questions Flashcards
What are the features of opioid misuse?
Rhinorrhoea Needle track marks Pinpoint pupils drowsiness watering eyes
What is the typical presentation of B12 deficiency?
Bilateral distal parasethesia
What are the triad of features in nephrotic syndrome?
Proteinuria (>3g/24 hr)
Hypoalbuminaemia (<30g/L)
Oedema
What are the features of nephritic syndrome?
Hypertension, haematuria
How do central rentinal vein and central retinal artery occulusion present differently?
Curtain coming down
vein occulsion has retinal haemorrhages on fundoscopy
artery occlusion has afferent pupillary defect and ‘cherry red’ spot on a pale retina
How does retinal detachment present compared to vitrous haemorrhage?
Haemorrhage is numerous dark spots then sudden loss of vision
Retinal detachment is a dense shadow that starts peripherally and moves towards the middle
How do you work out a morphine prescription?
Add up the total dose over 24 hours and prescribe this a slow release, one sixth of this dose is the breakthrough PRN dose
What is the presentation of lithium toxicity?
Coarse tremor
Confusion
Jerking leg movements
What are the antibodies in graves and hashimotos?
In graves there are antibodies to the TSH receptors causing them to be activated
In hashimotos there are antibodies against thyroid peroxidase resulting in reduced T3 and T4 production
What are the signs in fat embolism?
Typically following multiple fractures
Causes tachycardia, tachypnoea and pyrexia
A petechial rash and confusion
What is the presentation of epstein barr virus?
sore throat, fever, and malaise and also has
lymphadenopathy and pharyngitis
What are the triad of features in Wernicke’s encephalopathy?
Ataxia
Opthalmoplegia
Nystagmus
What is Charcots triad?
This is for ascending cholangitis
Fever
RUQ
Jaundice
What is the most important factor in determining the prognosis of melanoma?
Breslow thickness gives indication of 5 year survival
How is high INR managed pre-operatively?
On the day prior to operation INR must be corrected if >1.4
-Aggressive correction (if on warfarin for AF) - 5-10mg IV vit K then repeat INR in 6 hours, if no success speak to haem for prothrombin complex
-Cautious correction if recent PE or valve replacement, speak to seniors, usually reverse warfarin and cover with unfractionated heparin
If INR raised due to liver disease give 10mg IV vit K
How should high INR with warfarin be managed if urgent surgery is required?
If can be delayed for 6-12 hours then give phytomenadione (vit K)
If cant delay give vit K and prothrombin complex
What kind of rash does lichen planus cause?
It causes a itchy papular rash that is on flexor surfaces, palms and soles
It has white line pattern on the surface and exibits koebner phenomenon
What is the treatment of lichen planus?
Topical steriods are mainstay of treatment
What is the management of bells palsy?
1mg/kg prednisolone should be prescribed for 10 days if within 72 hours of onset
What is the pathogenesis of guillian barre?
It is an immune mediated demyelination typically following infection e.g. campylobacter
What are the presenting feauters of guillian barre?
Typically ascending with legs affected before arms
Proximal muscles are affected before distal ones
Can progress to involes resp muscles and cranial nerves
Can be treated with IV immunoglobulin
What are the management steps for stroke?
300mg aspirin should be given asap once haemorrhagic stroke excluded
Anticoags for AF should not be started until 14 days after ischaemic stroke
If cholesterol over 3.5 start statin but delay until 48 hours after stroke to reduce risk of haemorrhagic transformation
What is the time frame for thrombolysis? contraindications?
Within 4.5 ours of onset absolute contra: -prev intracranial haem -intracranial neoplasm -SAH suspected -Stroke in last 3 months -GI haemorrhage in last 3 weeks -active bleeding -pregnancy
How can stroke severity be assessed?
With the NIHSS
What secondary prevention should be done for stroke?
Clopidogrel
Carotid endarterectomy if greated than 70% carotid stenosis
What are the ottowa rules for ankle x rays?
Inability to weight bear for 4 steps
Tenderness of distal tibia
Bone tenderness over distal fibula
What ligament if most commonly damaged in inversion ankle injuries?
The anterior talofibular ligament is most often injured
How do polymyalgia and rheumatoid arthritis differ in their presentation?
Polymyalgia is typically proximal limb muscle morning stiffness, in exam questions will usually specify muscles e.g. thighs rather than joints
Rheumatoid arthritis is swollen painful joints in hands and feet initially, postive squeeze test
Which test is most specific for rheumatoid arthritis?
AntiCCP has similar sensitivity to rheumatoid factor but is much more specific
What is the volume of maintenace fluids required per day?
25-30ml/kg/day
What is the initial management of superficial thrombophlebitis?
NSAIDs
What is the management for urge incontinence?
Initially conservative - bladder retraining
Medical management - Anticholinergic medication e.g. oxybutynin
Surgical - botulinum toxin injection
What is the management of stress incontinence?
Conservative - weight loss, avoid caffiene, pelvic floor exercises
Surgery - mid urethral tape procedures
What bacteria causes acne?
Propionibacterium acnes
What are the causes of Haematuria on urine dipstick?
ONNIT
- Obstruction - calculi
- Neoplasm - transitional cell carcinoma, RCC
- Nephritic syndrome - due to GN
- Inflammation - UTI
- Trauma
What disease does presence of smear cells on blood film indicate?
Chronic lymphcytic leukaemia
What are the percentages for the wallace rule of 9s for burns?
Front of torse 18% Back of torso 18% Right arm 9% (4.5% front) Left arm 9% (4.5% front) Right leg 18% Left leg 18% Head and neck 9%
What conditions cause epithelial crescents to from in the glomeruli?
Most likely Goodpastures - anti-GBM - haemoptysis due to pulmonary haemorrhages
could also be Granulomatosis with polyangitis - cANCA - sinusitis and vasculitic rash
What is the management of hypercalcaemia?
Initially fluid resuscitation 3-4L per day
Can give bisphosphonates but take 2-3 days to work
Calcitonin can be used for faster response
Steroids in sarcoidosis
In an asthmatic treated with salbutamol nebs what electrolyte abnormality will cause muscle weakness?
Hypokalaemia
What is charcots triad?
For ascending cholangitis:
- RUQ pain
- Fever
- Jaundice
What reaction to transfusion is likely to cause fever?
Non haemolytic febrile reaction
What are the NEXUS criteria ruling out the need for C-spine imaging?
If they have any of the following they require imaging:
- Focal neurological defecit
- Midline spine tenderness
- Altered level of consiousness
- Intoxication
- Distracting injury
What antibiotics should patient with cellulitis recieve?
IV co-amox or cefuroxime
What medications should be stopped when taking macrolide antibiotics? e.g. clarithromycin
Statins should be stopped because macrolides inhibit the cytochrome p450 system that metabolises statins
Why should patients with c.diff potentially have opiates stopped?
To reduce constipation and allow bowels to flush out
What are the features of complete heart block?
Causes syncope
Bradycardia - ventricles natural rate (30-50)
Wide pulse pressure
Heart failure
Which nerve innervate the first web space of the foot?
The deep peroneal
Which analgesia should be avoided in asthma?
NSAIDs can cause brochospasm
What is the most specific sign for aspirin poisoning?
tinnitus
What is the parkland formula for fluid resuscitation in burns?
4x Body surface area (%) x weight (kg) = fluid in first 24 hours
What drug causes nystagmus, ataxia and intention tremour?
Phenytoin
What is the treatment for pneumonia when the patient is penicillin allergic?
Clarithromycin
Which drug is contraindicated with methotrexate for UTI?
Trimethoprim
