Quesmed 2 Flashcards
1
Q
No association between the p waves and QRS complex =>
A
Complete heart block
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
3
Q
Features of Henoch-Schonlein purpura
A
Rash
Abdominal pain
Arthralgia
Glomerulonephritis
4
Q
Mx of Henoch-Schonlein purpura
A
Analgesia and supportive
Corticosteroids
If pain severe, consider surgical referral
5
Q
Ix for ?PE in pregnant woman
A
V/Q scan
6
Q
Episodes of low mood, now seen believing she has super strength, Dx?
A
Bipolar disorder
7
Q
Lower back pain, warm to touch, Hx od IVDU, systemically unwell =>
A
Discitis
8
Q
Ix for discitis/osteomyelitis
A
Inflammatory markers
Imaging
MRI
9
Q
Mx of osteomyelitis
A
Antibiotics for a minimum of 4 weeks, usually 3-6mo!
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
11
Q
Treatment of vancomycin resistant enterococci
A
Linezolid
12
Q
Antibiotic for pyelonephritis
A
IV ciprofloxacin
13
Q
Symptoms of toxic shock syndrome
A
Shock
Fever
Erythroderma (red man syndrome)
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
15
Q
RF of toxic shock syndrome
A
Diabetes
Wounds
HIV
Tampon use
16
Q
What is streptococcus bovis associated with??
A
Colerectal carcinoma
17
Q
ix for infective endocarditis
A
BLood cultures
FBC
CRP
Echocardiogram
18
Q
Different causal spread for septic arthritis
A
Local (from say wound or osteomyelitis)
Haematogenous (IVDU)
Direct inoculation (car injury)
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
20
Q
Post spinal surgery
Now has pain at the lower back, even to percussion
Ix?
Dx?
A
MRI
Osteomyelitis
21
Q
RF for osteomyelitis
A
Diabetes mellitus
Orthopaedic surgery
Malnutrition
Immunosupression
22
Q
Symptoms of osteomyelitis
A
Fever
Pain
Swelling
Erythema
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
24
Q
Antibiotic for pseudomonal urinary tract infections
A
Gentamicin
25
Treatment of tapeworm
Praziquentel and niclosamide
26
Drug treatment for most parasites (tapeworm, schistosomiasis)
Praziquentel
27
Which WBC is raised in parasitis infection?
Eosinophil
28
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)
29
What is the tourniquet test used for
Dengue fever
30
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
31
What should you do when you hear an innocent murmur?
Review again in 2 weeks
32
What often precipitates an innocent murmur?
Viral illness
33
Important side effects to counsel regarding isotretinoin
Teratogenicity
| Suicidal risk
34
How do retinoids work
Reduce sebum production
| Inhibit bacterial growth
35
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
36
Symptoms of allergic rhinitis
```
Nasal obstruction
Clear nasal discharge
Sneezing
Nasal itching
Eye redness and watery discharge
```
37
Pathophysiology of allergic rhinitis
IgE mediated response to allergens (commonly pollen)
38
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
39
RF of subdural haemorrhage
Historic head trauma
Alcoholism
Anticoagulation
40
Features of extradural haemorrhage
Severe headache
Lucid period
Biconcave haematoma on CT scan
41
Features of extradural haemorrhage
Severe headache
Lucid period
Biconcave haematoma on CT scan
42
Features of sub-arachnoid haemorrhage
Seizures
Neurological deficits
Decreased consciousness
43
Treatment of bullous pemphigoid
Very potent topical steroids e.g. dermovate
44
Pemphigoid is deep or superficial?
Deep because oiD
| So you get large tense blisters
45
Features of cataract
Glare
Worse vision at night
Myopic shift (pt becomes more short sighted because the lens becomes more refractive!)
46
RF of cataracts
Diabetes
Smoking
Alcohol
47
Treatment of cataract
Catract surgery
48
1st line treatment of H.pylori +vs
Amoxicillin
Clarithromycin
Omeprazole
So called triple therapy
49
7 days after initiating triple therapy, still H.pylori positive, what do you swap the clarithromycin for?
A tetracycline
50
A pharyngeal pouch is also known as....
Zenker's diverticulum
51
Diagnostic test for COPD
Spirometry
52
Causes of pulmonary fibrosis
```
Coal dust
Idiopathic
Extrinsic allergic alveolitis
Systemic sclerosis
Amiodarone
Methotrexate
```
53
What is gastroparesis?
Syndrome of delayed gastric emptying in the absence of mechanical obstruction
54
Features of gastroparesis
```
Post-prandial fullness
Nausea
Vomiting
Bloating
Abdominal pain
```
Can be caused post bariatric surgery
55
RF of developing gastroparesis
Poorly controlled diabetes (because neuropathy)
| Parkinson's disease
56
Diabetic patients not eating or drinking, what should you do?
Variable rate infusion
57
Which dermatome supplies the medial thigh sensation?
L3 dermatome
58
Colorectal cancer with a single liver met, what should you do?
Resection of both
| 5x increased rate of survival after 5 years
59
1st line investigtion of ?bladder cancer
Cytoscopy
60
Complications of coeliac disease
Osteoporosis (DEXA scan)
| Cancer
61
Parvovirus can cause what significant complication?
Aplastic anaemia
62
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
63
What might you see on LP in MS
Oligoclonal bands of immunoglobulin
64
What crucial things must you ask if you are suspecting HOCM?
FH
| Any episodes of syncope (poor prognosis)
65
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
66
Child with pain and swelling in the knees after exercise with joint locking
Osteochondritis dissecans
67
Gold standard treatment of STEMI
PCI
68
Surgical treatment of prostate cancer
Robotically assisted laparoscopic postatectomy (RALP)
69
What can happen to blood pH in AKI?
Can get metabolic acidosis due to poor clearance of H+
70
Optimal pain killer in renal impairment
Oxycodone
| Tramadol
71
1st line Parkinson's treatment when already have functional impairment
Levodopa
72
1st line Parkinson's patient treatment when young and functional
Ropinirole
73
What diagnosis must you consider if croup treatment doesn't resolve symptoms
Bacterial trachietis
74
Treatment of croup
Humidified oxygen
Dexamethasone
Nebulised adrenaline
75
Malignancies that metastasise to bone
```
BLT and Kosher Pickle
Breast
Lung
Thyroid
Kidney
Prostate
```
76
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
77
Major Dukes criteria
Organisms in 2 seperate blood culture sets
78
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
79
Febrile, SOB, background of uncontrolled HIV, x-ray shows bilateral ground glass opacification prominent in the lung bases
Dx?
PCP
80
Treatment for PCP
Co-trimoxazole
81
Critically unwell patient with cellulitis, most important treatment
Debridement and washout
| Probably necrotising fasciitis
82
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
83
What test might you do if you suspect legionella pneumonia?
Urinary antigen testing
84
Management of essential tremor
Propranolol but can be managed conservatively
85
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
86
Risks of epidural
Hypotension
Dural puncture -> severe postural headache
Epidural haematoma
87
Most appropriate pain relief mediciations in trauma
Morphine
| IV paracetamol
88
Most common complication of haemodialysis
Dialysis-induced hypotension
89
Most common organism to cause peritoneal dialysis peritonitis
Staphylococcus epidermidis
90
Presentation of peritoneal dialysis peritonitis
Abdo pain
Fever
Cloudy dialysis bag
91
Management of peritoneal dialysis peritonitis
Take a sample of the fluid for culture
| IV antibiotics
92
RF for UTI
Contraceptive diaphragm, recurrent sexual intercourse, catheterisation, diabetes mellitus
93
Causes of pseudohyperkalaemia
Traumatic venepucture
Prolonged tourniquet use
Delayed analysis of sample
94
Which drugs can cause hyperprolactinoma
Typical anti-psychotics e.g. haloperidol, risperidone
95
What type of drug is goserlin
LH blocker
| Reduces testosterone production
96
If pain is not being controlled on morphine, by how much do you increase the total dose?
1/3 more
| E.g. 90->120
97
What proportion of the total dose should be for breakthrough pain?
1/6
98
Treatment of oral candiadiasis
Oral fluconazole
99
Management of decompensated liver disease (chronic, cirrhosis)
Good nutrition and alcohol abstinence
Avoid NSAIDs and opiates
Cholestyramine to manage pruritis
Fluid restriction (reduce ascites)
100
What should you check for in Myasthenia Gravis?
Thymoma
101
What should you check for if Dx of Grave's?
Coeliac disease
102
Investigation features of Paget's disease
Normal electrolytes but very raised ALP
Osteolytic, osteoblastic and sclerotic appearance on x-ray
Bone pain and deformity
103
What might hand preference before 2yr old suggest?
```
Cerebral palsy
Spastic hemiplegia (basically a type of cerebral palsy)
```
104
Buttock wasting and claudication =>
Leriche syndrome
105
How long does a positive B-hCG remain after termination of pregnancy?
6w
106
How long can vaginal loss following termination continue?
6w
107
The definitive diagnosis of PID
Laparoscopically
108
HIV+ patient with sudden onset severe abdominal pain, which organism could be causing it?
Mycobacterium avium
109
Multiple smooth lesions on the edge of the glans of the penis, Dx?
Pearly penile papules
110
What is Jarisch-Herxheimer reaction?
Antibiotics leading to death of bacteria -> release of toxins -> rigors and fever
Reassure and discharge with paracetamol
111
Gene associated with Marfan's
Fibrillin 1
112
Longstanding syphilis with thickened aorta, Dx?
Cardiosyphillis!
113
Most likely causative organism in epididymorchitis
E.coli
114
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
115
Most common cause of PID
Chlamydia
116
Treatment of Fitz-Hugh-Curtis syndrome
Doxycylcine
117
Multiple painful genital ulcers =>
Herpes
118
Ix for HSV
PCR
| Take sample from base of the ulcer
119
Ix for chlamydia
NIAA and urine sample
120
Management of asymptomatic mitral stenosis
Follow up in 6 months time
121
Features of mitral stenosis
Mid diastolic murmur loudest at apex on expiration
122
Main Ix for murmur
Echocardiogram
123
Symptoms of hypoglycaemia
```
Shaking/trembling
Sweating
Palpitations
Hunger
Headache
Double vision and difficulty concentrating
Slurred speech
Confusion
Coma
```
124
Mx of hypoglycaemia (BM <3) in pt able to swallow?
10-20g fast acting carbohydrate = 1-2 tubes of glucogel
125
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
126
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)
```
127
What type of drug is acetazolamide?
Carbonic anhydrase inhibitor
128
Brain tumour that crosses both hemispheres
Gliobastoma
129
Ix for suspected brain cancer
MRI
130
Where is BNP released from
Ventricles
131
What is Chagas disease?
Big old bug bites you and you end up getting heart failure
132
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
133
Many circular target lesions =>
Erythema multiforme
134
Triggers of erythema multiforme
Herpes
| Other infections
135
Management of erythema multiforme
Usually conservative
136
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
137
Virus causing chickenpox
VZV
| HHV3
138
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)
139
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
140
Chief Ix for pancytopaenia
Bone marrow biopsy
141
Ix for Down's syndrome
Quadruple testing
Chorionic villus sampling (<14w)
Amniocentesis (14w
142
Features of uterine inversion
Normal birth then suddenly the fundus cant be palpated
143
Initial management of uterine inversion
Push the fundus back
144
What other feature can be present with Bell's palsy?
Altered taste
| Dry eyes
145
Treatment of Paget's disease
Bisphosphonates
146
Long term treatment of provoked PE
3 months warfarin
147
Couple of hours after carotid surgery, tongue deviation to one side, most likely cause?
Hypoglossal nerve injury (deviates to the side of the lesion)
148
Which type of lung cancer can raise calcium levels?
Squamous cell carcinoma
| Releases PTHrP which liberates calcium
149
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
150
Management of crescendo TIA
300mg aspirin and review in TIA clinic in 24hr
151
What bedside test should you do for SLE?
Urine dipstick to check for lupus glomerulonephritis
152
Treatment of emergency Addisonian crisis
IV hydrocortisone
Replace that glucocorticoid!
Aggressive fluid rescucitation
153
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
154
Which drug can you use to replace mineralocorticoid
Fludrocortisone
155
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
156
When should patient with migraines with aura take their sumatriptan?
Take it when the headache starts, NOT when the aura starts
157
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
158
Blood findings in haemolytic uraemic syndrome
Anaemic
Thrombocytopenic
Raised bilirubin
Uraemic
159
Triad of HUS
Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute Kidney Injury
160
Most common cause of viral meningitis
Enteroviruses such as coxsackie virus
161
Causes of high SAAG
```
Cirrhosis
Heart failure
Budd Chiari syndrome
Constrictive pericarditis
Hepatic failure
```
162
Causes of low SAAG
Cancer of the peritoneum
Tuberculosis and other infections
Pancreatitis
Nephrotic syndrome
163
Management of ascites
Low salt diet
Address the cause
Spironolactone
164
Signs of Charcot Marie Tooth syndrome
Champagne bottle legs
| A sort of foot drop bilaterally
165
Ix for Charcot Marie Tooth
Nerve studies
166
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.
167
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
168
Gene associated with FAP
APC
169
Causes of bilateral conductive hearing loss
Otosclerosis
| Wax impactation
170
Management of otosclerosis
Hearing aid
171
1st line ADHD medication
Methylphenidate
172
RF for devleoping glaucoma
Long sighted (because narrower angle)
173
3 important red eye differentials
Acute angle-closure glaucoma
Anterior uveitis
Scleritis
174
Easy Ix to consider to rule out organic causes of dementia
Serum B12 as a vit B12 deficiency can cause cognitive decline
175
Management of SVCO syndrome brought on by hilar lung cancer
IV dexamethasone to reduce swelling of cancer
176
What is Pemberton's sign?
Sign of SVCO
| Put arms above head and see if the face swells up
177
How to categorise abdominal pain
```
Gynaecological = torsion, ruptured cyst, ectopic
Gastrointestinal = IBD, diverticulitis
Vascular = mesenteric ischaemia
```
178
1st line management for Bell's palsy presenting within 72hr
Oral prednisolone
179
Thickening of skin in neck and axilla =>
Acanthosis nigricans
180
Features of PCOS
```
Acanthosis nigricans
Infertility
Acne
Hirsuitism
Irregular periods
```
181
Ix for PCOS
TVUSS
182
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
183
Management of pancreatic insufficiency in CF (presents as diarrhoea, weight loss, recurrent abdo pain)
Creon
| Artificial pancreatic enzymes
184
Which drugs can cause acute interstitial nephritis (more signs of immune cell deregulation, urticaria etc)
Omeprazole
NSAIDs
Phenytoin
