PM2 Flashcards
[] is the intervention of choice for severe mitral stenosis
Percutaneous mitral commissurotomy is the intervention of choice for severe mitral stenosis
A patient is waiting for PCI.
They are within 2hrs of a PCI centre / in a PCI centre.
What is the longest time they can wait from symptom onset before considering alternative to PCI treatment?
within 12 hours of symptom onset and within 2 hours of medical contact
If patients present more than 12 hours of symptom onset, pharmacotherapy should be the management of choice provided they are asymptomatic and stable
A mammogram typically shows a star or rosette-shaped lesion with a translucent centre AND asymptomatic with no evidence of lumps = ?
Radial scar
- A radial scar is a benign breast condition which can mimic a breast carcinoma. It describes idiopathic sclerosing hyperplasia of the breast ducts
What are contraindications to thrombolysis for PCI? [+]
Aortic Dissection
GI bleed
Allergic reaction
Iatrogenic: recent surgery
Neurological disease: recent stroke (within 3 months), malignancy
Severe HTN (>200/120)
Trauma, including recent CPR
Label the side effects
What platelet levels indicate a transfusion in a normal patient? [no ongoing bleeding]? [1]
A threshold of 10 x 109 except where platelet transfusion is contradindicated or there are alternative treatments for their condition
What are the platelet levels that would indicate a transfusion for patients with:
- a clinically significant bleeding risk
- severe bleeding from critical sites, such as CNS
Offer platelet transfusions to patients with a platelet count of < 30 x 10 9 with clinically significant bleeding (World Health organisation bleeding grade 2- e.g. haematemesis, melaena, prolonged epistaxis)
Platelet thresholds for transfusion are higher (maximum < 100 x 10 9) for patients with severe bleeding (World Health organisation bleeding grades 3&4), or bleeding at critical sites, such as the CNS.
What causes this change? [1]
What FBC would you expect to see with this? [2]
Sideroblastic anaemia is a condition where red cells fail to completely form haem, whose biosynthesis takes place partly in the mitochondrion:
- hypochromic microcytic anaemia
- high ferritin iron & transferrin saturation
Infective endocarditis infection with Strep bovis indicates which further investigations? [1]
Why? [1]
Colonoscopy
- important link with colorectal cancer. Need to consider colonoscopy and biopsy in these patients.
Patient with suspected IE.
ECG recording reveals new PR interval length to be increased.
What is the next appropriate treatment? [1]
The newly lengthened PR interval (1st degree heart block) suggests peri-valvular abscess as a complication of infective endocarditis - indicates need for valve replacement
History of subacute infective endocarditis x acute abdominal pain = ?
Infective endocarditis caused acute mesenteric ischaemia
Common exam question: PR interval prolongation in a patient with Infective Endocarditis is an indication for [] as it can be secondary to []
Common exam question: PR interval prolongation in a patient with Infective Endocarditis is an indication for surgery as it can be secondary to aortic root abscess
Which of the following types of renal stones are radio-lucent?
Triple phosphate stones
Cystine stones
Calcium phosphate
Xanthine stones
Calcium oxalate
Which of the following types of renal stones are radio-lucent?
Triple phosphate stones
Cystine stones
Calcium phosphate
Xanthine stones
Calcium oxalate
cystine stones: semi-opaque
urate + xanthine stones: radio-lucent
If it helps, I just remember that the stones at the back of the alphabet are radio-lucent - Urate and Xanthine :) and then cystine being semi-opaque is just a weird one to rote learn
You believe he has Balanitis Xerotica Obliterans. What can be associated with this condition?
Protection from cancer
Phimosis
Protection from infection
Prostate hyperplasia
Basal cell carcinoma
You believe he has Balanitis Xerotica Obliterans. What can be associated with this condition?
Protection from cancer
Phimosis
Protection from infection
Prostate hyperplasia
Basal cell carcinoma
Describe how changes in potassium relate to digoxin toxicity [2]
Hypokalemia increases the risk of digoxin toxicity by facilitating binding to the sodium-potassium ATPase pump, and in turn, digoxin toxicity can lead to hyperkalemia due to excessive pump inhibition
What is the first line management for persistent pneumothorax?
First-line management is with surgical pleurodesis.
his patient has several signs of chronic (high-pressure) retention: >1L retention volume, abnormal renal profile and possibly postobstructive diuresis (>200 mL/h).
How do you manage this patient? [1]
Leave the catheter in situ
- These patients should not have a trial without catheter (TWOC) as it can further exacerbate renal impairment. Instead, they should have a long term catheter until further specialist review with regards to the underlying cause
How do you treat WPW? [1]
definitive treatment: radiofrequency ablation of the accessory pathway
medical therapy: sotalol, amiodarone, flecainide
sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation
Anal fissures are normally located in which position?
More than 90% of anal fissures are located in the posterior midline of the anal canal. There is evidence that circulation here is poor and anal spasms further reduce blood supply.
What can you use to reverse digoxin toxicity? [1]
DigiFab or Digibind are digoxin specific antibodies used in digoxin toxicity to neutralise free digoxin
What are the symptoms of digoxin toxicity? [+]
dizziness, nausea and vomiting, palpitations, bradycardia, visual disturbances, confusion, and hyperkalaemia.
What is the MoA of digoxin? [1]
Inhibiting the Na+ K+ ATPase enzyme, also known as the sodium-potassium pump. This causes sodium to build up inside the heart cells, decreasing the ability of the sodium-calcium exchanger to push calcium out of the cells, consequently causing calcium to build up in the sarcoplasmic reticulum.
Increased intracellular calcium results in a positive inotropic effect, which in turn has the effect of increasing the force of the heart’s contractions.
Patient has heart failure and presents with:
* Yellow-green colour disturbance
* Visual haloes
* Confusion
what is your first differential? [1]
Digoxin toxicity
A person has SVT.
What pathology would be a contraindication to giving them adenosine? [1]
What would you give instead? [1]
Asthma - instead give them verapamil
How would you define functional incontinence? [1]
This involves an individual having the urge to pass urine, but for whatever reason they’re unable to access the necessary facilities and as a result are incontinent.
Cholera can present with diarrhoea and []
Cholera can present with diarrhoea and hypoglycaemia
Which two meaurements are used to monitor tx of haemochromatosis? [2]
Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis
A patient is in asystole. Whilst you are performing CPR they switch to VF.
How do you manage this patient? [1]
Continue the 2 min of CPR then prepare to shock
What is amyloidosis:
- pathophysiology?
- difference between primary and secondary?
Pathophysiology:
- extracellular and or intracellular tissue deposition of insoluble amyloid fibrils that prevent the normal functioning of tissues and organs affected
Primary:
- deposits of monoclonal light chains in tissue
Secondary:
- Due to malignancy or chronical microbrial infection
Describe the clinical features of amyloidosis
Describe how you diagnose and treat amyloidosis
Dx:
- The diagnosis of Amyloidosis requires a tissue biopsy that shows apple-green birefringence when stained with Congo red and viewed under polarised light
Tx:
- In amyloid AA, management of chronic infection and inflammation is important
- In amyloid AL, strategies similar to myeloma therapy can be used (eg. dexamethasone and bortezomib as a first line) with measurements of serum-free light chains to assess response
The INR of a patient who has recently started treatment for tuberculosis drops from 2.6 to 1.3. Which one of the following medications is most likely to be responsible?
Rifampicin
Streptomycin
Ethambutol
Isoniazid
Pyrazinamide
The INR of a patient who has recently started treatment for tuberculosis drops from 2.6 to 1.3. Which one of the following medications is most likely to be responsible?
Rifampicin
Streptomycin
Ethambutol
Isoniazid
Pyrazinamide
Rifampicin is a P450 enzyme inducer and will therefore increase the metabolism of warfarin, therefore decreasing the INR.
What is a sign that a patient might be suffering from salicylate
Tinnitus is a feature of salicylate poisoning.
The biopsy findings and rapid decline of more than 50% in eGFR are suggestive of [] [] glomerulonephritis
What would this show on an biopsy? [1]
Rapidly progressive glomerulonephritis, also called cresenteric glomerulonephritis
The biopsy findings would show epithelial crescents (crescent-shaped scars) in most glomeruli.
Describe a complication of peripheral TPN [1]
TPN contains a combination of glucose, lipids and essential electrolytes. It is highly irritant to veins - thrombophlebitis
What deficiency increases a risk of anaphylaxis? [1]
IgA
How would warfarin poisoning present on a clotting screen? [3]
Rasied APTT; PT and INR
Normal platelet count
What is the first line treatment for TTP? [3]
What’s the aim for this? ^ [1]
- Plasma exchange
- IV methylprednisolone
- Rituximab
Aim is to get rid of ADAMST13 antibodies
Burkitt lymphoma is associated with which chromosome swap? [2]
8-14
If a patient has recurrent VTE, what anti-coagulant and INR do you aim for? [1]
Lifelong warfarin - target of 3.5
What happens to insulin and c-peptide levels when have a glicazide OD? [1]
Both increase
What effect does haemodialysis have on HbA1C levels? [1]
Falsely low
Give 5 causes of falsely increased HbA1C [5].
Describe why this occurs [1]
B12 deficiency
IDA deficiency
Chronic alcoholism
Splenectomy
Pregnancy
All increase the lifespan of Hb
Give 5 causes of falsely decreased HbA1C [5].
Describe why this occurs [1]
SCA
Haemodialysis
Splenomegaly
Thal.
Decreases the lifespan of Hb
Name a neurological side effect of pred. use [1]
steroid pyschosis
Describe how you would investigate if you suspect patient has diabetic kidney disease [1]
Peform an A:Cr screen:
1. Spot sample
2. Repeat if abnormal
How can HIV lead to adrenal insufficiency? [1]
CMV related necrotising adrenalitis
Budd-Chiari presents with a triad of…
- ascites
- abdomen pain
- tender hepatosplenomegaly
A patient has cancer. Prevent with DVT. How long do u ac them? [1]
6 months
‘mirror image nuclei’ refers to which cell type? [1]
Reed-Sternberg cells (HL)
Pregnancy & DMT2 Tx? [2]
Meformin & Insulin
How do you manage AIHA? [4]
Blood transfusions
Prednisolone
Rituximab (a monoclonal antibody against B cells)
Splenectomy
State 5 triggers for cold AIHI [4]
lymphoma
leukaemia
EBV/HIV
SLE
What is the most common cause of warm AIHA? [1]
Warm autoimmune haemolytic anaemia is the more common type. Haemolysis occurs at normal or above-normal temperatures. It is usually idiopathic, meaning that it arises without a clear cause.
How do you treat acute mesenteric ischaemia? [1]
urgent surgery is usually required - laporoscopic
Increased MCV and isolated GGT = ?
Alcohol XS
Which of TRALI & TACO cause hyper/otenion? [1]
TACO - hypertension
TRALI - hypotension
If patient has COPD and undergo rapid oxygen desaturation - what is the likely cause? [1]
Mucus plugging
Most asthma exacerbations are:
- bacterial
- fungal
- viral
- viral
A patient has warm AIHA - where does the haemolysis usually occur? [1]
In extravascular sites like the spleen
What is the usual surgery that patients with FAP undergo? [1]
Total proctocolectomy with end ileal anastomosis
Describe the first line management for sigmoid volvulus [2]
- endoscopic decompression is first-line, using either flexible or rigid sigmoidoscopy - corrects the volvulus; can leave in and later remove
- If there is evidence of ischaemia, perforation or mucosal gangrene, surgical management is still required in the first instance; might be laporoscopic or a Hartmans
Tx of caecal volvulus? [2]
Ileocaecal resection
or
R hemicolectomy
This patient has received which drug for treating a tachycardia
Adenosine
Amiodarone
Atropine
Aspirin
This patient has received which drug for treating a tachycardia
Adenosine
Amiodarone
Atropine
Aspirin
When is an S3 considered normal? [1]
Under 30
S4 can be heard in which cardiac conditions? [2]
HOCM
AS
How do you treat acute [1] and chronic [1] hydronephrosis?
Acute: nephrostomy
Chronic: ureteric stent
First and second line tx for acute constipation? [2]
how do you treat opiod induced constipation? [1]
- Ipsaghula husk
- macrogol
opoid induced: senna
A patient is diagnosed with DMT1.
What insulin regime are they started with? [1]
Twice daily basal-bolus insulin determir (l.a) with **insulin aspart **(s.a)
Dx of achalasia? [1]
high resolution manometry
Swimming pool + gastro problems? [1]
Gardia lambia
Symptomatic perianal fistuala tx:
- simple? [1]
- complex? [1]
SImple: oral metronizadole
Complex: seton placement
Overdosing on which substances would indicate the following reversal agents? [4]
formepizone
desferrioxamine
flumazenil
bicarb
anti freeze - formepizone
heavy metals- desferrioxamine
benzos- flumazenil
salicylate/ tricyclics- bicarb
Which complication of haemochromatosis does venesection help to reduce? [1]
HF (induced by cardiomyopathy)
How do you treat SVCO? [1]
Give dexamethasone
A patient presents with lipomas, supernumerary teeth, osteomas, and epidermoid cysts.
A 25 year old male patient presents to the general practitioner with a 1 month history of constipation, PR bleeding, and weight loss. He reports a family history of gastrointestinal problems.
What is the most likely diagnosis? [1]
Gardner’s variant of familial adenomatous polyposis (FAP): lipomas, supernumerary teeth, osteomas, and epidermoid cysts. FAP is caused by mutation of 1 allele in the APC gene A tumour suppressor gene)
When is the use of morphine CI? [1]
Name two alternatives that can be used [2]
Renal impairment / dialysis
Can use oxycodone or tramadol
How would you manage a hypertensive emergency in a patient undergoing simultaneous ACS? [1]
In the context of ACS, the first-line treatment of a hypertensive emergency is IV GTN as in addition to lowering the blood pressure, it will lead to coronary vasodilatation and help provide pain relief
What do you give to reverse poisoining from anti freeze?
formepizone
desferrioxamine
flumazenil
bicarb
What do you give to reverse poisoining from anti freeze?
formepizone
desferrioxamine
flumazenil
bicarb
What do you give to reverse poisoining from benzos?
formepizone
desferrioxamine
flumazenil
bicarb
What do you give to reverse poisoining from anti freeze?
formepizone
desferrioxamine
flumazenil
bicarb
What do you give to reverse poisoining from heavy metals?
formepizone
desferrioxamine
flumazenil
bicarb
desferrioxamine
What do you give to reverse poisoining from salicylates?
formepizone
desferrioxamine
flumazenil
bicarb
What do you give to reverse poisoining from salicylates?
formepizone
desferrioxamine
flumazenil
bicarb
[] is the most common complication of haemodialysis.
Dialysis-induced hypotension is the most common complication of haemodialysis.
What stain type do you use for PCP? [1]
Silver Stain
A patient presents with the following, alongside respiratory symptoms.
Which infective organism is most likely to have caused this?
Mycoplasma pneumonia
A patient presents with the following, alongside respiratory symptoms.
Which infective organism is most likely to have caused this?
Streptococcus pneumonia
Herpes labialis
What are the four criteria that determines if something is ARDS? [4]
The four criteria:
- acute onset (within 1 week of a known risk factor)
- pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
- non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
- pO2/FiO2 < 40kPa (200 mmHg)
What do you give patients prior to bronchoscopy? [2]
Benzodiazepam - for sedation
Fentanyl - for pain
When do you use CMV serenegative components? [2]
Patients at risk of severe CMV disease:
- Pregnant
- Neonates
When do you give irradiated components? [4]
When plalelet concentrates indicated for transfusion? [4]
When are fresh frozen plasma transfusions indicated? [4]
Which extra-intestinal manifestation occurs independently of the disease activity of IBD?
Episcleritis
1
Scleritis
2
Erythema nodosum
3
Primary sclerosing cholangitis
4
Large joint arthritis
Which extra-intestinal manifestation occurs independently of the disease activity of IBD?
Episcleritis
1
Scleritis
2
Erythema nodosum
3
Primary sclerosing cholangitis
4
Large joint arthritis
What is the commonest cause of anovulation in women? [1]
PCOS
HLA class I is made from which loci? [3]
Which cells do the HLA class 1 loci present to? [1]
HLA A B, C: Class 1 (e.g. HLA-A)
Present to CD8T cell
Class 1 = 1 letter (1x8 = 8)
HLA class II is made from which loci? [3]
Which cells do the HLA class 1 loci present to? [1]
Class II: DP, DQ, DR
Present to CD4 T cells
Class 2; (4x2=8)
What is the difference between potency and efficacy with regards to drugs? [2]
Efficacy: relative ability of drug-receptor complex to produce maximum functional response
Potency: amount of drug needed to give desired effect
Which blood group is associated with a risk of gastric cancer
A
B
AB
O
Which blood group is associated with a risk of gastric cancer
A
B
AB
O
How do you calculate osm.? [1]
2x (Na + K) + glucose
How d you treat a thrombotic and embolic acute limb ischaemia? [2]
For thrombotic causes:
- Angiography for incomplete ischaemia. This helps map the occlusion site and plan for intervention. Potential endovascular procedures include angioplasty, thrombectomy, or intra-arterial thrombolysis.
- Urgent bypass surgery for complete ischaemia.
For embolic causes:
- the leg is typically threatened, and immediate embolectomy is required. If embolectomy fails, on-table thrombolysis may be considered.
