Q

Cardinal features of Cushings?

A

Centripetal obesity, secondary HTN, glucose intolerance, proximal myopathy, hirsutism.

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15
Q

Adrenaline dose for anaphylaxis?

A

0.5ml of 1:1,000 IM. This should be the first step of management.

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16
Q

Managing bleeding varices?

A
  1. Control bleeding (Sengstake-Blakemore tube, sclerotherapy [inject glue] or banding)
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17
Q

What is epidural headache and what is the treatment?

A

Headache caused by persistent CSF leak after epidural/LP; treatment is blood patch (inject blood down epidural needle and allow clot to form).

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18
Q

Cx of LP?

A

Post-dural puncture headache is common; epidural headache (persistent CSF leak less so). Also can get psinal haematoma/abscess , transient parasthesiae and tonsillar herniation

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19
Q

When is tracheostomy indicated when weaning from ventilator?

A

If have been intubated for more than 7 days and weaning is difficult

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20
Q

Contraindications to NIV?

A

Facial trauma/surgery/deformity; cardiac arrest; resp arrest; inability to co-operate, unable to protect airway, high aspiration risk, recent oesophageal anastomosis

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21
Q

Reflex anoxic seizure?

A

Syncopal episode associated with seizure, usually preceded by minor head injury. Result of vasovagal.

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22
Q

Presentation of AFE?

A

Recognised complication of amniocentesis. Present with sudden cyanosis and collapse, often with shock or seizures. May be complicated by DIC. Management = ensure adequate oxygenation is key; also correct hypotension. Overhydration may cause ARDS.

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23
Q

Blood features of alcohol dependency?

A

Macrocytic anaemia, low urea and sodium, deranged LFTs and INR, ALT/AST ratio reversed. (all in keeping with alcoholic hepatitis in this case)

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24
Q

Triad of Graves’?

A

Acropachy (pseudoclubbing), orbitopathy and pre-tibial myxoedema

25
Q

Rx for Graves’?

A

Carbimzaole, propylthiouracil

26
Q

Rx for Graves’?

A

Carbimazole, propylthiouracil

27
Q

Treatment for methanol toxicity?

A

Fomepizole (ethanol less appropriate). Also the treatment for ethylene glycol toxicity

28
Q

ABG for methanol toxicity?

A

Raised anion gap met. acidosis

29
Q

Common AEs of tacrolimus?

A

Nephrotoxicity, DM and neurotoxicity (therefore typically do bloods 2 weekly after transplant)

30
Q

Meds causing hirsutism?

A

Phenytoin, ciclosporin, danazol (androgen agonists)

31
Q

NEXUS criteria and significance?

A

If patient has none, then can be considered for clearance of C-spine. If one or more, do plain films. Criteria are:

  1. Focal neuro deficit
  2. Midline spinal tenderness
  3. Altered GCS
  4. Intoxication present
  5. Distracting injury present
32
Q

Which nerve most likely to be damaged by supracondylar humeral fractures?

A

Median nerve so get loss of sensation to palmar aspects of first and second fingers and weakened wrist flexion

33
Q

Which dementia is associated with increased sensitivity to neuroleptics?

A

LBD

34
Q

Most common cause of hallux valgus?

A

Shoe-wearing

35
Q

Diagnostic test for myasthenia?

A

Nerve conduction studies with repetitive nerve stimulation

36
Q

Which part of NMJ affected by MG/LES?

A

MG - post synaptic

LES - pre synaptic (voltage-gated calcium channels)

37
Q

Amitryptylline OD Px?

A

Anticholinergic (dilated pupils, dry skin, confusion, urinary retention, tachycardia); prolonged QTc and wide QRS

38
Q

Lupus pernio?

A

Lesions on face associated with sarcoidosis; large, bluish-red and dusky purple infiltrated nodules and plaques on face

39
Q

Most common cause of delirium in elderly?

A

Acute medical illness

40
Q

Triad of Wernicke’s?

A

Ataxia, confusion, ophthalmoplegia

41
Q

Episcleritis px?

A

Usually mild/no discomfort; slight tender on palpating red patch. Pain may be worse on ocular movements. Vision normally unaffected. Redness in episcleritis is often sectorial versus the redness in conjunctivits where it is more diffuse and superficial

42
Q

Would phenylephrine improve redness in scleritis?

A

No - only in episcleritis as the deeper blood vessels involved in scleritis are not vasoconstricted

43
Q

Inheritance of Marfans?

A

AD

44
Q

Skeletal features of Marfans?

A

Tall and thin stature, disproportionately long arms, long fingers, arachnodactyly, chest deformity, (pectus excavatum or carinatum,) scoliosis

45
Q

Cardiovascular features of Marfans?

A

Aortic aneurysm, AR, MR, aortic dissection

46
Q

Ocular features of Marfans?

A

Lens dislcation, myopia, retinal detachemnt, early glaucoma, early cataracts

47
Q

Facial characteristics of Marfans?

A

Long narrow face, teeth overcrowding, high-arched palate

48
Q

Hypersegmented neutrophils are associated with which anaemia?

A

Megaloblastic

49
Q

Coeliac and anaemia?

A

Prone to malabsorption of iron and folic acid

50
Q

Pt with known SLE, normal MCV and MCHC, high reticulocytes, spherocytes on blood film, direct AG test positive, LFTs showing unconjugated hyperbilirubinaemia?

A

(autoimmune) haemolytic anaemia

51
Q

Lichen planus?

A

Chronic mucocutaneous dermatosis, unknown aetiology, in the mouth causes white striae/plaques/erosions. May be sore with spicy food. Get skin lesions (itchy papules, on flexor surfaces of shins and wrists). Treat with topical steroid. Can get nail and scalp involvement.

52
Q

Dermatitis herpetiformis?

A

An uncommon, symmetrical vesiculo-bullous disorder affecting the extensor surfaces. Presents in third or fourth decade and twice as common in men as women. Blisters are usually excoriated. Most patients have associated jejunal villous atrophy but GI symptoms (e.g. malabsorption etc. are unusual). Anti-endomysial antibodies present, skin biopsy shows IgA deposits along dermal papillae. Gluten free diet is treatment. Dapsone will control eruption until diet takes effect.

53
Q

Polycythaemia rubra vera?

A

Present with signs related to hyperviscosity e.g. headaches, TIAs, angina, Raynaud’s, itch; worse after hot bath. May get gout due to increased red cell turnover. May be associated bruising. Splenomegaly may occur. Treatment involves venesection or hydroxyurea.

54
Q

Ann Arbor staging: I-IV?

A 
I = single LN region or on extra lymphatic site
II = two or more LN regions on same side of diaphragm, or local extralymphatic extension with one or more LN sites on the same side of diaphragm
III = LN regions on both sides of diaphragm +/- local extralymphatic extension
IV = diffuse organs of one or more extralymphatic organs or sites
55
Q

Ann Arbor staging: A-B?

A

Each stage can be divided into A (no B symptoms), B (recurrent night sweats, unexplained w/l >10% baseline during 6 months prior to staging, recurrent unexplained fever >38). or X (bulky tumour i.e. single mass >10cm or mediastinal mass exceeding 1/3 of transthoracic diameter)

56
Q

Muco-cutaneous manifestations of iron deficiency?

A

Koilonychia (brittle), atrophic angular stomatitis/cheilitis, pruritis, post-cricoid webs (Plummer-Vinson syndrome)

57
Q

Initial management of acute hyperkalaemia (symptomatic with ECG findings)?

A

10% calcium gluconate 10% 10ml by slow IV injection (stabilises myocardium). Then give 10 units of Act Rapid insulin in 100ml of 20% glucose. Can give salbutamol nebulisers. Calcium resonium 15g orally or 30g rectally can mop up extra potassium in GI tract.

58
Q

ECG findings in hyperkalaemia?

A

Tall, peaked T waves with narrow base, shortened QT,

59
Q

Digoxin and visual disturbances?

A

Digoxin toxicity causes a yellow visual disturbance and may be precipitated by hypokalaemia and hypercalcaemia

A final year of medicine (20 decks)

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