Qus Flashcards
carbimazipine mech of action + side effect
sodium channel blocker
folate deficiency –> macrocystic anaemia
phenytoin mech of action + SE
sodium channel blocker
profound folate deficiency –> macrocystic anaemia
types of neuro tumours (3) + which are most common
60% gliomas
20% meningiomas
10% pituary tumours
how to treat increased ICP due to tumour mass
dexamethasone
vasogenic oedema caused by the breakdown of the BBB
swelling reduction
young female, obese - what you thinking?
idiopathic intracranial pressure
post herpatic neuralgia - what is your treatment for neuropathic pain?
duloxetine - SNRI
amytrypiline - TCA
gabapentin - GABA analogue
pregabalin - GABA analogue
how can you treat a child who is unresponsive to anti-epiletics?
ketogenic diet
high fat
low carb
controlled protein diet
oxygen is used as treatment for what kind of headache?
cluster
100% oxygen (80% response rate within 15 minutes)
SC triptans (75% response rate with 15 minutes)
cluster headache prophylaxis
verampiril - CCB
what drugs can exacerbate trigger mysthenia gravis?
penicillamine - Wilson's disease quinidine - anti-arrhythmic agent beta blocker lithium phenytoin
what do heinz’s bodies in a blood film signify?
Glucose 6 Phosphate Deficiency
a predisposition of RBC breakdown
G6PD is needed to protect RBC from oxidative stress
hyaline casts seen in urine - what does it mean?
patients taking loop diuretics
also healthy people after strenuous exercise
from distal convoluted tubule
brown granular cast in urine
acute tubular necrosis
what is a vesicucreteric reflex + imaging
back flow of urine from the bladder into the ureters + kidneys
diagnosed by micturating cystourethogram
common in kids –> can develop UTI
35% develop scarring
what immunisation is given at birth?
bcg
what can give a false-negative mantoux result
immunosuppression (AIDs)
sarcoidosis - reduced immunity
lymphona
roseola infantum
Human herpes virus 6 (HHV6)
measles
RNA parvmyxovirus
mumps
RNA parvmyxovirus
rubella / german measles
toga virus
chicken pox
varicella zoster virus
scarlet fever
group A haemolytic strept (strept pyogenes)
hand, foot + mouth
coxsackie A16
reasons for <24 jaundice
rhesus haemolytic disease
ABO heamolytic disease
hereditary spherocytics
G6P deficiency
measure bilirubin urgently <2hrs
At what timeframe should you refer for undescended testis ?
3 months
what is reflex anoxic seizures (RAS)?
non-epiletic seziures due to excessive stimulation of vagus nerve
quick post-ict recovery
Causes of widened mediastinum?
vascular problems - thoracic aneurysms
lymphoma
retrosternal goitre
thymus tumour
Infective COPD - most common organisms (3)
h.influenza
strept pneumonia
morexella catahhalis
NG tube is inserted. At what pH is it safe to feed??
<5.5
if >5.5 CXR is needed to confirm
What should you see on CXR to confirm correct NG placement?
NG tip is below the diaphragm
what is aspergillioma?
infection due to mould / fungi –> spore inhalation
commonly affects immunosuppressed
severe haemoptysis
PHx of TB
CXR shows rounded opacity
describe sarcoidosis
multisystem, chronic disease with granulatous inflammation
diagnostic asthma parameters (4)
FeNO >40 parts / billion
post bronchodilator >12% FEV1
post bronchodilator > 200ml lung volume
FEV1 / FVC ratio < 70%
diagnostic asthma parameters (5)
FeNO >40 parts / billion
post bronchodilator >12% FEV1
post bronchodilator > 200ml lung volume
FEV1 / FVC ratio < 70%
peak expiratory flow rate variability >20%
FEV1 / FVC ratio <70% (asthma is an obstructive disease)
what are the risk factors + features of transient tachypnoea of the newborn
c-section
- fluid in the lungs as they weren’t squeeze out as baby hasn’t gone through birth canal
settles in 1-2 days
what drugs are associated with cleft platelet when taken in pregnancy
anti-epileptics
loperimide
long-acting synthetic antidiarrheals
antagonize histamine and interfere with acetylcholine release locally.
brand name - imodium
tacrolimus
immunosuppresant
calcineurin inhibitor
irbesartan
angiotension receptor blocker
HTN tx
block the formation of angiotension II
dipyridamiole
platelet inhibitor
given in combo with aspirin
venlafaxine
Serotonin-Noradrenaline Reuptake Inhibitor
obstructive + restrictive lung conditions
OBSTRUCTIVE
- asthma
- COPD
- bronchietasis
- A1AT
RESTRICTIVE
- interstitial lung disease (fibrosis, coal miner, asbestos)
- neuromuscular (GBS)
- structural (scoliosis, ank spon, obesity)
high ACE levels signify?
acute sarcoidosis
how to certify for death?
A –> E assessment (minimium of 5 minutes)
Respiratory effort
Verbral stimuli
Painul stimuli
Carotid pulse
Pupils - fixed + dilated
end of life drugs (4)
sedation (midazolam)
analgesia (morphine)
anti-secretory (hyoscine)
anti-emetic (ondansatron)
what test should you do before starting azthromycin ?
LFTs ECG (long QT)
what is churgg strauss?
Mx
eosinophillia + vasculitis (p-ANCA)
- Allergic (asthma)
- Eosinophilia infilitrates to the tissue
- Vascultis
Mainstay of treatment is corticosteroids
what is granulomatosis with polyangitis?
systemic vasculitis (small + medium vessels)
triad
1. Upper RTI 2. Lower RTI 3. Glomerolonephritis
what is flail chest?
most common comp?
detached ribs moving separately of the rib cage
inspiration - moves in
expiration - moves out
asthma admission –> what are looking out for on ABG and what does it signify?
CO2 retention
pH <7.35 (due to the CO2 retention)
means that patient is tiring –> escalate quick
4 types of markers of disease from asbestos
pleural plaques
- benign + don’t undergo maligancy
- most common / calcification
pleural thickening
- similar pattern seen in empyema / haemothorax
asbestosis
- severity = length of time
- LOWER LOBE fib
mesothelioma
- malginant form of asbestos exposure
- very limited exposure can cause mesothelioma
what is a lesion in optic nerve (II) called and features (2)
marcus-gunn pupil
- deafferent pupil
- constricts to consensual light but not direct
name the eye muscles and their innervations ?
oculomotor (III)
- medial rectus
- inferior rectus
- superior rectus
- inferior oblique
trochlear (IV)
- superior oblique
abducens (VI)
- lateral rectus
whats the limit of Hb1Ac for adding 1st diabetes drug and 2nd diabetes drug?
1st - 48mmol
2nd - 58mmol
what is the criteria for giving fluids for burns?
fluids are not given for 1st degree burns
Given only for 2nd/3rd, covering >15% BSA
Chart used for most accurate burns?
lund and browder
two skin conditions caused by maslasseai furfur?
Pityriasis versicolor
seborrhatic dermatitis
describe features acne rosacea
flushing pustules + papules telangiestais nasal liabial sparing rhinophyma
how do you treat ance rosacea
metronidazole / tetracycline
Mx lichen planus
clobetsol propionate - steroid
describe features of ance vulagaris
pustules + papules
oilly skin
comodomes (closed + open)
complication of draining effusion too quickly
re-expansion of pulmonary oedema
Mx actinic keratoses
Fluorouracil
binds to uracil –> RNA –> destroys malignant cells
Mx seborrhatic dermatitis
ketoconazole
antibodies for Graves
TSH receptor antibodies (90%)
Anti-thyroid perioxidase (75%)
hashimoto’s
chronic immune thyroiditis
non-painful goitre
de quervain
- hyperthyroidism
- hypothyroidism
painful- gotire
what scores signify impaired fasting glucose?
Fasting Glucose 6.1 - 7.0 mmol/l
what scores signify impaired glucose tolerance?
fasting plasma glucose <7.0 mmol/l
OGTT 2-hour value greater than 7.8 to 11.1mmol/l
post surgery stress response
insulin
oestrogen
testosterone
what is the first treatment regime for newly diagnosed T1DM?
basal bolus insulin regimen
w/ twice daily insulin detemir
what is buerger’s disease
small / medium vessel disease
strong association with smoking
statins mech of action
what test is used to monitor statins?
HMG-CoA reductase –> rate limiting enzyme in hepatic cholesterol synthesis
LFT measured baseline, 3 months, 12 months
stop in pregnancy
cardiac tamponade
features
large drop in BP in inspiration = pulsus paradoxus
what is kussmaul’s sign?
where is it seen?
raise JVP with inspiration
constrictive pericarditis
side effects of statins
myopathy
liver impairment
Nicorandil
potassium channel activator
vasodilator –> angina
long QT syndrome mx
- long QT drug avoidance
- beta blockers
- impantable cardioverter debib (if >500ms)
what drug gives you angioedema ?
ACE-i
Mx torsades de pointes
magnesium sulphate
orthostatic hypertenson mx
fludrocortisone - steroid
increases renal sodium reabsorption and increases plasma volume
what is doxazosin?
selective a1 - blocker
treats HTN
pathophysiology of HHS
hyperglycaemia >30mmol
hyperosmolality >320
in the absence of lipolysis (small enough insulin production to suppress this
reduced insulin results in increased gluconeogenesis
- hyperglycaemia –> osmotic diuresis
- hypernatraemia along with hypovolaemia
- leads to progressive decline in eGFR –> aggrevates the hyperglycaemic state
pathophysiology of DKA
complication of T1DM
due to the lack of insulin –> glucolysis stops
body uses fatty acids for energy –> lipolysis
resulting in the production of ketones
diagnostic criteria for HHS
hypovolaemic
hyperglycaemia >30mmol
w/o ketoanaemia / acidosis
serum osmolality >320 mosmol/kg
Mx HHS
- monitor osmolality
- replace fluid / electrolytes –> potassium
- normalise blood glucose
aim to replace 3-6L within first 12 hours
IV 0.9 sodium chloride
already relievely hypotonic compared to blood os
correct potassium levels
AKI = causes hyperkal
Diuretics = causes hypokal
what are the indications for insulin in HHS?
presence of ketonaemia (mixed DKA/HSS picture)
then the recommended insulin dose is a fixed rate intravenous insulin infusion given at 0.05 units per kg per hour.
if NO ketonaemia then don’t give insulin
describe and explain the effects of hyper / hypo / isotonic fluids?
hyper - higher osmolality in order to draw fluid out from cells (intra –> extra)
iso - same osmolality for extravascular volume expansion
hypo - lower osmolaity in order to shift fluid into cells (intra –> extra)
how dehydrated are patients with HHS?
100 - 220ml/kg
so 70kg pt has lost 7 to 15.4L
develops over several days so is more profound than DKA
Mx of DKA (5)
1. fluids (isotonic)
pts have usually lost 5-8 litres
2. short acting insulin (0.1units/kg/hr)
3. 5% dextrose (once glucose <15)
4. correction of hypokalaemia
5. switch short insulin --> long insulinwhat kind of patients more at risk of developing cerebral oedema?
younger patients (18-25)
diagnostic criteria for DKA (4)
- glucose > 11mmol / known diabetic
- pH < 3.5
- bicarb <15 (high anion gap)
- ketones > 3mol
most common precipating factor for DKA
infection
missed insulin dose
MI
complications of DKA
- gastric stasis
- thromboembolism
- arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia
- iatrogenic due to incorrect fluid therapy: cerebral oedema*, hypokalaemia, hypoglycaemia
- acute respiratory distress syndrome
- acute kidney injury
administering vancomycin - what are concerns?
allergic reaction
red man syndrome (significant release of histamine)
pruritus, erythema
burning sensation of the upper chest
dengue fever
viral haemorrhagic fever
a form of DIC called dengue haemorrhagiv fever may develop
low plateletts
raised ALT
myalgia
maculopapular rash
HIV risk needle stick injury
encourage bleed
run under water
may start treatment 72 hours following exposure
refer to ED + oral antiretroviral therapy for 4 weeks
serological testing at 12 weeks following completion of post exposure
painful genital ulcer
more common
herpes simplex virus (more common)
- HSV type 2 (type 1 cold sores)
chancroid
- painful genital ulcers
- inguinal node enlargement
painless genital ulcers
syphilis (more common)
lymphogranuloma
- chlamydia trachomatis
–> Mx Doxycyline
Extensive otitis externa Mx
flucloxacillin
PID Mx
Doxycycline + metronidazole + ceftriaxone
atypical pneumonia
clarithromycin
Acute pyelonephritis
Broad-spectrum cephalosporin or quinolone
typhoid
salmonella typhi
- pea green diarrhoea
- fever >39
- relative bradycardia for level of infection
ciprofloxacin
what pneumonia causes:
- deranged LFTs
- hyponatriemia
legionella pneumophilia
erythema multiforme
mycoplasma pneumoniae
pneumonia following influenza
staph aureus
erythema migrans / lymes disease
Borrelia
test for lymes disease
ELISA antibodies
then if positive
immunoblot test for lymes
Mx for lymes
doxycycline (tetragenic)
ceftrixone if disseminated
Mx genital warts
HPV 6 / 11
multiple / non-keratinised
- topical podophyllum
solitary, keratinised
- cryotherapy
herpes simplex infection
HSV 1 - cold sores
HSV 2 - genital herpes
primary infection:
- gingivostomatitis (gum + mouth infection)
- cold sores
- painful gential ulceration
Mx
- oral / topical aciclovir
herpes simplex infection in pregnancy –> what is advised
if infected post-28 weeks
–> c-section advised
erythema infectiosum
parvovirus b19
IgM - recent infection
IgG - immunity
organism most associated with gangrene
staph aureus
- type 1 nec fas
strept pyogenes
- type 2 nec fas
clostridium perfringens
- type 3 nec fas
lactational mastitis
staph aureus
sewage worker
leptosporosis
- bilateral conjuctivits
- bilateral calf pains
- high fevers
most common CAP
strept pneumonia
most common infective COPD
H.influenza
bacterial vagionsis
gardenerella vaginalis
Mx - oral metronidazole
syphilis investigations
EIA - detects acute igM antiobody to syphilis
TPPA - remains positive for people who have been previously infected
Rapid plasma reagin (RPR) - used to monitor activity + reinfection
- –> the number of times a sample needs to be diluted to be come undetectable
- –> higher diluation means greater infection
Mx syphilis
IM benzathine penicillin G
3 types of pathogen for viral encepthalitis
herpes simplex virus (most common)
enterovirus
vericella zoster virus
Mx for MRSA from carrier once identified
mupirocin (nose) chlorhexidine gluconate (skin --> creases)
Chagas disease
95% patients are asymptomatic
african + american origin
concerned about cardiomyopathy = echocardiogram
how many tetanus jabs needed for lifelong immunity?
5
bupropion
anti-depressant
used to aid smoking cessation
lowers epilepsy threshold - bad
which pneumonia is associated with neurological symptoms?
mycoplasma pneumonia
how do you treat PID?
doxycycline + ceftriaxone
+ metronidazole
lymes disease pathogen + effects
borrelia
facial nerve involvement
post-splenectomy what organisms are patients at risk from?
pneumococcus
Haemophilus
meningococcus
what vaccines are given to patients undergone splenectomy?
annual influenza vaccine
pneumococcal vaccine every 5 years
what is given for post-splenectomy sepsis
Penicillin V or amoxicillin
