Quesmed 3 Flashcards
Features of constrictive pericarditis
Pericardial rub
Breathlessness
Chest pain
Raised JVP
May have Hx of radiotherapy as this can predispose to it
Most likely route of spread of breast cancer to the spine
Haematogneous
Methods of cancer spreading
Local invasion
Iatrogenic (surgery)
Haematogenous
Lymphatic
Delayed effects of radiotherapy
Increased risk of cancer, e.g. lung from breast cancer radiotherapy
Constrictive pericarditis
Scarring
Signs of testicular cancer
Hyperechoic lesion on USS
Raised aFP
Most likely type of testicular lesion?
Non-seminoma testicular cancer
Causes of raised aFP
Hepatocellular carcinoma Pancreatic carcinoma Neural tube defects Germ cell tumours (testicular) Biliary atresia Chronic hepatitis Cirrhosis
Prostate radiotherapy can lead to ….
Proctitis
May get bleeding per rectum
What type of lung cancer may result in weakness in legs that gets better with movement?
Small cell lung cancer resulting in paraneoplastic lambert-Eaton syndrome
Its like Myasthenia but its more in the legs and involves voltage gated channels
What hormone might squamous cell carcinomas of the lung secrete?
Parathyroid hormone related peptide
May result in hypercalcaemia
First line treatment of VTE in cancer patients?
LMWH for 6 months
1mo at treatment dose and 5 months at 80% dose
Cancer patients are at high risk of VTE because hypercoaguable
Injected into your stomach each day
Lung cancer patient with new clubbing and joint pain, what is this condition called?
Hypertrophic pulmonary osteodystrophy
HPOA
Treat by treating the cancer and giving NSAIDs for the pain
Side effects of chemotherapy
Peripheral nerve damage (vincristine)
Otoxicity
N+V
Orphan ann nuclei present in which type of cancer histology?
Papillary thyroid cancer
Ix for spinal cord compression
MRI of the entire spine
Morphine sulphate 30mg BD, how much can you presecibe IR for breakthrough pain?
6mg
1/6 of the total (60mg)
First line Mx for ?neutropaenic sepsis
IV tazocin STAT
Most common lung cancer in non-smokers
Adenocarcinoma
Features of lung adenocarcinoma
Pleuritic chest pain
Non-smokers
Peripheral lung
Can present with pleural effusion
Symptoms of hypercalcaemia
Confusion Muscle weakness Constipation Abdominal pain Nausea Depression
First line Mx of hypercalcaemia
Fluid bolus
Causes of confusion in oncology patients
Metabolic disturbance (hypoglycaemia, hypercalcaemia) Infection (pneumonia, UTI) Metastatic spread to the brain Anaemia Intense pain Side effects of pain medication
Whats the best Ix for cerebral metastases?
CT head with contrast
Whats the best Ix for cerebral metastases in a pt with renal failure?
Brain MRI
The contrast in CT head with contrast is too bad for the kidneys
Cause of bilateral lung fibrosis (apical)
Previous TB
What is T3 in S1Q3T3?
T wave inversion in lead III
More positive in lead III than I or II indicates which axis deviation?
Right axis deviation
What might you feel with right axis deviation?
Right ventricular heave
What do you add to look for a posterior MI?
3 more leads
Do a 15 lead ECG to check for posterior infarction
ECG change in WPW
Delta waves (curved upstroke)
What is bipartite patella?
Patella is made of 2 bones rather than 1
Normal varient
75% superolateral
What causes complete heart block?
Inferior MI
What examination finding may you find in complete heart block?
Cannon A waves
Contracting against a closed tricuspid valve because the timings all off
Mx of proximal thrombi causing strokes?
Which Ix should you do before hand
Thrombectomy
CT angiogram of the intracranial vessels
Features of prion disease
Rapidly progressing dementia
Muscle spasms
Ix for prion disease
EEG -> sharp wave complexes
Tonsillar biopsy
Features of Steven’s Johnson syndrome
Often after starting a new drug
Large blisters
Mucosal involvement
Very unwell
Features of subdural haematoma
Gradually worsening cognition
Usually in the elderly
Crescent shaped hyperdense opacity along the edge
Features of extradural haematoma
Lucid interval
Lens shaped hyperdense opacity
Features of specific focal epilepsy syndromes Temporal Frontal Parietal Occipital
Temporal lobe - Automatisms (eg. lip-smacking); déjà vu or jamais vu, emotional disturbance (eg. sudden terror); olfactory, gustatory, or auditory hallucinations.
Frontal lobe - Motor features such as Jacksonian features (walks up the arm), dysphasia, or Todd’s palsy.
Parietal lobe - Sensory symptoms such as tingling and numbness; motor symptoms - due to spread of electrical activity to the pre-central gyrus in the frontal lobe.
Occipital lobe - Visual symptoms such as spots and lines in the visual field
Management of absence seizures
Ethosuximide is the drug of choice for absence seizures.
Management of focal seizures
Gabapentin
Carbamazepine
Phenytoin
Good drugs for all seizure types
Lamotrigine
Valproate
Patient with limb weakness
No sensory loss
Reflexes intact
Anti-GBM positive
Multifocal motor neuropathy
First line investigation for SAH
Non-contrast CT
When should you order a high contrast CT rather than a normal CT?
Looking at spaces e.g. bowel
Diagnosistic Ix for bronchiectasis
High resolution CT scan
First line treatemnt of relapsing remitting MS
Injectable B interferon
How does a lesion in the left medial longitudinal fasciculis present in the left eye?
Can’t look to the right
This is because the abducens pulls to the right but also the left side adducts to turn the eye
How might corticobasal degeneration present?
Unable to follow instructions of movement but can do them voluntarily (because they can’t coordinate movement)
They also have Parkinsonian symptoms (bradykinesia, rigidity, shuffling gait, tremor
It’s a Parkinson’s + syndrome
Features of Friedrich’s ataxia
Cerebellar issues Peripheral neuropathy high arched foot Difficulty in balance Its a trinucleotide repeat disorder
Features of Charcot Marie Tooth
Neurological issues High arched foot Neuropathy usually goes up the leg Loss of sensation Weakness Its autosomal dominant
When should ACEi be taken?
At night
Side effects of tacrolimus and whats its indication?
Cardiomyopathy, peripheral
neuropathy, diabetes, pancytopenia,
tremor
Transplant
Side effects of ciclosporin and whats its indication?
Gingival hypertrophy,
hypertrichosis, nephrotoxicity
Transplant
Mx of acute pulmonary oedema
Oxygen Diuretics (Furosemide 20-80mg IV STAT) Nitrates (SL then infusion) Consider: CPAP, inotropes, furosemide infusion Daily weights and daily UEs thereafter
First line management of mastitis
Flucloxacillin
1st line SSRI in children
Fluoxetine
Side effects of SSRI
GI upset, peptic ulcer, insomnia, reduced libido
The S’s
Stomach ulcers, sleep, sex, serotonin syndrome
GTN spray advice
2 sprays sublinguially with chest pain
Repeat after 5 mins
Then 5 mins
Then call ambulance
Can cause headache
Maintenance fluid prescribing in children, calculate for 28kg child
- 1st 10kg = 100ml/kg/day = 1000mL
- 2nd 10kg = 50ml/kg/day = 500mL
- Remaining = 20ml/kg/day = 8kg x 20ml/kg/day = 160mL
So 1660 for this child over 24hr
How much in a fluid bolus?
500ml over 15minutes
What type of drug is tamsulosin?
a blocker
Can cause orthostatic hypotension
Mx of orthsostatic hypotension
Conservative medical
Medication review
Fluid, salt, compression stockings
Medical = midodrine or fludrocortisone
Why should you perform an ECG before starting donepezil?
Because it is CI in bradycardia
What drug might you give if cancer has ?spread to bone? High calcium for example
Pamidronate aswell as IV fluids for the hypercalcaemia
Small pituitary tumour, pt on cabergoline for 1 year, what do you do?
Wean off the dopamine agonist because will probably have made the tumour shrink already
An 18 year old female patient with known type 1 diabetes was admitted 4 days previously with DKA. She has been switched to her normal subcutaneous insulin and was due for discharge following diabetic team review. A nurse has taken her blood sugar (9:00am) before breakfast and informs you that her blood glucose is 2.5 she has no symptoms. The patient is alert.
What would be the next appropriate step?
Glucogel because her sugar is very low and indicates a hypo
Need a fast response so give glucogel
DO NOT omit the next dose of insulin (can get rebound hyperglycemia)
Which drug can be used in Cushings to decrease levels?
Metyrapone
What are the investigations for Cushing’s?
To identify cortisol excess:
24 hour urinary free cortisol
Low-dose Dexamethasone suppression test
Localisation:
Plasma ACTH High-dose dexamethasone suppression test Inferior petrosal sinus sampling MRI of the pituitary CT Chest and Abdomen (suspected tumour)
When might you consider screening for GDM?
High BMI
First degree relative with diabetes
Previous macrosomia
Normal T4
Low TSH
High T3
Dx?
T3 toxicosis
Often the predroma for an actual thyroid disease e.g. Graves
Drug to reduce symptoms of hyperthyroidism
Propranolol
Most important hormone to replace in hypopituitarism
Cortisol
Medical treatment for Grave’s disease
Carbimazole
A 40 year old woman with known Grave’s disease has recently been started on treatment with Carbimazole. She has begun to respond to treatment. Unfortunately she has been experiencing problems over the past 1 week with a bad chest infection.
Now she has developed symptoms of agitation, confusion, high temperature, palpitations and tachycardia, and vomiting.
On examination, she is jaundiced has pulmonary oedema and is clinically dehydrated. What is the likely diagnosis?
Thyroid storm High mortality (30-50%)
Management of thyroid storm
ITU
IV anti-thyroid medication
Signs of cocaine overdose
Sweaty
Tachycardic
DILATED PUPILS (becasue sympathetic!)
What is a Stokes-Adams attack?
Sudden attack of bradycardia
Mx of Stokes-Adams attacks?
IV atropine
Pt with confusion, nausea and vomiting
Cherry red skin
Dx?
Mx?
CO poisoning
Hyperbaric oxygen therapy
Major haemorrhage, pt on warfarin, the order of priority for Mx
Major haemorrhage protocol
Deal with the bleed by tourniquet if possible
IV vit K
IV Prothrombin complex (needs the vit K to work!)
BLOOD
A 60-year-old man presents to the Emergency Department (ED) with severe, sudden onset chest pain. This was soon associated with weakness in both of his legs. On examination, the patient is found to have a flaccid paraparesis and a new early diastolic murmur that is loudest over the lower left sternal edge.
Which of the following is the most likely diagnosis?
Aortic dissection
False lumen grows and compresses branches of the aorta
Most common cause of bronchiolitis
RSV
Signs of respiratory distress
Increased RR Use of accessory muscles Intercostal and subcostal recessions Nasal flaring Head bobbing Tracheal tugging Cyanosis Abnormal airway noises
What is the incubation period for chickenpox
21 days
When are children with chickenpox infective?
When the rash appears until they all crust over
1st line management of ?intussception?
Abdominal ultrasound
Looking for target sign
Management of acute hypoglycaemia. Pt may have injected too much insulin or missed a few meals
If not too serious -> biscuit or lucozade
If drowsy and no IV -> IM glucagon
If IV access -> dextrose infusion
Causes of precocious puberty
Causes of Gonadotrophin-dependent precocious puberty (GDPP):
Idiopathic (>90%) Brain neoplasms and cranial radiotherapy Cranial disability conditions such as hydrocephalus, cerebal palsy or post-infection (meningitis) Traumatic head injury Associated with sexual abuse
Gonadotrophin independent precocious puberty (GIPP):
Ovarian causes: follicular cysts of the ovary, granulosa cell tumours, Leydig’s cell tumours, and gonadoblastoma.
Testicular causes: Leydig’s cell tumours and a defect of luteinising hormone (LH) receptor function (testotoxicosis or familial GIPP).
Adrenal causes: 21-hydroxylase congenital adrenal hyperplasia (CAH) in males results in GIPP. CAH in females presents with signs of virilisation (e.g., pubic and axillary hair and clitoromegaly) but no breast development.
McCune-Albright syndrome (MAS)
What are the WETFLAG criteria?
When you are unsure of the childs weight, can use these criteria for crucial initiatial management
Weight: (Age + 4) * 2 Energy: 4J/kg Tube size: (Age/4) + 4 Fluids: 20ml/kg normal saline bolus (10ml/kg if septic, trauma or in heart failure) Lorazepam: 0.1mg/kg Adrenaline: 10 micrograms/kg Glucose: 2ml/kg of 10% dextrose
Management of nephrotic syndrome
Fluid restriction and reduced salt intake
Corticosteroid therapy: prednisolone
Human albumin and furosemide
Cause of inguinal hernia in children
Failure of the processus vaginalis to obliterate
So, there is a patent processes vaginalis
Components of a baby check
She is alert, moving all limbs spontaneously, and appears pink. The fontanelles are soft. The chest is clear with heart sounds I and II with no extra sounds or murmurs. You see a red reflex on ophthalmoscopy.
Check the hips and genitalia and a general inspection for any abnormalities
