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Passmed finals > Quesmed 3 > Flashcards

Quesmed 3 Flashcards

1
Q

Features of constrictive pericarditis

A

Pericardial rub
Breathlessness
Chest pain
Raised JVP

May have Hx of radiotherapy as this can predispose to it

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2
Q

Most likely route of spread of breast cancer to the spine

A

Haematogneous

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3
Q

Methods of cancer spreading

A

Local invasion
Iatrogenic (surgery)
Haematogenous
Lymphatic

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4
Q

Delayed effects of radiotherapy

A

Increased risk of cancer, e.g. lung from breast cancer radiotherapy
Constrictive pericarditis
Scarring

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5
Q

Signs of testicular cancer
Hyperechoic lesion on USS
Raised aFP
Most likely type of testicular lesion?

A

Non-seminoma testicular cancer

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6
Q

Causes of raised aFP

A 
Hepatocellular carcinoma
Pancreatic carcinoma
Neural tube defects
Germ cell tumours (testicular)
Biliary atresia
Chronic hepatitis
Cirrhosis
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7
Q

Prostate radiotherapy can lead to ….

A

Proctitis

May get bleeding per rectum

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8
Q

What type of lung cancer may result in weakness in legs that gets better with movement?

A

Small cell lung cancer resulting in paraneoplastic lambert-Eaton syndrome
Its like Myasthenia but its more in the legs and involves voltage gated channels

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9
Q

What hormone might squamous cell carcinomas of the lung secrete?

A

Parathyroid hormone related peptide

May result in hypercalcaemia

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10
Q

First line treatment of VTE in cancer patients?

A

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

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11
Q

Lung cancer patient with new clubbing and joint pain, what is this condition called?

A

Hypertrophic pulmonary osteodystrophy
HPOA
Treat by treating the cancer and giving NSAIDs for the pain

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12
Q

Side effects of chemotherapy

A

Peripheral nerve damage (vincristine)
Otoxicity
N+V

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13
Q

Orphan ann nuclei present in which type of cancer histology?

A

Papillary thyroid cancer

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14
Q

Ix for spinal cord compression

A

MRI of the entire spine

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15
Q

Morphine sulphate 30mg BD, how much can you presecibe IR for breakthrough pain?

A

6mg

1/6 of the total (60mg)

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16
Q

First line Mx for ?neutropaenic sepsis

A

IV tazocin STAT

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17
Q

Most common lung cancer in non-smokers

A

Adenocarcinoma

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18
Q

Features of lung adenocarcinoma

A

Pleuritic chest pain
Non-smokers
Peripheral lung
Can present with pleural effusion

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19
Q

Symptoms of hypercalcaemia

A 
Confusion
Muscle weakness
Constipation
Abdominal pain
Nausea
Depression
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20
Q

First line Mx of hypercalcaemia

A

Fluid bolus

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21
Q

Causes of confusion in oncology patients

A 
Metabolic disturbance (hypoglycaemia, hypercalcaemia)
Infection (pneumonia, UTI)
Metastatic spread to the brain
Anaemia
Intense pain
Side effects of pain medication
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22
Q

Whats the best Ix for cerebral metastases?

A

CT head with contrast

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23
Q

Whats the best Ix for cerebral metastases in a pt with renal failure?

A

Brain MRI

The contrast in CT head with contrast is too bad for the kidneys

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24
Q

Cause of bilateral lung fibrosis (apical)

A

Previous TB

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25
Q

What is T3 in S1Q3T3?

A

T wave inversion in lead III

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26
Q

More positive in lead III than I or II indicates which axis deviation?

A

Right axis deviation

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27
Q

What might you feel with right axis deviation?

A

Right ventricular heave

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28
Q

What do you add to look for a posterior MI?

A

3 more leads

Do a 15 lead ECG to check for posterior infarction

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29
Q

ECG change in WPW

A

Delta waves (curved upstroke)

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30
Q

What is bipartite patella?

A

Patella is made of 2 bones rather than 1
Normal varient
75% superolateral

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31
Q

What causes complete heart block?

A

Inferior MI

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32
Q

What examination finding may you find in complete heart block?

A

Cannon A waves

Contracting against a closed tricuspid valve because the timings all off

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33
Q

Mx of proximal thrombi causing strokes?

Which Ix should you do before hand

A

Thrombectomy

CT angiogram of the intracranial vessels

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34
Q

Features of prion disease

A

Rapidly progressing dementia

Muscle spasms

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35
Q

Ix for prion disease

A

EEG -> sharp wave complexes

Tonsillar biopsy

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36
Q

Features of Steven’s Johnson syndrome

A

Often after starting a new drug
Large blisters
Mucosal involvement
Very unwell

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37
Q

Features of subdural haematoma

A

Gradually worsening cognition
Usually in the elderly
Crescent shaped hyperdense opacity along the edge

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38
Q

Features of extradural haematoma

A

Lucid interval

Lens shaped hyperdense opacity

39
Q 
Features of specific focal epilepsy syndromes 
Temporal
Frontal
Parietal
Occipital
A

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

40
Q

Management of absence seizures

A

Ethosuximide is the drug of choice for absence seizures.

41
Q

Management of focal seizures

A

Gabapentin
Carbamazepine
Phenytoin

42
Q

Good drugs for all seizure types

A

Lamotrigine

Valproate

43
Q

Patient with limb weakness
No sensory loss
Reflexes intact
Anti-GBM positive

A

Multifocal motor neuropathy

44
Q

First line investigation for SAH

A

Non-contrast CT

45
Q

When should you order a high contrast CT rather than a normal CT?

A

Looking at spaces e.g. bowel

46
Q

Diagnosistic Ix for bronchiectasis

A

High resolution CT scan

47
Q

First line treatemnt of relapsing remitting MS

A

Injectable B interferon

48
Q

How does a lesion in the left medial longitudinal fasciculis present in the left eye?

A

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

49
Q

How might corticobasal degeneration present?

A

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

50
Q

Features of Friedrich’s ataxia

A 
Cerebellar issues
Peripheral neuropathy
high arched foot 
Difficulty in balance 
Its a trinucleotide repeat disorder
51
Q

Features of Charcot Marie Tooth

A 
Neurological issues 
High arched foot 
Neuropathy usually goes up the leg 
Loss of sensation
Weakness 
Its autosomal dominant
52
Q

When should ACEi be taken?

A

At night

53
Q

Side effects of tacrolimus and whats its indication?

A

Cardiomyopathy, peripheral
neuropathy, diabetes, pancytopenia,
tremor
Transplant

54
Q

Side effects of ciclosporin and whats its indication?

A

Gingival hypertrophy,
hypertrichosis, nephrotoxicity
Transplant

55
Q

Mx of acute pulmonary oedema

A 
Oxygen
Diuretics (Furosemide 20-80mg IV STAT)
Nitrates (SL then infusion)
Consider: CPAP, inotropes, furosemide infusion
Daily weights and daily UEs thereafter
56
Q

First line management of mastitis

A

Flucloxacillin

57
Q

1st line SSRI in children

A

Fluoxetine

58
Q

Side effects of SSRI

A

GI upset, peptic ulcer, insomnia, reduced libido
The S’s
Stomach ulcers, sleep, sex, serotonin syndrome

59
Q

GTN spray advice

A

2 sprays sublinguially with chest pain
Repeat after 5 mins
Then 5 mins
Then call ambulance

Can cause headache

60
Q

Maintenance fluid prescribing in children, calculate for 28kg child

A
  • 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

61
Q

How much in a fluid bolus?

A

500ml over 15minutes

62
Q

What type of drug is tamsulosin?

A

a blocker

Can cause orthostatic hypotension

63
Q

Mx of orthsostatic hypotension

Conservative medical

A

Medication review
Fluid, salt, compression stockings

Medical = midodrine or fludrocortisone

64
Q

Why should you perform an ECG before starting donepezil?

A

Because it is CI in bradycardia

65
Q

What drug might you give if cancer has ?spread to bone? High calcium for example

A

Pamidronate aswell as IV fluids for the hypercalcaemia

66
Q

Small pituitary tumour, pt on cabergoline for 1 year, what do you do?

A

Wean off the dopamine agonist because will probably have made the tumour shrink already

67
Q

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?

A

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)

68
Q

Which drug can be used in Cushings to decrease levels?

A

Metyrapone

69
Q

What are the investigations for Cushing’s?

A

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)
70
Q

When might you consider screening for GDM?

A

High BMI
First degree relative with diabetes
Previous macrosomia

71
Q

Normal T4
Low TSH
High T3
Dx?

A

T3 toxicosis

Often the predroma for an actual thyroid disease e.g. Graves

72
Q

Drug to reduce symptoms of hyperthyroidism

A

Propranolol

73
Q

Most important hormone to replace in hypopituitarism

A

Cortisol

74
Q

Medical treatment for Grave’s disease

A

Carbimazole

75
Q

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?

A 
Thyroid storm 
High mortality (30-50%)
76
Q

Management of thyroid storm

A

ITU

IV anti-thyroid medication

77
Q

Signs of cocaine overdose

A

Sweaty
Tachycardic
DILATED PUPILS (becasue sympathetic!)

78
Q

What is a Stokes-Adams attack?

A

Sudden attack of bradycardia

79
Q

Mx of Stokes-Adams attacks?

A

IV atropine

80
Q

Pt with confusion, nausea and vomiting
Cherry red skin
Dx?
Mx?

A

CO poisoning

Hyperbaric oxygen therapy

81
Q

Major haemorrhage, pt on warfarin, the order of priority for Mx

A

Major haemorrhage protocol
Deal with the bleed by tourniquet if possible
IV vit K
IV Prothrombin complex (needs the vit K to work!)
BLOOD

82
Q

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?

A

Aortic dissection

False lumen grows and compresses branches of the aorta

83
Q

Most common cause of bronchiolitis

A

RSV

84
Q

Signs of respiratory distress

A 
Increased RR
Use of accessory muscles 
Intercostal and subcostal recessions 
Nasal flaring 
Head bobbing 
Tracheal tugging 
Cyanosis 
Abnormal airway noises
85
Q

What is the incubation period for chickenpox

A

21 days

86
Q

When are children with chickenpox infective?

A

When the rash appears until they all crust over

87
Q

1st line management of ?intussception?

A

Abdominal ultrasound

Looking for target sign

88
Q

Management of acute hypoglycaemia. Pt may have injected too much insulin or missed a few meals

A

If not too serious -> biscuit or lucozade
If drowsy and no IV -> IM glucagon
If IV access -> dextrose infusion

89
Q

Causes of precocious puberty

A

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)

90
Q

What are the WETFLAG criteria?

A

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
91
Q

Management of nephrotic syndrome

A

Fluid restriction and reduced salt intake
Corticosteroid therapy: prednisolone
Human albumin and furosemide

92
Q

Cause of inguinal hernia in children

A

Failure of the processus vaginalis to obliterate

So, there is a patent processes vaginalis

93
Q

Components of a baby check

A

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

Passmed finals (17 decks)

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