Quesmed 2 Flashcards
No association between the p waves and QRS complex =>
Complete heart block
Signs of Brown-Sequard syndrome
Ipsilateral paralysis
Loss of vibration and hyperreflexia below the lesion
Contralateral loss of pain and temperature sensation
Spinal Cord Disease
Features of Henoch-Schonlein purpura
Rash
Abdominal pain
Arthralgia
Glomerulonephritis
Mx of Henoch-Schonlein purpura
Analgesia and supportive
Corticosteroids
If pain severe, consider surgical referral
Ix for ?PE in pregnant woman
V/Q scan
Episodes of low mood, now seen believing she has super strength, Dx?
Bipolar disorder
Lower back pain, warm to touch, Hx od IVDU, systemically unwell =>
Discitis
Ix for discitis/osteomyelitis
Inflammatory markers
Imaging
MRI
Mx of osteomyelitis
Antibiotics for a minimum of 4 weeks, usually 3-6mo!
Drug to give alongside IV antibiotics (ceftriaxone) in bacterial meningitis
IV dexamethasone
To reduce inflammation and reduce side effects such as hearing loss and neurological sequelae
Treatment of vancomycin resistant enterococci
Linezolid
Antibiotic for pyelonephritis
IV ciprofloxacin
Symptoms of toxic shock syndrome
Shock
Fever
Erythroderma (red man syndrome)
Typical Hx of toxic shock syndrome
Wound (maybe while gardening)
Or tampon left in too long
Exotoxin released and causes widespread cytokine release
RF of toxic shock syndrome
Diabetes
Wounds
HIV
Tampon use
What is streptococcus bovis associated with??
Colerectal carcinoma
ix for infective endocarditis
BLood cultures
FBC
CRP
Echocardiogram
Different causal spread for septic arthritis
Local (from say wound or osteomyelitis)
Haematogenous (IVDU)
Direct inoculation (car injury)
Swinging fevers coming on predictably every 2 days, accompanied by rigors and night sweats. In Kenya recently. Ix and Dx?
Malaria
Thick and thin blood films
Post spinal surgery
Now has pain at the lower back, even to percussion
Ix?
Dx?
MRI
Osteomyelitis
RF for osteomyelitis
Diabetes mellitus
Orthopaedic surgery
Malnutrition
Immunosupression
Symptoms of osteomyelitis
Fever
Pain
Swelling
Erythema
Fever Malaise Painful joints Several lesions on torso surrounded by annular (tree like) rings Raised anti-streptolysin O titres Dx Rx?
Rheumatic fever
Benzylpenicillin
Antibiotic for pseudomonal urinary tract infections
Gentamicin
Treatment of tapeworm
Praziquentel and niclosamide
Drug treatment for most parasites (tapeworm, schistosomiasis)
Praziquentel
Which WBC is raised in parasitis infection?
Eosinophil
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?
Staphylococcal scalded skin syndrome
Positive Nikolsky sign (layers of skin seperate with gentle pressure)
What is the tourniquet test used for
Dengue fever
What is the thinking behind the tourniquet test?
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
What should you do when you hear an innocent murmur?
Review again in 2 weeks
What often precipitates an innocent murmur?
Viral illness
Important side effects to counsel regarding isotretinoin
Teratogenicity
Suicidal risk
How do retinoids work
Reduce sebum production
Inhibit bacterial growth
Stepwise management of acne vulgaris
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
Symptoms of allergic rhinitis
Nasal obstruction Clear nasal discharge Sneezing Nasal itching Eye redness and watery discharge
Pathophysiology of allergic rhinitis
IgE mediated response to allergens (commonly pollen)
Treatment of subdural haemorrhage (tends to present gradually with increasing headache and confusion).
Depends on if a clot has organised but can involve supportive measures, mannitol or surgery e.g. burr hole craniostomy
RF of subdural haemorrhage
Historic head trauma
Alcoholism
Anticoagulation
Features of extradural haemorrhage
Severe headache
Lucid period
Biconcave haematoma on CT scan
Features of extradural haemorrhage
Severe headache
Lucid period
Biconcave haematoma on CT scan
Features of sub-arachnoid haemorrhage
Seizures
Neurological deficits
Decreased consciousness
Treatment of bullous pemphigoid
Very potent topical steroids e.g. dermovate
Pemphigoid is deep or superficial?
Deep because oiD
So you get large tense blisters
Features of cataract
Glare
Worse vision at night
Myopic shift (pt becomes more short sighted because the lens becomes more refractive!)
RF of cataracts
Diabetes
Smoking
Alcohol
Treatment of cataract
Catract surgery
1st line treatment of H.pylori +vs
Amoxicillin
Clarithromycin
Omeprazole
So called triple therapy
7 days after initiating triple therapy, still H.pylori positive, what do you swap the clarithromycin for?
A tetracycline
A pharyngeal pouch is also known as….
Zenker’s diverticulum
Diagnostic test for COPD
Spirometry
Causes of pulmonary fibrosis
Coal dust Idiopathic Extrinsic allergic alveolitis Systemic sclerosis Amiodarone Methotrexate
What is gastroparesis?
Syndrome of delayed gastric emptying in the absence of mechanical obstruction
Features of gastroparesis
Post-prandial fullness Nausea Vomiting Bloating Abdominal pain
Can be caused post bariatric surgery
RF of developing gastroparesis
Poorly controlled diabetes (because neuropathy)
Parkinson’s disease
Diabetic patients not eating or drinking, what should you do?
Variable rate infusion
Which dermatome supplies the medial thigh sensation?
L3 dermatome
Colorectal cancer with a single liver met, what should you do?
Resection of both
5x increased rate of survival after 5 years
1st line investigtion of ?bladder cancer
Cytoscopy
Complications of coeliac disease
Osteoporosis (DEXA scan)
Cancer
Parvovirus can cause what significant complication?
Aplastic anaemia
GnRH analogue prescribed for prostate cancer, now has weakness in legs and incontinence, which investigation should you do?
MRI spine
Sounds like cauda equina
Probably bone metastases exacerbated by GnRH analogues
What might you see on LP in MS
Oligoclonal bands of immunoglobulin
What crucial things must you ask if you are suspecting HOCM?
FH
Any episodes of syncope (poor prognosis)
What Ix would you like to do for a pt of African origin with a neck swelling and FLAWS?
Blood film
Looking for starry sky appearance of Burkitt’s lymphoma
Child with pain and swelling in the knees after exercise with joint locking
Osteochondritis dissecans
Gold standard treatment of STEMI
PCI
Surgical treatment of prostate cancer
Robotically assisted laparoscopic postatectomy (RALP)
What can happen to blood pH in AKI?
Can get metabolic acidosis due to poor clearance of H+
Optimal pain killer in renal impairment
Oxycodone
Tramadol
1st line Parkinson’s treatment when already have functional impairment
Levodopa
1st line Parkinson’s patient treatment when young and functional
Ropinirole
What diagnosis must you consider if croup treatment doesn’t resolve symptoms
Bacterial trachietis
Treatment of croup
Humidified oxygen
Dexamethasone
Nebulised adrenaline
Malignancies that metastasise to bone
BLT and Kosher Pickle Breast Lung Thyroid Kidney Prostate
Features of atopic eczema
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
Major Dukes criteria
Organisms in 2 seperate blood culture sets
Ix for infective endocarditis
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
Febrile, SOB, background of uncontrolled HIV, x-ray shows bilateral ground glass opacification prominent in the lung bases
Dx?
PCP
Treatment for PCP
Co-trimoxazole
Critically unwell patient with cellulitis, most important treatment
Debridement and washout
Probably necrotising fasciitis
Severe pain in one arm, lost weight recently, wasting of hand and sensory loss
Same sided ptosis and aniscoria (uneven pupils)
Squamous cell lung carcinoma
Pancoast tumour
What test might you do if you suspect legionella pneumonia?
Urinary antigen testing
Management of essential tremor
Propranolol but can be managed conservatively
Symptoms of epidural haematoma
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
Risks of epidural
Hypotension
Dural puncture -> severe postural headache
Epidural haematoma
Most appropriate pain relief mediciations in trauma
Morphine
IV paracetamol
Most common complication of haemodialysis
Dialysis-induced hypotension
Most common organism to cause peritoneal dialysis peritonitis
Staphylococcus epidermidis
Presentation of peritoneal dialysis peritonitis
Abdo pain
Fever
Cloudy dialysis bag
Management of peritoneal dialysis peritonitis
Take a sample of the fluid for culture
IV antibiotics
RF for UTI
Contraceptive diaphragm, recurrent sexual intercourse, catheterisation, diabetes mellitus
Causes of pseudohyperkalaemia
Traumatic venepucture
Prolonged tourniquet use
Delayed analysis of sample
Which drugs can cause hyperprolactinoma
Typical anti-psychotics e.g. haloperidol, risperidone
What type of drug is goserlin
LH blocker
Reduces testosterone production
If pain is not being controlled on morphine, by how much do you increase the total dose?
1/3 more
E.g. 90->120
What proportion of the total dose should be for breakthrough pain?
1/6
Treatment of oral candiadiasis
Oral fluconazole
Management of decompensated liver disease (chronic, cirrhosis)
Good nutrition and alcohol abstinence
Avoid NSAIDs and opiates
Cholestyramine to manage pruritis
Fluid restriction (reduce ascites)
What should you check for in Myasthenia Gravis?
Thymoma
What should you check for if Dx of Grave’s?
Coeliac disease
Investigation features of Paget’s disease
Normal electrolytes but very raised ALP
Osteolytic, osteoblastic and sclerotic appearance on x-ray
Bone pain and deformity
What might hand preference before 2yr old suggest?
Cerebral palsy Spastic hemiplegia (basically a type of cerebral palsy)
Buttock wasting and claudication =>
Leriche syndrome
How long does a positive B-hCG remain after termination of pregnancy?
6w
How long can vaginal loss following termination continue?
6w
The definitive diagnosis of PID
Laparoscopically
HIV+ patient with sudden onset severe abdominal pain, which organism could be causing it?
Mycobacterium avium
Multiple smooth lesions on the edge of the glans of the penis, Dx?
Pearly penile papules
What is Jarisch-Herxheimer reaction?
Antibiotics leading to death of bacteria -> release of toxins -> rigors and fever
Reassure and discharge with paracetamol
Gene associated with Marfan’s
Fibrillin 1
Longstanding syphilis with thickened aorta, Dx?
Cardiosyphillis!
Most likely causative organism in epididymorchitis
E.coli
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?
Co-trimoxazole
Most common cause of PID
Chlamydia
Treatment of Fitz-Hugh-Curtis syndrome
Doxycylcine
Multiple painful genital ulcers =>
Herpes
Ix for HSV
PCR
Take sample from base of the ulcer
Ix for chlamydia
NIAA and urine sample
Management of asymptomatic mitral stenosis
Follow up in 6 months time
Features of mitral stenosis
Mid diastolic murmur loudest at apex on expiration
Main Ix for murmur
Echocardiogram
Symptoms of hypoglycaemia
Shaking/trembling Sweating Palpitations Hunger Headache Double vision and difficulty concentrating Slurred speech Confusion Coma
Mx of hypoglycaemia (BM <3) in pt able to swallow?
10-20g fast acting carbohydrate = 1-2 tubes of glucogel
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
Acute closed angle glaucoma aggrevated by amytriptylline use
Initial Mx of acute closed angle glaucoma
Topical timolol (beta blocker to open up angle) IV acetazolamide (carbonic anhydrase inhibitor) Pilocarpine eye drops (muscarinic antagonist)
What type of drug is acetazolamide?
Carbonic anhydrase inhibitor
Brain tumour that crosses both hemispheres
Gliobastoma
Ix for suspected brain cancer
MRI
Where is BNP released from
Ventricles
What is Chagas disease?
Big old bug bites you and you end up getting heart failure
Criteria for long term oxygen therapy in COPD
Low paO2 (<7.3)
OR
PaO2 <7.8 and other signs, such as pulmonary hypertension (pulmonary artery pressure >25) or pulmonary oedema
Many circular target lesions =>
Erythema multiforme
Triggers of erythema multiforme
Herpes
Other infections
Management of erythema multiforme
Usually conservative
Causes of metabolic alkalosis
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
Virus causing chickenpox
VZV
HHV3
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?
Stop the prednisolone (he’s going to be going NBM) and change to IV hydrocortisone (50-100mg)
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?
Lambert-Eaton syndrome
Chief Ix for pancytopaenia
Bone marrow biopsy
Ix for Down’s syndrome
Quadruple testing
Chorionic villus sampling (<14w)
Amniocentesis (14w
Features of uterine inversion
Normal birth then suddenly the fundus cant be palpated
Initial management of uterine inversion
Push the fundus back
What other feature can be present with Bell’s palsy?
Altered taste
Dry eyes
Treatment of Paget’s disease
Bisphosphonates
Long term treatment of provoked PE
3 months warfarin
Couple of hours after carotid surgery, tongue deviation to one side, most likely cause?
Hypoglossal nerve injury (deviates to the side of the lesion)
Which type of lung cancer can raise calcium levels?
Squamous cell carcinoma
Releases PTHrP which liberates calcium
Confused patient with large postural drop. Blood results show low sodium and high potassium. U&E show raised creatinine and urea. Dx?
Addison’s disease
Causing hypovolaemia
Management of crescendo TIA
300mg aspirin and review in TIA clinic in 24hr
What bedside test should you do for SLE?
Urine dipstick to check for lupus glomerulonephritis
Treatment of emergency Addisonian crisis
IV hydrocortisone
Replace that glucocorticoid!
Aggressive fluid rescucitation
Causes of Addison’s disease
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
Which drug can you use to replace mineralocorticoid
Fludrocortisone
Test you can use like a D-dimer to rule out long standing Addison’s
Morning serum cortisol
If this is inconclusive, then you can do ACTH stimulation
When should patient with migraines with aura take their sumatriptan?
Take it when the headache starts, NOT when the aura starts
Which type of lung cancer is classically associated with paraneoplastic syndromes?
Small cell cancer
Cushingoid and SIADH
So they have Cushingoid symptoms and barely pissing
Blood findings in haemolytic uraemic syndrome
Anaemic
Thrombocytopenic
Raised bilirubin
Uraemic
Triad of HUS
Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute Kidney Injury
Most common cause of viral meningitis
Enteroviruses such as coxsackie virus
Causes of high SAAG
Cirrhosis Heart failure Budd Chiari syndrome Constrictive pericarditis Hepatic failure
Causes of low SAAG
Cancer of the peritoneum
Tuberculosis and other infections
Pancreatitis
Nephrotic syndrome
Management of ascites
Low salt diet
Address the cause
Spironolactone
Signs of Charcot Marie Tooth syndrome
Champagne bottle legs
A sort of foot drop bilaterally
Ix for Charcot Marie Tooth
Nerve studies
4 Ts of post partum haemorrhage
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.
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?
Pyogenic granuloma
Microtrauma
Gene associated with FAP
APC
Causes of bilateral conductive hearing loss
Otosclerosis
Wax impactation
Management of otosclerosis
Hearing aid
1st line ADHD medication
Methylphenidate
RF for devleoping glaucoma
Long sighted (because narrower angle)
3 important red eye differentials
Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Easy Ix to consider to rule out organic causes of dementia
Serum B12 as a vit B12 deficiency can cause cognitive decline
Management of SVCO syndrome brought on by hilar lung cancer
IV dexamethasone to reduce swelling of cancer
What is Pemberton’s sign?
Sign of SVCO
Put arms above head and see if the face swells up
How to categorise abdominal pain
Gynaecological = torsion, ruptured cyst, ectopic Gastrointestinal = IBD, diverticulitis Vascular = mesenteric ischaemia
1st line management for Bell’s palsy presenting within 72hr
Oral prednisolone
Thickening of skin in neck and axilla =>
Acanthosis nigricans
Features of PCOS
Acanthosis nigricans Infertility Acne Hirsuitism Irregular periods
Ix for PCOS
TVUSS
Causes of primary amenorrheoa
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
Management of pancreatic insufficiency in CF (presents as diarrhoea, weight loss, recurrent abdo pain)
Creon
Artificial pancreatic enzymes
Which drugs can cause acute interstitial nephritis (more signs of immune cell deregulation, urticaria etc)
Omeprazole
NSAIDs
Phenytoin
