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Y3 Medicine > Random 10 > Flashcards

Random 10 Flashcards

1
Q

What are the symptoms of Fibromyalgia?

A
  • Generalised fatigue
  • Weakness
  • Tender spots on the joints
  • Brain fog
  • Pins and needles
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2
Q

What is the difference between T and Z scores?

A

T-scores are used to compare an individual’s bone mineral density (BMD) to the average BMD of a healthy young adult of the same sex.

Z-scores, on the other hand, compare an individual’s BMD to the average BMD of people of the same age, sex, ethnicity, and body size.

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3
Q

What T score is indicative of Osteoporosis?

A

-2.5 or lower

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4
Q

What infections are more common in alcoholic patients?

A

Staph aureus and Klebsiella (red currant jelly sputum)

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5
Q

Why is pseudomonas difficult to treat and how do you treat it?

A

Forms a biofilm and is treated with a high dose of Tazocin (4.5g) QDS

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6
Q

What testingExplain the purpose of an ENA (Extractable Nuclear Antigen) screen in diagnosing myositis. What specific antibodies might the test detect, and how do these antibodies aid in the diagnosis process?

A

The ENA screen is a blood test used to detect specific antibodies associated with autoimmune diseases, including myositis. In the context of myositis, it helps identify antibodies such as anti-Jo-1, anti-Mi-2, anti-SRP, and anti-MDA5. These antibodies aid in diagnosis by indicating the presence of certain subtypes of myositis, helping healthcare providers classify the specific form of the disease and plan appropriate treatment strategies.

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7
Q

Describe the symptoms of myositis. What are the common clinical manifestations, and how might a healthcare provider differentiate myositis from other conditions with similar symptoms?

A

Myositis presents with muscle weakness, pain, and inflammation. Patients often experience difficulty in activities requiring muscle strength. Other symptoms can include skin rashes, fatigue, and difficulty swallowing (dysphagia). To differentiate myositis from other conditions, healthcare providers rely on a combination of patient history, physical examination, blood tests (including ENA screening), and often a muscle biopsy. By analyzing specific symptoms, laboratory results, and biopsy findings, healthcare providers can establish a definitive diagnosis and distinguish myositis from other conditions with similar presentations, such as muscular dystrophy or certain neurological disorders.

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8
Q

Can you explain what P1NP is and how it is used in the diagnosis and monitoring of osteoporosis?

A

P1NP, or Procollagen Type 1 N-Terminal Propeptide, is a biomarker that reflects the rate of bone formation. In osteoporosis, measuring P1NP levels helps doctors diagnose the condition and monitor the effectiveness of treatments. Low P1NP levels might indicate reduced bone formation, a characteristic of osteoporosis.

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9
Q

What is Lupus pernio?

A

Lupus Pernio is a distinctive skin manifestation associated with sarcoidosis, a multisystem inflammatory disorder characterized by the formation of granulomas. These granulomas are abnormal clumps of inflammatory cells. Lupus Pernio specifically refers to a chronic skin lesion, often purplish or dusky red in color, usually found on the nose, cheeks, ears, and lips.

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10
Q

What are some functions of bones?

A
  • Calcium reservoirs
  • Buffers, HCO3- in bones
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11
Q

What are factors that determine good bones?

A
  • Genetics
  • Calcium and vitamin D
  • Physical activity
  • Maintenance of healthy weight
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12
Q

How much calcium do you need a day?

A

700mg

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13
Q

What are risk factors for osteoporosis?

A
  • Darker skin colour
  • Age >65
  • Low sun exposure
  • End stage liver disease
  • Pregnant or breastfeeding
  • Malabsorption
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14
Q

What is the difference between osteomalacia, osteoporosis and osteopenia?

A

Osteoporosis is a bone disease characterized by reduced bone mass and tissue deterioration.

Osteomalacia is a condition where bones become soft and weak due to a deficiency in vitamin D, calcium, or phosphate, hindering the mineralization of the bone matrix.

Osteopenia refers to lower-than-normal bone mineral density (BMD), indicating reduced bone density but not to the extent seen in osteoporosis. It serves as a precursor to osteoporosis.

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15
Q

How much exercise should people >65 each week?

A

> 150 minutes

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16
Q

What year is your peak bone mass?

A

30

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17
Q

How much vitamin D should patients at a high risk of osteoporosis take each day?

A

400IU

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18
Q

What does a T score of -2.5 to -1 indicate?

A

Osteopenia

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19
Q

What is the NOGG graph for?

A

Gives 10 year risk of a fracture. Whether they should be treated or not.

Very high risk should be referred onto rheumatology.

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19
Q

Where do fragility fractures occur?

A
  • Spine
  • Hip
  • Wrist
  • Humerus
  • Rib
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20
Q

How do ACEi slow the progression of chronic kidney disease?

A

You are partly correct. ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) slow the progression of chronic kidney disease primarily by dilating efferent arterioles in the kidneys, reducing intraglomerular pressure and protein filtration, thus protecting the kidneys from further damage.

21
Q

What is the medical management to control high calcium and prevent kidney stones?

A

Thiazide diuretics, bisphosphonates and calcimimetics.

22
Q

A 45-year old female has end stage renal cancer. Due to her cancer she has stage 4 chronic kidney disease. Which is the best drug to prescribe in her syringe driver for pain?

A

Alfentanil because it is not renally excreted

23
Q

What do you give in SEVERE hyperkalaemia?

A

Calcium chloride (instead of calcium gluconate)

24
Q

On an abdominal X ray, what would a thickened bowel wall be a sign of?

A

Thumbprinting (Crohn’s)

25
Q

On an abdominal X ray, what would a loss of haustra signify?

A

Leadpipe colon (Ulcerative colitis) Serious as this can lead to toxic megacolon

26
Q

What could be going on if you can see the bowel very clearly on an abdominal x ray?

A

Air in the peritoneum

27
Q

What is the rule to determine which type of obstruction is going on?

A

369 rule
>3cm= Small bowel
>6cm= Large bowel
>9cm= Caecum

28
Q

What is a coffee bean sign?

A

Sigmoid volvulus goes from the bottom left to the top right.

29
Q

What is a fetus sign?

A

Caecal volvulus from bottom right to top left.

30
Q

What are staghorn calculi?

A

A staghorn calculus, a type of kidney stone with branches, happens in some cases because of repeated infections. The branches can block urine from leaving the kidney, causing kidney failure.

31
Q

What are causes of small bowel obstruction?

A

Adhesion, adhesion, adhesion and maybe a femoral hernia

32
Q

How do you treat small bowel obstruction?

A
  1. NBM
  2. Fluid resuscitation and NG tube to aspirate content for decompression (‘Drip and suck’)
  3. Gastrografin can be administered as both a diagnostic and therapeutic measure in cases of partial obstruction. Lubricates the bowel.
33
Q

What is the treatment for large bowel obstruction?

A
  1. NBM
  2. NG tube
  3. IV fluids
  4. Surgery is more indicated, especially if there is an underlying malignancy.
34
Q

What is Hartmann’s procedure?

A

It involves the removal of part of the sigmoid colon (the lower part of the colon) and the rectum, often due to conditions such as cancer, diverticulitis, or perforated diverticular disease.

35
Q

How do you treat toxic megacolon?

A
  1. Corticosteroids
  2. Infliximab
  3. Oral vancomycin, IV metronidazole
  4. Fluids IV
  5. Analgesia and antiemetics
  6. DVT proph
36
Q

Apart from ulcerative colitis, what is another cause of toxic megacolon?

A

Pseudomembranous colitis from C.diff

37
Q

Medical management to maintain remission in Crohn’s?

A

Azathioprine or mercaptopurine should be offered 1st line.
Methotrexate may be considered in patients who are intolerant/have a contraindication to azathioprine or mercaptopurine or who do not respond to azathioprine or mercaptopurine monotherapy.

38
Q

Medical management to induce remission in Crohn’s?

A

Patients should be offered monotherapy with glucocorticoids (prednisolone or IV hydrocortisone).
Enteral nutrition may be considered as an alternative in children (as steroids suppress growth).
Azathioprine or mercaptopurine may be added on to induce remission if there are 2 or more exacerbations in a 12-month period or the glucocorticoid cannot be tapered.
It is important to assess for thiopurine methyltransferase (TPMT) activity before offering azathioprine or mercaptopurine.
Methotrexate may be considered as add-on therapy in patients who do not tolerate azathioprine or mercaptopurine or who are TPMT deficient.

Biological agents (such as infliximab or adalimumab) are recommended in patients with severe Crohn’s disease who fail to respond to the above.

39
Q

What are the signs of heart failure on an x ray to remember?

A

A-E
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels (batwing)
Pleural effusions

40
Q

What is the antibody in anti-phospholipid syndrome?

A

Cardiolipin

41
Q

What are features of polymyalgia rheumatica?

A

> 60
Fatigue, pain and stiffness in the pelvic, shoulder and girdle
Symptoms are bilateral and symmetrical
Dramatic response to steroids
HLA-DRB1
Ck- normal
Muscle biopsy is normal

42
Q

What are features of some GCA?

A

Amarosis fugax
Scalp tenderness
Jaw claudication
Headache

43
Q

What sign is seen on ultrasound of temporal arteritis (GCA)?

A

Halo sign and the artery is not compressable

44
Q

What is significant on a biopsy of temporal arteritis?

A

Classical histological findings include granulomatous inflammation of the inner half of the media with infiltration of inflammatory cells including giant cells
3–5 cm of the artery should be biopsied because of skip lesions (ie. the lesions are segmental and tend to skip parts of the artery)
A negative biopsy does not rule out disease

45
Q

What is the gold standard (according to Dr Pickering) for fluids someone NBM?

A

1L 0.9% saline + 20K+
1L 5% dextrose +20K+
1L 5% dextrose +20K+

46
Q

What topical NSAID is first-line in osteoarthritis?

A

Diclofenac sodium

47
Q

What is delerium tremens?

A

Delirium tremens (DT) is a severe form of alcohol withdrawal that presents with acute confusion, hallucinations, autonomic hyperactivity, and, in rare cases, seizures. Typically occurring around 72 hours after the cessation of alcohol intake, DT necessitates immediate medical attention and management. The first-line treatment is lorazepam, administered either orally or parenterally, followed by maintenance management strategies.

48
Q

What do you give to patients in alcohol withdrawl with a CIWA (Clinical Institute Withdrawal Assessment for Alcohol) score of more than 10?

A

Chlordiazepoxide is frequently used to manage alcohol withdrawal symptoms. It helps prevent or reduce symptoms such as tremors, agitation, and anxiety that can occur when a person stops drinking alcohol suddenly. The medication helps to stabilize the central nervous system during alcohol detoxification.

49
Q

Where in the lungs do you get fibrosis from Silicosis?

A

Comes from the floor and upper lobes.

Y3 Medicine (17 decks)

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