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Passmed finals > Quesmed 2 > Flashcards

Quesmed 2 Flashcards

1
Q

No association between the p waves and QRS complex =>

A

Complete heart block

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2
Q

Signs of Brown-Sequard syndrome

A

Ipsilateral paralysis
Loss of vibration and hyperreflexia below the lesion
Contralateral loss of pain and temperature sensation

Spinal Cord Disease

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3
Q

Features of Henoch-Schonlein purpura

A

Rash
Abdominal pain
Arthralgia
Glomerulonephritis

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4
Q

Mx of Henoch-Schonlein purpura

A

Analgesia and supportive
Corticosteroids

If pain severe, consider surgical referral

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5
Q

Ix for ?PE in pregnant woman

A

V/Q scan

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6
Q

Episodes of low mood, now seen believing she has super strength, Dx?

A

Bipolar disorder

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7
Q

Lower back pain, warm to touch, Hx od IVDU, systemically unwell =>

A

Discitis

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8
Q

Ix for discitis/osteomyelitis

A

Inflammatory markers
Imaging
MRI

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9
Q

Mx of osteomyelitis

A

Antibiotics for a minimum of 4 weeks, usually 3-6mo!

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10
Q

Drug to give alongside IV antibiotics (ceftriaxone) in bacterial meningitis

A

IV dexamethasone

To reduce inflammation and reduce side effects such as hearing loss and neurological sequelae

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11
Q

Treatment of vancomycin resistant enterococci

A

Linezolid

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12
Q

Antibiotic for pyelonephritis

A

IV ciprofloxacin

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13
Q

Symptoms of toxic shock syndrome

A

Shock
Fever
Erythroderma (red man syndrome)

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14
Q

Typical Hx of toxic shock syndrome

A

Wound (maybe while gardening)
Or tampon left in too long
Exotoxin released and causes widespread cytokine release

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15
Q

RF of toxic shock syndrome

A

Diabetes
Wounds
HIV
Tampon use

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16
Q

What is streptococcus bovis associated with??

A

Colerectal carcinoma

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17
Q

ix for infective endocarditis

A

BLood cultures
FBC
CRP
Echocardiogram

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18
Q

Different causal spread for septic arthritis

A

Local (from say wound or osteomyelitis)
Haematogenous (IVDU)
Direct inoculation (car injury)

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19
Q

Swinging fevers coming on predictably every 2 days, accompanied by rigors and night sweats. In Kenya recently. Ix and Dx?

A

Malaria

Thick and thin blood films

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20
Q

Post spinal surgery
Now has pain at the lower back, even to percussion
Ix?
Dx?

A

MRI

Osteomyelitis

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21
Q

RF for osteomyelitis

A

Diabetes mellitus
Orthopaedic surgery
Malnutrition
Immunosupression

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22
Q

Symptoms of osteomyelitis

A

Fever
Pain
Swelling
Erythema

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23
Q 
Fever
Malaise
Painful joints 
Several lesions on torso surrounded by annular (tree like) rings 
Raised anti-streptolysin O titres 
Dx
Rx?
A

Rheumatic fever

Benzylpenicillin

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24
Q

Antibiotic for pseudomonal urinary tract infections

A

Gentamicin

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25
Q

Treatment of tapeworm

A

Praziquentel and niclosamide

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26
Q

Drug treatment for most parasites (tapeworm, schistosomiasis)

A

Praziquentel

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27
Q

Which WBC is raised in parasitis infection?

A

Eosinophil

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28
Q

A 4 year old girl is brought into Paediatric Emergency with a 2 day history of high fever and irritability. She has developed red, peeling skin over the past day. Her mother reports that she had a sore throat prior to this, which has since resolved. On examination, she has widespread erythema with several blisters. Her skin is extremely tender to touch and peels easily when rubbed.

What is the most likely diagnosis?

A

Staphylococcal scalded skin syndrome

Positive Nikolsky sign (layers of skin seperate with gentle pressure)

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29
Q

What is the tourniquet test used for

A

Dengue fever

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30
Q

What is the thinking behind the tourniquet test?

A

Recommended by WHO to differentiate between Dengue fever and gastroentertis
Put the tourniquet on for a while and see if theres lots of petichiae => dengue fever

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31
Q

What should you do when you hear an innocent murmur?

A

Review again in 2 weeks

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32
Q

What often precipitates an innocent murmur?

A

Viral illness

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33
Q

Important side effects to counsel regarding isotretinoin

A

Teratogenicity

Suicidal risk

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34
Q

How do retinoids work

A

Reduce sebum production

Inhibit bacterial growth

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35
Q

Stepwise management of acne vulgaris

A

1st line (mild Acne) = topical Benzoyl Peroxide

2nd line (mild Acne) = topical antibiotic or topical retinoid

3rd line (moderate Acne) = oral antibiotic or oral anti-androgen (females only)

4th line (severe Acne) = oral retinoid

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36
Q

Symptoms of allergic rhinitis

A 
Nasal obstruction
Clear nasal discharge
Sneezing 
Nasal itching 
Eye redness and watery discharge
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37
Q

Pathophysiology of allergic rhinitis

A

IgE mediated response to allergens (commonly pollen)

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38
Q

Treatment of subdural haemorrhage (tends to present gradually with increasing headache and confusion).

A

Depends on if a clot has organised but can involve supportive measures, mannitol or surgery e.g. burr hole craniostomy

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39
Q

RF of subdural haemorrhage

A

Historic head trauma
Alcoholism
Anticoagulation

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40
Q

Features of extradural haemorrhage

A

Severe headache
Lucid period
Biconcave haematoma on CT scan

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41
Q

Features of extradural haemorrhage

A

Severe headache
Lucid period
Biconcave haematoma on CT scan

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42
Q

Features of sub-arachnoid haemorrhage

A

Seizures
Neurological deficits
Decreased consciousness

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43
Q

Treatment of bullous pemphigoid

A

Very potent topical steroids e.g. dermovate

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44
Q

Pemphigoid is deep or superficial?

A

Deep because oiD

So you get large tense blisters

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45
Q

Features of cataract

A

Glare
Worse vision at night
Myopic shift (pt becomes more short sighted because the lens becomes more refractive!)

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46
Q

RF of cataracts

A

Diabetes
Smoking
Alcohol

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47
Q

Treatment of cataract

A

Catract surgery

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48
Q

1st line treatment of H.pylori +vs

A

Amoxicillin
Clarithromycin
Omeprazole

So called triple therapy

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49
Q

7 days after initiating triple therapy, still H.pylori positive, what do you swap the clarithromycin for?

A

A tetracycline

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50
Q

A pharyngeal pouch is also known as….

A

Zenker’s diverticulum

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51
Q

Diagnostic test for COPD

A

Spirometry

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52
Q

Causes of pulmonary fibrosis

A 
Coal dust 
Idiopathic 
Extrinsic allergic alveolitis 
Systemic sclerosis 
Amiodarone
Methotrexate
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53
Q

What is gastroparesis?

A

Syndrome of delayed gastric emptying in the absence of mechanical obstruction

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54
Q

Features of gastroparesis

A 
Post-prandial fullness
Nausea
Vomiting 
Bloating 
Abdominal pain

Can be caused post bariatric surgery

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55
Q

RF of developing gastroparesis

A

Poorly controlled diabetes (because neuropathy)

Parkinson’s disease

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56
Q

Diabetic patients not eating or drinking, what should you do?

A

Variable rate infusion

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57
Q

Which dermatome supplies the medial thigh sensation?

A

L3 dermatome

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58
Q

Colorectal cancer with a single liver met, what should you do?

A

Resection of both

5x increased rate of survival after 5 years

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59
Q

1st line investigtion of ?bladder cancer

A

Cytoscopy

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60
Q

Complications of coeliac disease

A

Osteoporosis (DEXA scan)

Cancer

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61
Q

Parvovirus can cause what significant complication?

A

Aplastic anaemia

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62
Q

GnRH analogue prescribed for prostate cancer, now has weakness in legs and incontinence, which investigation should you do?

A

MRI spine
Sounds like cauda equina
Probably bone metastases exacerbated by GnRH analogues

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63
Q

What might you see on LP in MS

A

Oligoclonal bands of immunoglobulin

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64
Q

What crucial things must you ask if you are suspecting HOCM?

A

FH

Any episodes of syncope (poor prognosis)

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65
Q

What Ix would you like to do for a pt of African origin with a neck swelling and FLAWS?

A

Blood film

Looking for starry sky appearance of Burkitt’s lymphoma

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66
Q

Child with pain and swelling in the knees after exercise with joint locking

A

Osteochondritis dissecans

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67
Q

Gold standard treatment of STEMI

A

PCI

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68
Q

Surgical treatment of prostate cancer

A

Robotically assisted laparoscopic postatectomy (RALP)

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69
Q

What can happen to blood pH in AKI?

A

Can get metabolic acidosis due to poor clearance of H+

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70
Q

Optimal pain killer in renal impairment

A

Oxycodone

Tramadol

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71
Q

1st line Parkinson’s treatment when already have functional impairment

A

Levodopa

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72
Q

1st line Parkinson’s patient treatment when young and functional

A

Ropinirole

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73
Q

What diagnosis must you consider if croup treatment doesn’t resolve symptoms

A

Bacterial trachietis

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74
Q

Treatment of croup

A

Humidified oxygen
Dexamethasone
Nebulised adrenaline

75
Q

Malignancies that metastasise to bone

A 
BLT and Kosher Pickle 
Breast
Lung 
Thyroid
Kidney 
Prostate
76
Q

Features of atopic eczema

A

Most common form of eczema
Dry, pruritic, erythematous rash
Often on the extensor aspects and on the face when young
Then in the flexors when older

77
Q

Major Dukes criteria

A

Organisms in 2 seperate blood culture sets

78
Q

Ix for infective endocarditis

A

ECG
Chest Xray
Blood tests: FBC, UE, LFT, CRP
At least 3 sets of blood cultures should be taken at different times from various sites.
Transthoracic echocardiogram is the first line imaging investigation
Transoesophageal echocardiogram is the most sensitive diagnostic test

79
Q

Febrile, SOB, background of uncontrolled HIV, x-ray shows bilateral ground glass opacification prominent in the lung bases
Dx?

A

PCP

80
Q

Treatment for PCP

A

Co-trimoxazole

81
Q

Critically unwell patient with cellulitis, most important treatment

A

Debridement and washout

Probably necrotising fasciitis

82
Q

Severe pain in one arm, lost weight recently, wasting of hand and sensory loss
Same sided ptosis and aniscoria (uneven pupils)

A

Squamous cell lung carcinoma

Pancoast tumour

83
Q

What test might you do if you suspect legionella pneumonia?

A

Urinary antigen testing

84
Q

Management of essential tremor

A

Propranolol but can be managed conservatively

85
Q

Symptoms of epidural haematoma

A

Recent epidural
Recovered fine then started to get back pain and shooting sensations down the legs as well as potential bladder incontinence

Basically Sx of cord compression

86
Q

Risks of epidural

A

Hypotension
Dural puncture -> severe postural headache
Epidural haematoma

87
Q

Most appropriate pain relief mediciations in trauma

A

Morphine

IV paracetamol

88
Q

Most common complication of haemodialysis

A

Dialysis-induced hypotension

89
Q

Most common organism to cause peritoneal dialysis peritonitis

A

Staphylococcus epidermidis

90
Q

Presentation of peritoneal dialysis peritonitis

A

Abdo pain
Fever
Cloudy dialysis bag

91
Q

Management of peritoneal dialysis peritonitis

A

Take a sample of the fluid for culture

IV antibiotics

92
Q

RF for UTI

A

Contraceptive diaphragm, recurrent sexual intercourse, catheterisation, diabetes mellitus

93
Q

Causes of pseudohyperkalaemia

A

Traumatic venepucture
Prolonged tourniquet use
Delayed analysis of sample

94
Q

Which drugs can cause hyperprolactinoma

A

Typical anti-psychotics e.g. haloperidol, risperidone

95
Q

What type of drug is goserlin

A

LH blocker

Reduces testosterone production

96
Q

If pain is not being controlled on morphine, by how much do you increase the total dose?

A

1/3 more

E.g. 90->120

97
Q

What proportion of the total dose should be for breakthrough pain?

A

1/6

98
Q

Treatment of oral candiadiasis

A

Oral fluconazole

99
Q

Management of decompensated liver disease (chronic, cirrhosis)

A

Good nutrition and alcohol abstinence
Avoid NSAIDs and opiates
Cholestyramine to manage pruritis
Fluid restriction (reduce ascites)

100
Q

What should you check for in Myasthenia Gravis?

A

Thymoma

101
Q

What should you check for if Dx of Grave’s?

A

Coeliac disease

102
Q

Investigation features of Paget’s disease

A

Normal electrolytes but very raised ALP
Osteolytic, osteoblastic and sclerotic appearance on x-ray
Bone pain and deformity

103
Q

What might hand preference before 2yr old suggest?

A 
Cerebral palsy 
Spastic hemiplegia (basically a type of cerebral palsy)
104
Q

Buttock wasting and claudication =>

A

Leriche syndrome

105
Q

How long does a positive B-hCG remain after termination of pregnancy?

A

6w

106
Q

How long can vaginal loss following termination continue?

A

6w

107
Q

The definitive diagnosis of PID

A

Laparoscopically

108
Q

HIV+ patient with sudden onset severe abdominal pain, which organism could be causing it?

A

Mycobacterium avium

109
Q

Multiple smooth lesions on the edge of the glans of the penis, Dx?

A

Pearly penile papules

110
Q

What is Jarisch-Herxheimer reaction?

A

Antibiotics leading to death of bacteria -> release of toxins -> rigors and fever
Reassure and discharge with paracetamol

111
Q

Gene associated with Marfan’s

A

Fibrillin 1

112
Q

Longstanding syphilis with thickened aorta, Dx?

A

Cardiosyphillis!

113
Q

Most likely causative organism in epididymorchitis

A

E.coli

114
Q

A 42 year old female visits A&E with exertional shortness of breath.

A chest X-ray is requested and demonstrates bilateral bihilar interstitial infiltrates.

She has a past history of using intravenous drugs.

Given the most likely diagnosis, what is the most appropriate initial treatment?

A

Co-trimoxazole

115
Q

Most common cause of PID

A

Chlamydia

116
Q

Treatment of Fitz-Hugh-Curtis syndrome

A

Doxycylcine

117
Q

Multiple painful genital ulcers =>

A

Herpes

118
Q

Ix for HSV

A

PCR

Take sample from base of the ulcer

119
Q

Ix for chlamydia

A

NIAA and urine sample

120
Q

Management of asymptomatic mitral stenosis

A

Follow up in 6 months time

121
Q

Features of mitral stenosis

A

Mid diastolic murmur loudest at apex on expiration

122
Q

Main Ix for murmur

A

Echocardiogram

123
Q

Symptoms of hypoglycaemia

A 
Shaking/trembling
Sweating
Palpitations
Hunger
Headache
Double vision and difficulty concentrating
Slurred speech
Confusion
Coma
124
Q

Mx of hypoglycaemia (BM <3) in pt able to swallow?

A

10-20g fast acting carbohydrate = 1-2 tubes of glucogel

125
Q

A 35-year old East Asian lady presents to the A&E department complaining of a headache, which came on quite suddenly last evening. She also feels very nauseous and noticed her left eye becoming quite red.

Apart from having migraines as a teenager, she is otherwise fit and healthy with no significant past medical history. She recently started taking amitriptyline as she had trouble sleeping. She has no drug allergies.

Dx

A

Acute closed angle glaucoma aggrevated by amytriptylline use

126
Q

Initial Mx of acute closed angle glaucoma

A 
Topical timolol (beta blocker to open up angle)
IV acetazolamide (carbonic anhydrase inhibitor)
Pilocarpine eye drops (muscarinic antagonist)
127
Q

What type of drug is acetazolamide?

A

Carbonic anhydrase inhibitor

128
Q

Brain tumour that crosses both hemispheres

A

Gliobastoma

129
Q

Ix for suspected brain cancer

A

MRI

130
Q

Where is BNP released from

A

Ventricles

131
Q

What is Chagas disease?

A

Big old bug bites you and you end up getting heart failure

132
Q

Criteria for long term oxygen therapy in COPD

A

Low paO2 (<7.3)
OR
PaO2 <7.8 and other signs, such as pulmonary hypertension (pulmonary artery pressure >25) or pulmonary oedema

133
Q

Many circular target lesions =>

A

Erythema multiforme

134
Q

Triggers of erythema multiforme

A

Herpes

Other infections

135
Q

Management of erythema multiforme

A

Usually conservative

136
Q

Causes of metabolic alkalosis

A 
Loss of chloride:
Vomiting
NG suction
Diuretics (thiazides, loop diuretics)
Diarrhoea (e.g. chloride secreting villous adenoma)
Cystic fibrosis
Loss of potassium:
Primary hyperaldosteronism
Cushing’s syndrome
Liquorice
Bartter’s, Liddle’s and Gitelman’s syndromes

Other causes:
Milk-alkali syndrome
Carbonate overuse
Massive transfusion

137
Q

Virus causing chickenpox

A

VZV

HHV3

138
Q

A 63-year-old man is admitted to the hospital the day before an elective hernia repair. His medical history includes polymyalgia rheumatic for which he takes 15mg prednisolone OD orally.

What is the most appropriate perioperative management of his steroid therapy?

A

Stop the prednisolone (he’s going to be going NBM) and change to IV hydrocortisone (50-100mg)

139
Q

Neurological examination reveals reduced power in the proximal muscles of the lower limb and hypo-reflexia in the knee and ankle reflexes. The doctor demonstrates the case to his colleague and notes that on repeated testing of the lower limb reflexes, they become more brisk.
Dx?

A

Lambert-Eaton syndrome

140
Q

Chief Ix for pancytopaenia

A

Bone marrow biopsy

141
Q

Ix for Down’s syndrome

A

Quadruple testing
Chorionic villus sampling (<14w)
Amniocentesis (14w

142
Q

Features of uterine inversion

A

Normal birth then suddenly the fundus cant be palpated

143
Q

Initial management of uterine inversion

A

Push the fundus back

144
Q

What other feature can be present with Bell’s palsy?

A

Altered taste

Dry eyes

145
Q

Treatment of Paget’s disease

A

Bisphosphonates

146
Q

Long term treatment of provoked PE

A

3 months warfarin

147
Q

Couple of hours after carotid surgery, tongue deviation to one side, most likely cause?

A

Hypoglossal nerve injury (deviates to the side of the lesion)

148
Q

Which type of lung cancer can raise calcium levels?

A

Squamous cell carcinoma

Releases PTHrP which liberates calcium

149
Q

Confused patient with large postural drop. Blood results show low sodium and high potassium. U&E show raised creatinine and urea. Dx?

A

Addison’s disease

Causing hypovolaemia

150
Q

Management of crescendo TIA

A

300mg aspirin and review in TIA clinic in 24hr

151
Q

What bedside test should you do for SLE?

A

Urine dipstick to check for lupus glomerulonephritis

152
Q

Treatment of emergency Addisonian crisis

A

IV hydrocortisone
Replace that glucocorticoid!
Aggressive fluid rescucitation

153
Q

Causes of Addison’s disease

A

Auto-immune (most-common)
Surgical removal
Trauma
Infections (Tuberculosis: more common in the developing world)
Haemorrhage (Waterhouse-Friderichsen syndrome)
Infarction
Less common: neoplasm, sarcoidosis, amyloidosis

154
Q

Which drug can you use to replace mineralocorticoid

A

Fludrocortisone

155
Q

Test you can use like a D-dimer to rule out long standing Addison’s

A

Morning serum cortisol

If this is inconclusive, then you can do ACTH stimulation

156
Q

When should patient with migraines with aura take their sumatriptan?

A

Take it when the headache starts, NOT when the aura starts

157
Q

Which type of lung cancer is classically associated with paraneoplastic syndromes?

A

Small cell cancer
Cushingoid and SIADH
So they have Cushingoid symptoms and barely pissing

158
Q

Blood findings in haemolytic uraemic syndrome

A

Anaemic
Thrombocytopenic
Raised bilirubin
Uraemic

159
Q

Triad of HUS

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute Kidney Injury

160
Q

Most common cause of viral meningitis

A

Enteroviruses such as coxsackie virus

161
Q

Causes of high SAAG

A 
Cirrhosis
Heart failure
Budd Chiari syndrome
Constrictive pericarditis
Hepatic failure
162
Q

Causes of low SAAG

A

Cancer of the peritoneum
Tuberculosis and other infections
Pancreatitis
Nephrotic syndrome

163
Q

Management of ascites

A

Low salt diet
Address the cause
Spironolactone

164
Q

Signs of Charcot Marie Tooth syndrome

A

Champagne bottle legs

A sort of foot drop bilaterally

165
Q

Ix for Charcot Marie Tooth

A

Nerve studies

166
Q

4 Ts of post partum haemorrhage

A

Tone
The most common cause of PPH is uterine atony, which is the failure of the uterus to contract after delivery.
Trauma
PPH may come from a birth canal injury or tear. This risk is increased in instrumented deliveries.
Tissue
Retained placental or fetal tissue can lead to continued bleeding
Thrombin
Coagulopathies can lead to continued bleeding due to a failure of clotting.

167
Q

Small brown spot on finger, rapidly grew over the course of a week to a shiny red nodule that’s causing a bit of discomfort. Whats the Dx and what can precipitate the condition?

A

Pyogenic granuloma

Microtrauma

168
Q

Gene associated with FAP

A

APC

169
Q

Causes of bilateral conductive hearing loss

A

Otosclerosis

Wax impactation

170
Q

Management of otosclerosis

A

Hearing aid

171
Q

1st line ADHD medication

A

Methylphenidate

172
Q

RF for devleoping glaucoma

A

Long sighted (because narrower angle)

173
Q

3 important red eye differentials

A

Acute angle-closure glaucoma
Anterior uveitis
Scleritis

174
Q

Easy Ix to consider to rule out organic causes of dementia

A

Serum B12 as a vit B12 deficiency can cause cognitive decline

175
Q

Management of SVCO syndrome brought on by hilar lung cancer

A

IV dexamethasone to reduce swelling of cancer

176
Q

What is Pemberton’s sign?

A

Sign of SVCO

Put arms above head and see if the face swells up

177
Q

How to categorise abdominal pain

A 
Gynaecological = torsion, ruptured cyst, ectopic
Gastrointestinal = IBD, diverticulitis
Vascular = mesenteric ischaemia
178
Q

1st line management for Bell’s palsy presenting within 72hr

A

Oral prednisolone

179
Q

Thickening of skin in neck and axilla =>

A

Acanthosis nigricans

180
Q

Features of PCOS

A 
Acanthosis nigricans 
Infertility
Acne 
Hirsuitism 
Irregular periods
181
Q

Ix for PCOS

A

TVUSS

182
Q

Causes of primary amenorrheoa

A

Chromosomal or genetic abnormalities such as Turner syndrome (45 XO), Kallmann syndrome and androgen insensitivity syndrome.
Disruption of the functioning of the hypothalamic or pituitary glands. For example as a result of:
Anorexia and other eating disorders,
Excessive exercise
Extreme physical or psychological stress

Structural abnormalities of the genital tract such as:
Imperforate hymen obstructing menstrual flow (leading to haematocolpos)
Uterine agenesis

183
Q

Management of pancreatic insufficiency in CF (presents as diarrhoea, weight loss, recurrent abdo pain)

A

Creon

Artificial pancreatic enzymes

184
Q

Which drugs can cause acute interstitial nephritis (more signs of immune cell deregulation, urticaria etc)

A

Omeprazole
NSAIDs
Phenytoin

Passmed finals (17 decks)

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