PT 1.0 Flashcards
Hypercalcaemia causes
- Primary hyperparathyroidism
- Malignancy:
-bony mets
-myeloma
-PTHrP from squamous cell lung cancer - Sarcoidosis
Viral meningitis LP vs Bacterial
Viral (commonly Coxsackie B): lymphocyte predominant, mildly elevated protein and normal glucose
Bacterial: low glucose, high protein, polymorphs
Acoustic neuroma (vestibular schwannoma) Sx
vertigo
hearing loss
tinnitus
absent corneal reflex
-CNVIII: unilateral sensorineural hearing loss, unilateral tinnitus
-CN V: absent corneal reflex
-CNVII: facial palsy
Ix: MRI cerebellopontine angle
Genital herpes Sx and Ix
Sx: painful ulcers, systemic upset, painful lymphadenopathy
Ix: nucleic acid amplification test
Tx: oral aciclovir
Bacterial vaginosis Sx + Mx
Gardnerella vaginalis
-Fishy offensive vaginal smell
-thin, white discharge
-ph >4.5
None if asymptomatic
Symptomatic- oral metronidazole 5-7 days
Bacterial vaginosis vs Trichomonas
BV: thin, white dischagre
Trich: frothy, yellow/green discharge, strawberry cervix and vuvlvovaginitis
Vaginal candidiasis (thrush) Sx, Ix, Mx
‘cottage cheese’ discharge
vuvitis- superficial dyspareunia, dysuria
itch
No Ix needed
Mx: oral fluconazole 150mg single dose
Bechet’s syndrome Sx
Oral and genital ulcers
Anterior uveitis
Thrombophlebitis/DVT
Syphillis Sx
-painless ulcer
-local non-tender lymphadenopathy
later can get:
-fevers, lymphadenopathy, painless warty lesions
Pain on drinking alcohol+ lymph node swelling
Hodgkin’s lymphoma
Testicular torsion vs epididymitis
TT: severe, unilateral pain and swelling, raising it does NOT alleviate pain
Epididymitis: elevation eases pain
Pneumonia + hyponatraemia
Legionella pneuomonia
Histo: Reed-sternberg/ large multinucleate cells with eosinophillic features/ mirror image nucleoi
Hodgkin’s lymphoma
Scabies treatment
Permethrin 5%, all household and close contacts should be treated
Psoriatic arthritis xray
erosions in joint- ‘pencil in cup’ appearance
Post op complications
5 Ws
Day 1-2: ‘Wind’ - Pneumonia, aspiration, Pulmonary Embolism
Day 3-5: ‘Water’ - Urinary tract infection (esp. if catheterised)
Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation
Day 5+: ‘Walking’ - Deep vein thrombosis or Pulmonary embolism
Any time: ‘Wonder Drugs’, transfusion reactions, sepsis, line contamination.
AAA surgery threshold
> 5.5cm / symptomatic
US every 3 months
Acute bronchitis Mx
with co-morbidities: oral doxycycline
without: supportive management
Heart failure CXR findings
Alveolar oedema (bat’s wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
COPD target 02 sats
Non-CO2 retainer: 94-98%
CO2 retainer: 88-92%
Check ABG to see if they are a CO2 retainer
Acoustic neuroma (vestibular schwannoma) Sx
-unilateral deafness/tinnitus
-vertigo
-absent corneal reflex
MRI of cerebellopontine angle
Otosclerosis Sx
-bilateral conductive hearing loss/ tinnitus
-+ve family history
-age of onset 20-40
Meniere’s disease sx
Hearing loss, vertigo, tinnitus and sensation of fullness or pressure in one or both ears
Episodic
Types of hypersensitivity
Type I: IgE e.g. hayfever, rhinitis, drug/food anaphylaxis
Type II: IgG/M e.g. transfusion reactions
Type III: IgG/IgM e.g. SLE, RA, post strep glomerulo
Type IV: T cell e.g. T1DM, MS
Perthes’ disease
Sx: Hip pain over a few weeks, limp, stiffnes and reduced movement
can have muscle wasting over hip and +ve trendelenburg
Dx: X-ray
Viral labryinthitis sx
Vertigo exacerbated by movement
N&V, hearing loss, tinnitus
usually self limiting, prochlorperazine may help with vertigo
COPD LOT threshold
If resting sats 92% test ABG,
if PO2 <7.3kPa, O2 therapy referral
Lupus flare vs infection
Flare: isolated rise in ESR
Infection: CRP, WBC, ESR raise
Pregnant women UTI
Symptomatic: nitrofurantoin
Asymptomatic: amoxicillin 7 days
Myeloma histology
Rouleaux formation
Sickle cell crisis sx + ix + mx
Vaso-occlusive events: obstruction of blood flow by sickled erthrocytes
Ix: haemoglobin electrophoresis
-analgesia, rehydrate, O2
chronic myeloid leukaemia blood film
increase in granulocytes at different stages of maturation +/- thrombocytosis
Sx: splenomegaly
multiple myeloma histo
increased number of plasma cells
Most common type of prostate cancer
Adenocarcinoma
Bilateral nerve block given in the vagina for instrument assisted delivery blocks which nerve?
Pudendal (supplies the vagina, external genitalia and perianal area)
Cerebral venous sinus thrombosis
Sx: headache, seziure, decreased GCS, raised ICP symptoms, papiloedema
RF: pregnancy, COCP
Dx: MRI with venography
Ovarian cancer on a bx of endometriosis histology
-endometrioid carcinomas with clear cell
in NON ENDOMETRIOSIS
serous carcinomas with epithelial cells
clozapine side effects
-agranulocytosis, neutropenia
-reduced seizure threshold
-constipation
-myocarditis
MOA + SE retinoblastoma
Loss of copies on both genes (C13)
SE: absence of red-reflex, strabismus and visual problems
COPD MOA
Proteolytic destruction of alveoli
Stages of labour
Active stage 1: 4cm dilated to fully
Stage 2: delivery
Stage 3: delivery of fetus and membranes
Phaeochromocytoma sx
hypertension
headaches
palpitations
sweating
anxiety
IX: 24 hour metanephrines
Mx: initially alpha blocker e.g. phenoxybenzamine then surgical
primary hyperaldosteronism Sx
hypertension, hypokalemia (muscle weakness)
Mastitis Mx
1st line: continue breastfeeding with analgesia + warm compress
If sign of infection or not improving, give 10 days oral flucloxacillin 10-14 days which can be breastfed with
Pre-eclampsia vs eclampsia Mx
Pre-eclampsia management: Oral labetalol
Eclampsia management: Magnesium sulfate (to prevent seizures in severe pre-eclampsia and if seizures begin)
Calcium channel blocker SEs
HF, constipation, hypotension, heart failure, ankle swelling
IgA nephropathy vs Post-Streptococcal glomerulonephritis
IgA: HPP rash, 1-2 days posst URTI, haemturia, arthralgia
PSG: oedema, hypertension, headache, proteinuria
DVT prophylaxis in pregnancy
apixaban is NOT safe in pregnancy
Dalteparin is
Ibuprofen pregnancy RF
Premature closure of ductus arteriosus
Epidural drug used
Bupivacaine
what receptors do atypical antipsychotics work on?
dopamine D2 receptors
what are the main inhibitory and excitatory neurotransmitters in the CNS?
Exitatory: glutamate
Inhibitory: GABA
Scleritis vs episcleritis vs anterior uveitis
Scleritis (RA/SLE): painful red eye
Episcleritis: red eye not painful
AU: acute painful may have small irregular pupil worse at night
any painful eye gets same day opthal assessment
Neutropenic sepsis
usually 7-14 days after chemo
-high temp (>38)
cause: coagulase-negative, Gram-positive bacteria are the most common cause, particularly Staphylococcus epidermidis
ANTIBIOTICS IMMEDIATELY!
ARB side effects
hypotension, hyperkalemia
UMN vs LMN signs
UMN: INCREASED tone, rigidity and spasticity
Increased reflexes
Babinski +ve
LMN: DECREASED tone, muscle wasting and fasciculation,
Decreased or absent reflexes
Normal/no movement
AAA screening
-Less than 3cm: no action
-3-4.4cm: rescan every 12 months
-4.5-5.4cm: rescan every 3 months
->5.5cm: 2ww for surgery
Benign rolandic epilepsy
-childhood epilepsy syndrome
can occur in sleep/ clusters
sx: unilateral facial sensorimotor signs e.g. tongue paraesthesias, cheeck numbness, dysphagia
can also have tonic clonic movements
Most common nerve damage with humerus fracture
radial (C5,6,7,8, T1)
