PLAB Flashcards
1
Q
Beck’s triad
A
cardiac tamponade
increased JVP
muffled heart sound
HoTN
2
Q
IE criteria
A
Duke’s criteria (2maj + 1min OR 1maj + 3min OR 5min)
Major: (+) blood culture/ (+) echo
Minor: FROM JANE Fever >38'C Roth's spot Osler nodes Murmur
Janeway lesion
anaemia
Nail haemorrhage
Emboli
3
Q
empirical tx of infective endocarditis
A
NVE: amoxicillin + genta
if penicillin allergic/ MRSA: vanco + genta
prosthetic valve: van + genta + rifampicin
4
Q
CHA2DS2-VASc
A
Congestive HF HTN Age >75 (2) DM Preve stroke, TIA, thromboembolism (2)
Vascular disease (MI, PAD, aortic plaque) Age 65-74 (2) Sex cat (Female)
if >2 give Warfain/ DOAC
5
Q
NTEMI tx
A
- NSTEMI ECG
- Check Tropnin if elevated
- LMWH or fondaparinux + aspirin 300mg
6
Q
post MI long-term tx
A
AABC + S
Aspirin life long ACEi BB @ least 12mo Clopidogrel 12mo Statin
7
Q
Pulmonary oedema Tx
A
MONF
Diamorphine 2.5-5mg iv slowly
O2
Nitrate GTN spray 2 puff sublingual
Furosemide
pulmonary oedema secondary to HF: add ACEi
8
Q
Multiple sclerosis dx, tx
A
REMEMBER OPTIC NEURITIS
Dx:
MRI: dissemination in space should be confirmed
CSF: increased total protein, high oligoclonal
Tx:
relapses: po/ iv methylprednisolone 500mg/d 5d
disease modifying: INF-b, Glatiramer
9
Q
Trigeminal neuralgia tx
A
anti-convulsant: carbamazepine
10
Q
DM neuropathy tx
A
1st: amitryptiline
gabapentin, duloxetine, pregabalin
11
Q
Diabetic drugs safe to use for renal impairment
A
RIP (repaglinide, linagliptin, pioglitazone)
insulin, DDP4-i (gliptin)
12
Q
diabetic drugs cause weight gain
A
SPR
sulphonylureas (gliclazide)
pioglitazone
repalignide
13
Q
Pioglitazone
A
weight gain
bladder cancer concern
heart failaure
fracture
14
Q
antiDM med not to use in RF
A
MS
metformin
sulfonylureas
15
Q
Impaired glucose tolerance
A
Impaired glucose tolerance
16
Q
antiDM cause hypoglycaemia
A
sulfonylurea, repaglinide
17
Q
Adrenal insufficiency
A
Primary: Addison
Secondary: HPA (iatrogenic)
18
Q
Addison disease
A
Low cortisol, low aldosterone
hyperK+
hypo: Na+, glycaemia
Metabolic acidosis
Tx: hydrocortisone 15-30mg
if primary: give fludrocortisone 50-30ug/d
19
Q
Glucocorticoid excess
A
Cushing disease, sy: metyrapone, ketoconazole, mitotane
20
Q
Hyperaldosteronism
A
Pri: Conn’s disease
Secondary
21
Q
Conn’s disease
A
Hyperaldosteronism
HyperNa+, hypoK+
metabolic alkalosis
tx: spironolactone (Aldosterone ATG)
22
Q
SIADH
A
tx: vaptan (vassopressin R- ATG), furosemide, fludrocortisone
23
Q
DI
A
ineffective ADH
central: desmopressin
nephro: bendroflumethiazide
24
Q
Primary PTH
A
high PTH
High Ca2+
Low PO4
Vit D: norm/ low
25
Secondary PTH
high PTH
Low/ norm Ca2+
high/norm PO4
V. Low Vit D
26
Tertiary PTH
V. High PTH
High Ca2+
High PO4
Low/ norm vit D
27
SIADH tx
fluid restriction 800-1000ml/d
vasopressin R ATG: tolvaptan, conivaptan
Severe: demeclocycline
28
hypokalaemia ECG, sx
fainting, tiredness/weakness, leg cramps, generalised wekaness, constipation, severe muscle weakness, paralysis, resp failure, tetany
ECG: flat T-watnes, ST depression, U waves Prolonged QT interval
29
hypokalamiae tx
<2.5mmol/l or <3mmol/l w/ ECG
- 40mmol/l KCl in 1L 0.9% normal saline w infusion rate NOT >20mmol/hr
>2.5mmol/l w/ no ECG changes
- oral K-supplement stbl TDS po Sando-K
30
hyperkalaemia sx (>5.5mmol/l)
ECG: tall-tented T, flattening p-waves, broad QRS, sinu wave pattern, VFib
31
hyperkalaemia tx
stop drug
1st line: iv-Ca-gluconate
insulin + dextrose
Salbutamol inhalation
32
hypercalcaemia sx
polyuria, polydipsia, depression, muscle weakness, constipation, PT shortened
33
hypercalcamia tx
```
1st line: fluid
bisphosphonate
calcitonin
steroids
cinacalcet
```
34
hypocalcaemia sx
siezure, tetany, spasm, perioral paraesthesia, muscle tone increased, orentation impaired, dermatitis, impetigo herpetiformis, chvostek, trousseau
ECG: prolonged QT
35
hypocalcaemia tx
Ca-gluconate
36
Wernicke-Korsakoff sy
COAT RACK
confusion
ophthalmoplegia
Ataxia
Thiamine NB aspect of tx
Retrograde amnesia
anterograde amnesia
confabulsation
Korsakoff's psychosis
37
TCA poisoning tx
0.9% norm saline 250ml + 8.4% NaHCO3 50mmol/l iv slowly
38
Paracetamol poisoning N-acetylcysteine admin
Pt present >8hrs after ingestion
uncertatinty of timing of overdose
unconscious or have suspected overdose
staggered overdose
39
stages of hypovolaemic shock
stage 1: norm, 10-15%
stage 2: >100bpm, 15-30%
stage 3: >120 30-40%
stage 4: >140 >40%
40
smudge cell
CLL
41
Auer Rod
AML
42
DIC bleeding time
increased: PT, aPTT, INR, D-dimer,
decreased: fibrinogen, plt
43
haemophilia bleeding time
increase aPTT + muscle/ joint bleeding
44
vWD bleeding time
increase aPTT + BT + mucosal bleeding
decreased fVIII
Normal PT
plt count norm
45
ITP bleeding time
decreased: plt + Bleeding/ purpura w/ or w/o Hx URTI
46
anaemia in preg
MUST NEVER GO BELOW <10g/dL
T1: <11g/dL
T2: <10.5g/dL
T3: <10g/dL
47
What cell are found in G6PD deficiency?
heinz bodies, bite cells
48
what cells are found in CLL?
Smudge cells
49
CYP450 inducers
```
Bull Shit CRAP GPS
Barbiturate
St Johns Wort
Carbamazepine
Rifampin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
```
50
CYP450 inhibitor
```
SICKFACES.COM
Sodium valporate
Isoniazide
Cimetidine
ketoconazole
fluconazole
alcohol
Chloramphenicol
Erythromycin
sulfonamide
ciprofloxacin
omeprazole
metronidazole
```
51
status epilepticus tx
1. 2 separate doses: iv lorazepam (hospital)/ buccal midazolam or rectal diazepam (outpt)
2. iv phenytoin>phenobarbital
3. iv phenobarbital
52
restless leg sy tx
1stline: n-ergot DA-AG
53
medullary stroke
ipsilat horner sy
loss pain & temp of face
contralat loss pain & temp limb
54
trigeminal neuralgia tx
carbamazepine 1st line
| gabapentin + ropivacaine injection
55
PID empirical tx
OM!!/ CDM
ceftriaxone 500mg single dose im --> doxycycline 100mg x2/d + metronidazole 400mg x2/d 14d
po ofloxacin 400mg x2/d + po metronidazole 400mg x2/d 14d
56
PID hospital tx
CDM-DM
iv doxycycline 100mg x2/d, single dose iv ceftriaxone 2g od, iv metronidazole --> po doxycycline 100mg x2/d + metronidazole 400mg x2/d 14d
57
Pre-eclampsia MgSo4
MgSO4 loading dose 4g infusion 5-10min in 0.9% NaCl 100ml --> further infusion 1g/hr maintained for 24hrs after last seizure
If recurrent seizures: bolus 2g MgSO4 or increase infusion rate 1.5-2g/hr
Maintenance 1g/hr for 24hrs
58
Chlamydial cervicitis
ABCD
Azithromycin before chlamydial doxycycline
59
Gonorrhoea cervicitis
A+C
| Ceftriaxone 1g im as single dose
Azithromycine 1g po
60
CI for COCP
smoking or Hx smoking, obesity >30kg/m2, Hx thromboembolism, learning difficulties, postpartum (if breast feeding >6mo if not 6wks), migraine w/ aura, HTN even if controlled
61
Acute alcohol w/drawal sx management
BDZ: chlordiazepoxide/ diazepam first then thiamine
62
alcohol hallucination/ seizure (Delirium Tremens)
iv Lorazepam OR diazepam
63
Wernicke's encephalopathy
vit B1
64
What to check for pt on Li?
TFT, Renal
65
What to check for pt on amiodarone?
electrolytes, urea
66
steps for ectopic preg?
```
Urine preg test (+)
TBUS check if uterus empty
if pt stable check hCG
- >1400: laparoscopy
- <1400: observe & repeat vagina US later
```
if unstable SBP <90mmHg laparotomy
67
Rapid tranquilisers
HOL
| Haloperidol, olanzapine, lorazepam
68
tardive dyskinesia management?
depot risperidone
EPS: long term antipsychotic SE
69
antidepressant for pt w/ MI?
sertraline> citalopram
70
Antidepressant for pt taking warfarin?
mirtazapine
71
antidepressant for young people & children?
fluoxetine
72
Plummer Vinson Sy
Dysphagia
Fe-def anaeamia
Esophageal Webs
73
Dx acute pancreatitis
initial: lipase & amylase (lipase more specific & sensitive)
confirm: CT w/ contrast of pancreas
74
Charcot Triad
FRJ
Fever, RUQ pain, jaundice
Seen in pt w/ acute cholangitis
75
Cholangitis
Inflammation of bile duct
76
Traveller's diarrhoea empirical ABTx
Most common E. Coli
ciprofloxacin 500mg bd for 3d
77
Campylobacter jejuni w/ travel Hx in Southeast Asia ABtx
Quinolone resistance
1st line: erythromycin (clari/ azithro if erythro NOT well tolerated)
2nd line: ciprofloxacin
78
Salmonella tx
1st line: Ciprofloxacin
79
Giardiasis Tx
Metronidazole
| alternative: Tinidazole
80
Bloody diarrhoea organism
Bampylobacter
Shigella
Salmonella
E. Coli O.157
81
Campylobacter ABtx
usually not required
1st line: erythromycin 250-500mg pds for 5-7d
Azithromycin/ Clarithromycin alternative
Ciprofloxacin 500mg bd 5-7d alternative
82
H. Pylori tx
do NOT perform urea breath test/ Stool Ag test if PPI used w/in 2wks OR ABtx used w/in 4wks
1st line: 7-14d PPI+ amoxicillin 1g + clarithromycin 500mg OR metronidazole 400mg (all x2/d)
2nd line: PPI, amoxicillin + clarithromycin OR metronidazole (whichever not used in first line)
3rd line: PPI + bismuth subcitrate + tetracycline + metronidazole
83
Triple tx for H/ Pylori
PPI + Amoxicillin + clarithromycin 7-14d
eg. esomeprazole 20mg bid
amoxicillin 1g bid
clarithromycin 500mg bid
84
DX Coeliac disease
Auto-Ab: TTG (IgA), EMS (TTG 1st choice)
jejunal/ duodenal biopsy
pt should be on gluten for ~6wks before testing!!!
85
PBC ass disease
sjogren
86
PSC ass disease
IBD UC>CD
87
Clostridium Difficile tx
1st line: Metronidazole
2nd line: vancomycin
88
Acute Fatty liver of preg
ELLP + low glucose + high NH3
89
laxative: no impacted stool
phosphate enema
90
laxative: hard stool + NO impacted
stool softeners: liquid paraffin
91
laxative: constipation w/ soft stool
(stimulant laxative) also used for cancer pt
increased fibre diet
Senna (+) laxative 1st line
2nd line: latulose, macrogol
92
laxative: preg
lactulose 1st line
93
severe UC/ acute exacerbation
6, 30, 90
```
>6 bowel movements + visible blood in lare amounts
ESR >30
HR >90 bpm
temp >37.8
Anaemia
```
94
Diffuse oesophageal spasm dx, tx
Barium meal: corkscrew appearance
most accurate test: manometric studies
Tx: CCB, Nitrate
95
CD tx
inducing remission: CS, if CI budesonide or 5-ASA
Maintaining: azathioprine, mercaptopurine, MTX
96
UC tx
inducing: 5-ASA topical then rectal (rectal 5-ASA> rectal steroid)
2nd line: add oral pred
Remission: oral aminosalicylates/ po azathioprine or mercaptopurine
for acute exacerbation iv hydrocortisone
97
Gilbert's sy
AR disorder: low UGT-1
unconjugated hyperBb; no haemolysis; norm liver enzymes; NO evidence of liver disease!!!
Tx: no need
98
Hb level BEFORE surgery?
Elective
>100g/L (>10g/dL): proceed
<100g/L (10g/dL): investigate
<80g/L (<8g/dL): + sx: transfuse & defer surgery
EMERGENCY
If Hb <100g/L (10g/dL): always proceed w/ emergency operation
<80g/L (8g/dL): transfuse w blood
99
Reynolds pentad
Acute cholangitis:
Fever, abdom pain, jaundice
+ confusion, HoTN
100
Scabies tx
1st line: Topical Permethrin 5%
2nd line: Malathion 0.5% aqueous liquid
101
Lyme disease tx
erythema migrans
2-3wks Doxycyclin 100mg bd OR amoxicillin 500mg tds
Defuroxime 500mg bd if both CI
Preg, Breast feeding, Children <12yrs: amoxicillin or cefuroxime
Systemic: Ceftriaxone iv
102
outpt meningitis tx
| Adults & children
Children: Benzylpenicillin im/ iv
<1yr: 300mg
1-9yrs: 600mg
>10yrs: 1200mg
Adults: Benzylpenicillin or 3rd gen cephalosporin immediately
103
inpt initial meningitis empirical tx
>3mo <60yrs: iv ceftriaxone (cefotaxime preferable)
>60yrs: iv ampicillin/ amoxicillin
<3mo: iv cefotaxime + amoxicillin/ ampicillin
104
Listeria meningitis
<3mo: iv amoxillinc/ ampicillin 21d + gentamicin least first 7d + ceftriaxone
105
Cryptococcal meningitis
Amphotericin B
106
meningitis prophylaxis for contacts
ciprofloxacin >> rifampicin
107
HIV/ADIS vaccination cI
NO BCG, Yellow fever
If <200cells/ml NO MMR in adult!!!
<1yr: <750cells
1-5 <500cells
>5yr <200cells
108
Nesseria meningitis tx
iv ceftriaxone 7d
109
Toxoplasmosis tx
immunocomp: pyrimethamin, sulfadiazine, folinic acid 4-6wks
immunocompromised: trimethoprim/ sulfamethoxazole prophylaxis
Mat & foetal infection: spiramycin asap!
110
Malaria N-falciparum malaria
Chloroquine if fail quinine, artemether + lumefantrine OR atovaquonone proguanil
111
P. falciparum malariae
quinine + doxycycline OR clindamycin for preg
112
Schuffner's dots
primaquine
113
Prophylaxis for malaria
Mefloquine
114
ABtx neutropenic sepsis
Empiric ABtx: piperacillin w/ tazobactam immediately
if after 48hrs: meropenem + vanco
if pt still unwell 4-6d: investigate for fungal infection
115
Mumps (MMR) vaccine HIV (+) pt
Contraindicated
Adults: <200cells/ml
>5yrs: <200
1-5yrs: <500
<1yrs: <750
116
otitis externa tx
Acetic acid 2% + aminoglycoside + topical CS
Avoid AG (gentamicin) if there is TM perforation rather use ciprofloxacin
117
Otitis Media tx
reassess after 3mo
ALL pt w/ AOM:
- pain & fever: paracetamol, ibuprofren
Most children 5d amoxicillin if allergic--> erythromycin/ clarithromycin
118
Benign Paroxysmal positional vertigo dx & tx technique
dx: Hallpike's Manoeuvre
Tx: Epley
119
Hearing test in Children
<6mo: otoacoustic emission, audiological brainstem response
6-18mo: distraction testing
2-4: speech discrimination, conditioned response audiometry
>5yrs: Pure tone audiogram
120
whipple's disease biopsy result
deposition of Ma in lamina propria containing granules which stain (+) PAS
121
PJP tx
Co-trimoxaole (Trimethoprim-sulfamethoxazole)`
122
MRSA tx
Vancomycin
| Teicoplanin
123
Tonsillitis ABtx
if >3 Centro criteria
5-10d phenoxymethylpenicillin (allergic: clarithromycin/ erythromycin)
124
Tonsillectomy criteria
episodes of sore throat disabling & prevent norm functioning
>7 sore throats 1yr
>5 2yrs
>3 each of preceding 3yrs
125
Centro criteria
tonsillitis criteria <1 (+) unlikely to have group A beta strep
126
Acute attacks of Meniere disease tx
vertigo & causea: prochlorperazine, cinnarizine, cyclizine, promethazine
127
c-ANA
Wegener's Granulomatosis (granulomatosis w/ polyangiitis)
128
p-ANCA
Churg Strauss (Eosinophilic granulomatosisw/ polyangiitis)
UC
Primary sclerosing cholangitis (PSC)
129
anti-mitochondiral (AMA)
PBC
130
Mild SLE tx:
| Skin, arthralgia, myalgia, malaise
NSAIDS, local CS, hydroxychloroquine--> 1st line but (retinal toxicity)
131
Severe SLE tx: lupus nephritis, vasculitis, cerebral disease
Cyclophosphamide (resna; haemorrhagic cystitis), systemic CS, mycophenolate mofetil
132
SLE Maintenance tx:
po CS (prednisolone); azathioprine, MTX
133
Drug induced SLE: causative drugs
SHIPP
```
sulfasalazine
**Hydralazine
isoniazid
Phenytoin
**Procainamide
**quinine
```
134
Antihistamine for pregnancy
chlorpheniramine
135
N-sedating H1 anti-histamine
cetirizine, loratadine
136
Acne Rosacea
Mild-mod: Topical metronidazole
| Mod-severe: oxytetracycline, tetracycline
137
Tinea capitis
children: griseofulvin
Adult: terbinafine, itraconazole, fluconazole
138
Impetigo Tx
Localised infection: fusidic acid, topical retapamulin 2nd line
Extensive disease: flucloxacillin 1st line
erythromycin 2nd line
139
Goodpasture's characteristic
haematuria + haemoptysis
Acute rapidly progressive GN + pulmo alveolar haemorrhage
anti-glomerular BM Ab (anti-GBM Ab)
140
Goodpasture's sy tx
prednisolone, cyclophosphamide, plasma exchange
141
Acute pyelonephritis tx
Fluid analgesia
Adults: 1st line ciprofloxacin OR co-amoxiclav 7d (500mg bd OR 500/125mg tds)
Trimethoprim used if culture confirms sensitivity 200mg bd 14d
Children: 1st line co-amoxiclav; 2nd line cefixime
Preg: cefalexin
142
Nephrolithiasis tx
<0.5cm (5mm): increase ifluid intake get rid of it in urine
0.5-2cm: ESWL or ureteroscopy w/ dormia basket
Stone >2cm: percutaneous nephrolithotomy
143
HUS triad
Haemolytic anaemia
Uremia
Thrombocytopenia
E. Coli
144
TTP sx
HUS triad
Fever
Neurological manifestation
145
Septic arthritis
Flucloxacillin 4-6wks longer if infection
Clindamycin if penicillin allergy
MRSA: vanco 4-6wks
Gonococcal gram (-): cefotaxime/ ceftriaxone 4-6wks
146
Reiter's triad
seronegative spondyloarthritis: reactive arthritis
CANNOT SEE: conjunctivitis, uveitis
CANNO PEE: urethritis
CANNOT CLIMB A TREE: arthritis
+skin manifestation
147
Reactive arthritis skin manifestation
Circinate Balanitis: apinless vesicles on coronal margin of prepuce
Keratoderma blenorrhagica: waxy yellow/ brown papules on palms & soles
Erythema nodosum: tender red nodules over shins
148
Superficial peroneal nerve
lat compartment of leg
| EVERT!!!
149
Deep peroneal nerve
ant compartment of leg DORSIFLEX, sensation in web space btw BIG TOE & 2nd TOE
150
T1 nerve root injury
finger abduction & finger adduction
weakness upon adduction of thumb
151
Anterior uveitis ass disease
ankylosing spondylitis
reactive arthritis
UC, CD
152
Anterior uveitis
cycloplegics (cyclopentolate)
| Prednisolone: reduce inflammation
153
Central retinal artery occlusion tx
If w/in 90-100min: ocular massage
Lower IOP: acetazolamide, w/drawal little fluid from ant chamber
154
Central retinal artery occlusion ass disease
giant cell arteritis (temporal arteritis)
155
Acute closed angle glaucoma
Initial: topical glaucoma med + iv acetazolamide
BB: timolol
Steroids: Prednisolone 1every 15min for hrly
acetazolamide iv
Pilocarpine -2% for pt w/ natural lens
Phenylephrine 2.5% for pt who do NOT have their own lens
156
Scaphoid fracture
Tender in anatomical snuff box & over scaphoid tubercle
157
osteoarthritis tx
drugs: Paracetamol &/or topical NSAIDS then opioid
intra-articular injection: CS injection
158
thiazide SE
bendroflumethiazide, chlorthalidone, indapamide
HYPONa+
HYPOK+
GOUT: increases uric acid levels
HYPERGLYCAEMIA: impaired glucose tolerance
159
Loop diuretics SE
Furosemide, bumetanide, ethacrynic acid
```
HYPONa+
HYPOK+
Gout
Postural HoTN
HYPOCa2+
```
160
K+ sparing diuretics SE
Spironolactone, eplerone, amiloride, tiramterene
HYPERK+
HYPONa+
Gynecomastia
161
cyclizine indication
antiemetic: antimuscarinic & antihistamine action CNS
Motion sickness, vestibular disorder & palliative care
162
Odansetron
Selective 5HT3-R ATG prevent N/V due to chemotx, radiotx, surgery
163
Parkinson CI indicated anti-emetics
haloperidol
metocloprammide
Use levomepromazine
164
Antiemetics for vertigo
Severe N/V: Buccal prochlorperazine
Less severe N/V: po prochlorperazine, cinnarizine, cyclizine, promethazine
165
po morphine to sc morphine
divide 2
166
po morphine to sc diamorphine
divide 3
167
po tramadol to iv morphine
divide 20
168
Breakthrough pain morphine
1/6 of total 24hr opioid dosage
169
Calculate alcohol unit for pure alcohol
strength (ABV) % x volume (ml)/ 1000 units
170
Neuroleptic malignant sy Tx
```
stop antipsychotic
Rapid cooling
iv fluids to prevent renal failure
Dantrolene: NMS muscle relaxant
DA-agent: Bromocriptine
```
171
NMS Sx
```
AMS: catatonia, mutism
hyperpyrexia
autonomic instability
metabolic acidosis
Rhabdomyolysis
LEAD PIPE RIGIDITY
```
SLOW ONSET 1-3d; no exposure to triggers!!
172
Neuropathic pain Tx
Away Goes D neruopathic Pain
Amitriptyline 1st line
Gabapentin, Duloxetine, Pregabalin
173
1% of lidocaine
1g/100ml
| 1000mg/100ml
174
medication to stop for dehydration pt
```
DAMN
Diuretics
ACEi/ ARB
Metformin
NSAIDS
```
175
osteoid osteoma characteristic
<1cm dense osteoid benign bone tumour
Pain worse @ night relieveed by NSAIDS!!!
176
Urge incontinence (Detrusor overactivity) Tx
Leakage of urine when there is sensation of need to void
```
Bladder drill (retraining): gradually increase periods betw voiding for 6wks
Antimuscarinic: oxybutynin
```
177
Benign prostatic hyperplasia Tx
drugs: alpha ATG (Tamsulosin, doxazocin, alfuzosin, prazosin)
5-alpha-reductase inhibitor: finasteride, dutasteride
TURP surgery
178
PSA level according to age
40-49: >2ng/ml
50-59: >3ng/ml
60-69: >4ng/ml
>70: >5ng/ml
179
Seminoma marker
LDH
180
yolk sac tumour of testes
AFP
181
VUR Dx
initial: Renal US + urinalysis, urine culture, sensitivity
Gold std: MCUG
Parencymal damage: cortical scars: DMSA
182
Hunner's ulcer
reddened mucosal area ass w/ small vessels radiating toward central scar ==> INTERSTITIAL CYSTITIS
183
epididymo-orchitis Empirical ABtx
STD: ceftriaxone 250mg im single dose + doxycycline 100mg po x2/d 10-14d
Enteric: ofloxacin OR ciprofloxacin
Pseudomonas: cefuroxime
184
Rhmatoid arthritis ass eye sx
keratoconjunctivitis sicca: most common
episcleritis: presents w/ erythema (pain also present but less severe than scleritis)
Scleritis: presents w/ erythema & pain
Iatrogenic steroid-induced cataracts
185
dacrocystitis tx
inflmmation of lacrimal sac result of infection
children: co-amoxiclav or defaclo
Adults: co-amoxiclav or defalexin
186
SLE Ab
anti-dsDNA; Anti-smith, ANA
187
drug induced lupus Ab
anti histone
188
Systemic sclerosis
anti-scl70
189
anti-centromere
limited sclerosis/ CREST sy
190
polymyositis
anti-jo> anti-mi
191
sjogren's disease Ab
anti-ro anti-la
192
PBC Ab
AMA
193
dermatomyositis
Anti-Mi> Anti-jo
194
Polymyalgia Rheumatica tx
Corticosteroid required for 1-2yrs
195
systemic sclerosis Ab
Anti-topoisomerase 1 (anti-Scl 70)
Anti-centromere Ab
Anti-RNA polymerase III Ab
Anti-fibrillarin (anti-U3RNP)
196
Giant cell arteritis tx
steroid: start immed 40mg prednisolone/ day
if claudication sx: 60mg/d
NEED osteoporosis prophylaxis needed: bisphosphonate
Low dose aspirin + PPI
197
Acute gouty attack tx
1st line: NSAIDS (diclofenac, naproxen, indomethacin)
Colchicine
corticosteroid when both fail!
198
Gout tx btw attacks
normally lifelong & regular monitoring needed
Allopurinol: never started during acute attacks wait for 1-2wk after attack resolves. May cause acute attack co-prescribe colchicine or low dose NSAIDS and do not stop their allopurinol during acute attacks!
199
reactive arthritis tx
NSAIDS, corticosteroid- intra articular injection or systemic tx
ABtx identified causative organism
200
de Quervain's tenosynovitis
washerwoman's sprain, gamer's tjumb
pain under root of thumb
201
Rheumatic arthritis
```
Rheumatoid facotr (+) 60-70%
anti-CCP Ab: if pt (-) for rheumatoid factor
```
202
Rheumatic arthritis Tx
DMARDS
1st line: hydroxychlorquine
Other: MTX, leflunomide, sulfasalazine
203
polymyalgia Rheumatica ass disease
temporal arteritis
ESR >30 CRP >6
204
Mikulicz's sy
persistent swelling of lacrimal & parotic gland
Dry mouth, face swelling
Lymphocytic infiltration
205
light criteria
pleural fluid protein/ serum protein >0.5
pleural fluid LDH/ LDH >0.6
Pleural fluid LDH ?2/3 upper limits of norm serum LDH
206
anti-emetic for increased ICP
cyclizine
Dexamethasone: help relieve the increased ICP by shrinking the oedema around the tumour & relieve the nausea & other sx
207
capsular pain management
NSAIDS: ibuprofen/ naproxen
208
analgesic ladder
1: paracetamol, NSAIDS, Aspirin
2: codein, tramadol, dihydrocodeine
3: morphine, fentanyl patches, diamorphine, oxycodone
209
Hiccups
metoclopramide: intractable hiccup due to liver pㅁ가metastasis--> periph hiccup due to diaphragmatic irritation by liver metastasis
210
Cystic Fibrosis screening test
Guthrie test: geel prick test 7-10d old
211
Alport Sy characteristics
SD
kidney disease: haematuria, proteinuria, ESRD
Hearing loss SNHL
Eye abnormalities
212
Jarisch-Herxheimer reaction tx
reaction to tx for Syphilis
antipyretics
reassure
213
Refeeding sy electrolyte disturbance
hypo phospate, Mg2+, K+
214
Neisseria gonorrhoea
uncomplicated gonococcal anogenital infection: Ceftriaxone 500mg im stat + (azithromycin 1g po stat NOT Anymore!!!!! )
215
Chlamydia tx
uncomplicated chlamydial infection: doxycycline 100mg x2/d 7d OR single dose 1g azithromycin
216
Meig sy
Benign ovarian tumour + ascites + pleural effusion
217
Meckel's diverticulum dx
initial dx: radioisotope scan
Definitive dx: laparotomy
218
Scarlet fever pathogen
strep pyogene
219
scarlet fever tx
ABtx: penicillin or azithromycin 10d; amoxicillin used in children if compliance w/ penicillin problem
2nd line: cephalosporin
220
Broncholitis
RSV 80%
supportive, NGT, humidified O2
221
croup tx
Parainfluenza virus
po dexamethasone
severe: O2 + nebulised adrenaline
222
otosclerosis
commonest progressive conductive hearing loss in Young Adults 15-45yrs
223
Dx prostate cancer
1. DRE
2. serum PSA
3. if clinically suspect localised prostate cancer: multiparametric MRI
4. follow up PSA
224
tetanus vaccine
2,3,4mo
3-5yr
13-18yrs
after 5th vaccine: immunity considered for life
225
Tetanus management
If dirty/ contaminated/ compound fracture
-yes: pt not fully accinated: tetanus Ig
if fully vaccinated 5 doses: do nOT give tetanus vaccine
if incomplete: give complete course of vaccine or full course of DTP
226
HIV PEP
start asap after exposure: n-safe sexual intercourse w/ high risk indiv, needle stick injury
48-72hrs continued for @ least 28d
reassure contact person: antiretroviral >6mo & HIV viral load <200
227
Generalised tonic-clinic seizure
Na-valporate; if unsuitable offer lamotrigine
228
Absence seizure
ethosuximide/ Na-valporate to children, young people & adults
229
focal seizure
carbamazepine/ lamotrigine
230
stroke management
Alteplase <4.5hrs
ASA 300mg for 2wks
clopidogrel 75mg
231
DOAC
READ
Rivaroxaban
endoxaban
apixaban
dabigatran
232
AFib management
Rate control: 1st line
RATE: BB/Ca2+; Amiodarone
233
Mallet finger
rupture of terminal extensor tendon attachment
234
SSRI
citalopramfluxetine
| Sertraline
235
SNRI
venlafaxine
| Duloxetine
236
TCA
amitriptyline
237
pericarditis vs dressler sy
percarditis 2d; dressler sy 2-6wks after MI
pleuritic chest pain worsens by lying flat during insp
Pericardial rub, widespread saddle shaped ST elevation
238
dressler sy
2-6wks post MI
autoimmune reaction against antigenic proteins formed as myocardium recovers
ECG: widespread saddle shaped ST elevatopm; PR depression
Tx: NSAIDS
239
LMWH example
dalteparin, enoxaparin
240
NSTEMI Tx
Aspirin 300mg+ ticagrelor 180mg + LMWH/ fondaparinoux
if low GRACE score: ASA, ticagrelor, BB, statin, ACEi
igh GRACE: PCI
V. high GRACE: GP IIb/IIIa (eptifibatide/ tirofiban)
241
oral candida infection tx
children: miconazole gel/ fluconazole 50mg od po for 7d OR fluconazole oral suspension
immunocompromised: po miconazole gel or by statin suspension.
242
menorrhagia only
tranexamic acid
243
menorrhagia w/ dysmenorrhoea
mefanamic acid
244
nerve injury with Colle's fracture
Median nerve
245
colles fracture definition
distal radial fracture where displacement of carpus dorsal/ posterior!!
dinner fork deformity
246
Smith/ reversed colle's fracture
distal radial fracture + displacement in volar/ anterior position!
Garden spade deformity
247
vestibular neuritis
inflammation of vestibular nerve but aetology vestibular neuropathy
Hx URTI
vertigo, vomiting
vertigo may be exacerbated by movement
248
Labyrinthitis
vertigo + Hx common cold + hearing loss/ tinnitus
249
Lewy body dementia
Parkinsonism + dementia + visual hallucination with or w/o delusion
fluctuating course w/ lucid intervals of hallucination
250
Shy Drager sy sx
Shy gy: erectile function, wets his pants
Drags his feet: cerebellar ataxia
Drops his BP: postural HoTN
251
Multiple systemic atrophy hallmark
glial cytoplasmic inclusion (GCI)
252
guillain-barre sy management
plasma exchange
IvIg: severe disease started w/in 2wks from onset
corticosteroid
253
Guillain-barre sy dx
LP: high CSF protein; NO elevation in CSF cell counts
Ab to periph & central nerves
Nerve conduction study most useful confirmatory test
254
acute cholecystitis management
stable pt: laparoscopic cholecystectomy
n-stable: emergency laparotomy
incidental finding gallstone: reassure
gallstone in CBD: laparoscopic cholecystectomy
255
Diphtheria dx
definitive: (+) culture from resp tract secretion or cutaneous lesion & (+) toxin assay
256
Diphtheria tx
ABtx: erythromycin, azithromycin, clarithromycin, penicillin
contacts: ALL contacts erythromycin/ penicillin
257
Erythema migrans
round pink/red/ purple erythema rash target like appearance caused by Lyme disease
258
which drugs shouldn't be used with levothyroxine
oral ferrous sulphate: Fe supplements interfere w/ absorption of levothyroxine
259
type of cough in croup & resp sx
barking cough
| STRIDOR: harsh low pitched noise during insp heard @ rest or only when child is agitated or active
260
X-ray or croup
steeple sign
261
Bronchiolitis resp sx
wheeze, crackles on chest auscultation
| Persistent dry cough
262
addison's disease definition
Primary adrenal insufficiency
low cortisol + aldosterone
263
Addison ass disease
vitiligo, Pri hypothyroidism, DM1, neuro deficits
264
adrenal crisis management
blood, cortisol, ATCH
Hydrocortisone 100mg iv stat, iv fluid bolus (crystalloid/ colloid); monitor blood glucose
continue: glucose iv if hypoglycaemic, iv fluids, continue hydrocortisone 120mg/8hrs iv/im
change to oral steroids after 72hrs
hydrocortisone iv/im: 100mg adult; 50-100mg >6yrs; 50mg 1-5yrs; 25mg <1yr
265
VT, SVT drug management
SVT: adenosine
VT: Amiodarone
266
radiation of aortic stenosis
radiate carotid
Ejection systolic
267
radiation of pulmo stenosis
radiate infraclavicular
| ejection systolic
268
radiation to mitral regurgitation
radiate Axilla
PAN systolic
269
LEFT vs Right heart murmur insp Or exp
LEFT: EXP
Right: insp
270
Straight heart border
Mitral valve stenosis
271
rupture of papillary muscle
2-15d postMI
Acute mitral regurgitation
early to mid systolic/ pansystmolic murmur
272
gold std for chronic pancreatitis dx
Contrast CT
273
Acute pancreatitis tx
NPO, iv infusion 0.9% saline, analgesia (pethidine, morphine)
274
migraine aura relationship
aura: gradual onset over min, last 5min-hr before H/A
275
galactosaemia sx
poor feeding, vomiting, hepatomegaly
Hepatomegaly, cataracts, mental handicap
yellow stool, pale urine
276
pre-eclampsia definition
SBP >140mmHg DBP >90mmHg in 2nd half or preg w/ >1+ proteinuria or >0.3g
277
MgSO4 side effect
confusion, loss of reflexes (deep tendon reflexes), resp depression, HoTN
278
Burn when to give fluid replacement
adult: >15% TBSA or child >10%
adult: 4ml Hartmann's solution/kg BW/ & total body surface area
half of this calculated bolume given in first 8hrs other half given over following 16hrs
children: replacement fluid above + maintenance 0.45% saline w/ 5% dextrose
279
parkland formula
TBSA (%) x weight (kg) x 4ml
280
anti-plt MI
Aspirin lifelong + ticagrelor/ clopidogrel 12mo
281
PCI anti-plt
Aspirin life + prasugrel or ticagrelor 12mo
282
TIA anti-plt
Aspirin 300mg 2wks the clopidogrel 75mg life
283
Afib + ischaemic stroke
Aspirin 300mg 2wks--> start anti-coagulation (warfarin/ DOAC)
284
Asthma steps
1. SABA
2. SABA + ICS
or alternative LT-R ATG/ Na-cromoglicate/ theophylline
3. ICS + LTRA
4. ICS + LABA
5. increase ICS or add LT-R ATG or tiotropium LAMA
6. oral steroids
285
life threatening asthma
1. O2 + nebulised salbutamol + ipratropium; po pred OR iv hydrocortisone
2. single dose MgSO4 1.2-2g over 20min
286
exercise asthma tx
SABA
SABA + ICS
SABA + ICS or LTRA/ LABA/ Na-cromogligate
287
Acute exacerbation adults
O2
SABA
Corticosteroid: iv hydrocortisone/ po prednisolone
288
MgSO4 indication
eclampsia- seizured
TdP
refractory asthma
289
Acute exacerbation in paeds
```
O2
SABA back to back
+ LAMA nebuliser
CS: po pred/ iv hydrocortisone
If still in asthma exacerbation: iv SABA/ iv aminophylline/ iv MgSO4
```
290
placenta praevia dx
TVUS
291
c8 radiculopathy sx
thumb abduction & extension, ulnar deviation of the write
292
T1 raddiculopathy
finger abduction + adduction
293
schistosomiasis sx
clacified contracted bladder & evidence of obstructive uropathy
S. mansoni: intestine, liver
S. haematobium: urinary bladder
294
Leptospirosis Dx
zoonotic infection
Red discolouration of eye- subconjenctival haemorrhage
Dx: blood first 7-10d
Urine: after 7d upto 30d
295
sulfonylureas eg
gliclazide/ glibenclamide
296
ECG of LV aneurysm
usually post MI 4-6wks
ECG: ST elevation + LV failure
297
HIV ass lymphoma
NHL
298
TIA ass w/ Afib management
DOAC (READ rivaroxaban, edosaban, apixaban, dagabitra)+ statin
299
RIA ass w/o AFib
clopidogrel + statin
300
Preop ABtx for colectomy
Cefuroxime + metronidazole
301
Number needed to treat
1/ absolute risk reduction
Absolute risk reduction= AR control - AR tx
302
Relative risk
risk of disease in exposed/ risk of disease in unexposed
303
Absolute risk
number of event in tx or control/ number of people in that group
304
Mycoplasma pneumoniae sx
Dry cough
| erythema multiforme/ erythema nodosum/ urticarial
305
Mycoplasma pneumoniae CXR
bilat patchy consolidation, reticular nodular shadowing
306
Legionella: sx, electrolyte disturb, CXR
tends to be most severe of penumonia. Natural water supplies & soil
HYPONa+
patchy alveolar infiltrates, bibasal consolidation
307
Legionella tx
Macrolide: clarithromycin/ azithromycin + (rifampicin)
fluoroquinolone, tetracycline
308
Klebsiella CXR
cavitating pneumo upper lobe
309
correction of deficit in children
deficit in ml= weight (kg) x % dehydration x 10
310
Maintenance fluid claculation in children
100ml first 10kg
50ml for next 10kg
20ml any weight after 20kg
311
Anal fissure tx
fluid intake, fiber diet
| 5% lidocaine ointment + GTN ointment 0.2-0.4% OR topical diltiazem 2%
312
ECG pulmo embolism
S1Q3T3
| RBBB
313
anaphylaxis tx
Adult: 0.5mg= 500ug un
>12yrs: 0.5mg= 500ug
6-12: 0.3mg= 300ug
<6yrs: 0.15mg= 150ug
314
antiphospholipid Ab
aPL
anticardiolipin
Lupus coagulation
315
antiphospholid management in preg pt
antenatal admin LMWH + low-dose aspirin 75mg throughout preg
316
vWD tx
tranexamic acid for mild bleeding
desmopressin: increase vWF
fVIII concentrate
317
Meningitis initial secondary care
dexamethasone: children ?3mo suspected/ confirmed bact meningitis asap 0.15mg/kg x4/d
Adults 10mg x4/d for 4d if penumococcal infection confirmed
318
meningitis menigococcis tx
iv ceftriaxone 7d
319
HIB meningitis
>3mo: ceftriaxone 14d
| adults: cefotaxime/ ceftriaxone
320
complication of tonsillectomy
pri haemorrhage: w/in first 24hrs inadequate haemostasis--> operation
Sec haemorrhage: after discharge 1-10d ABtx
321
hyperthyroidism tx in preg pt
PTU: preferred PREconception & T1
Carbimazole: T2 + T3
322
Hyperthyroidism tx
in emergency PTU> carbimazole
When not acute: carbimazole > PTU
BB
323
when should you add 2nd hypoglecaemic agent?
when HbA1c >58mmol/l
324
pericarditis tx
viral/ idiopathic: NSAIDS
ASA 2-4g/d
ibuprofen 1200-1800mg/d 7-14d
Indomethacin 75-150mg/d
325
Osler node
seen in IE painful, red nodules on had/ feet that can persist for hrs to days
326
Janeway lesion
IE: vascular
n-tender, small, erythematous/ haemorrhagic macular or nodular lesion on soles or palms
(they occur due to septic micro-emboli that deposit bacteria under skin)
327
n-sedating antihistamine
cetririzine, loratidine, fexofenadine
328
Central retinal artery occlusion
retina pale + macula cherry red spots + attenuation of vessels
329
Central retinal vein occlusion
retina haemorrhagic, flam-shaped scattering haemorrhage & macular swollen
330
Edward sy
trisomy 18
```
prominent calcaneus
Prominent occiput
microcephaly
micrognathia (small jaw)
hands clenched into fist
```
331
Patau sy
trisomy 13
```
prominent calcaneus
cleft lip + palate
microcephaly
microphthalmia (small eyes)
polydactyly
```
332
Alzheimer tx
ACHEi: Rivastigmine, Donepezil, Galantamine
2nd line: Memantine NMDA-ATG
333
Toxoplasmosis CNS lesion
Multiple ring-enhancing lesion
Foetal/ neonatal: ventriculomegaly, CNS calcification, placental changes, hepatomegaly, splenomegaly, ascites, pericardial/ pleural effusion
334
Bradycardia tx
1st line: atropin 0.5mg iv push repeat up to 3mg
2nd line: dopamine/ epinephrine
335
volvulus sx & imaging
BILIOUS vomiting common: Green or yellow vomiting presumed to have volvulus until proved otherwise!!!
AXR: dilated small-bowel loops, marked gastric or prox duodenal dilatation w/ or w/o intestinal gas & air-fluid level may be seen: Double bubble might be seen
336
When to give anti-D Ig to Rh (-) pt
28 & 34GW
337
restrictive lung disease lung function test
FEV1 decrease
FVC decrease
FEV1/FVC: normal
338
DIC management
Tx underlying condition
Transfusion plt/ plasma: severe bleeds or high risk of bleeding plt <50x 109/L
Bleeding pt w/ CID @ prolonged TP, aPTT: admin FFP
critically ill, n-bleeding pt: prophylaxis heparin/ LMWH
339
Placental abruption what to do first
1st: CTG!!! (not US)
if foetal distress: C/S
if norm: TVUS r/o placenta previa
340
Lichen Planus
topical steroid
Other: azathioprine, calcineurin inhibitor, mycophenolate mofetil, dapsone, retinoids
Psoralen + PUVA
341
Electrolyte in rhabdomyolysis
high: K+; phosphate
Low: Ca2+
342
G6PDH dx
G6PD enzyme activity definitive test: done 6wks after haemolytic episodes !!!
343
Hunner's ulcer
interstitial cystitis
344
interstitial cystitis management
1st line: bladder training, pelvic floor exercise, NSAIDS
2nd line: amitriptyline, oxybutynin, gabapentin
345
SVT management
1st: carotid massage
2nd: 6mg adenosine rapid iv bolus (CCB: verapamil if CI)--> give 12mg iv if no effect--> give 12mg iv adenosine
3rd: DC cardioversion
346
Epidural haematoma tx
If n-comatose pt EDH <30cm volume: conservative observe
>30cm3: surgical evacuation
high ICP: iv mannitol
347
metastasis of seminoma
para-aortic nodes
348
metastasis of teratoma
liver, lung, bone, brain (haematogenous)
349
Urine testing for UTI in children
<3mo: surgent microscopy & culture. Refer to paediatrician
>3mo <3yrs: urgent microscopy & culture. Wait for result before giving ABtx
>3yrs: if leukocyte esterase & nitrate (+): ABtx start
leukocyte esterase (-); nitrite (+): start ABtx
Leukocyte esterase (+); nitrite (-): send urine sample for microscopy & culture; only start ABtx if evidence of infection
350
UTI follow up examination in children
<6mo: USS during infection; DMSA 4-6mo after infection; MCUG
6mo-3yrs: USS w/in 6wks; DMSA 4-6months after acute infection, consider MCUG
>3yrs: USS w/in 6wks; DMSA 4-6mo after infection
If <6mo: US w/in 6wks
If >6mo: do NOT US if straightforward UTI
MCUG for >3yrs always wrong!!
351
Auspitz sign
psoriasis: vigorous scraping causes pinpoint bleeding
352
kobner's reaction
psoriasis: new lesion @ site of injury or trauma to skin
353
Polycythaemia rubra vera management
Low risk: phlebotomy, low dose ASA
High risk: cytoreductive- hydroxycarbamide & INF-alpha std 1st line, Busulfan, chlorambucil, pipobroman
JAK2: Ruxolitinib
354
sarcoidosis management
1st line: glucocorticoids
antimetabolite: MTX, azathioprine, leflunomide, mycophenolate
Anti-TNF: low dose glucocorticoids + antimetabolite
355
Cluster H/A management
Acute: sumatriptan + 100% O2 mask
Prophylaxis: verapamil 1st line; perdnisolone, Li, melatonin, topiramate, Na-valporate, ergotamine, nifedipine
