Random Flashcards
causes of gingival hyperplasia?
Drugs:
phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)
Other:
acute myeloid leukaemia (myelomonocytic and monocytic types)
adverse reactions of metronidazole
Adverse effects
disulfiram-like reaction with alcohol
increases the anticoagulant effect of warfarin
Think of a man in an army jacket (WARfarin) vomiting and bleeding in the metro station. He also has AA chips -> disulfiram
Communicable disease vs infectious disease
communicable diseases spread from human to human
infectious diseases are a superset of that
NBC and CBRN threats (public health terms)
nuclear
biological
chemical
Chemical
biological
radiological
nuclear
Describe the position of club foot
inverted
plantarflexed
NOT passively correctable
SE of interferon alpha
flu-like sx
when do you notify a disease?
clinical timing
at the point of suspicion
not confirmation/diagnosis!
What medications should patients with stable angina be started on?
statin
aspirin 75 mg OD
antihypertensive
consider ACEi if also have diabetes
nitrate
Mx of idiopathic intracranial HTN
conservative: weight loss
medical: Acetazolamide.(carbonic anhydrase inhibitor, thought to decrease CSF production)
Inteventional: regular LPs
What is Meig’s syndrome?
ascites and pleural effusion (transudate) in association with a benign ovarian tumor
The combination of which antibiotic with alcohol causes a disulfiram like reaction?
Metronidazole
list the 5 live attenuated vaccines
BCG
MMR
oral polio
yellow fever
oral typhoid
Commonest pathogens found in pyogenic liver abscessess
Staphylococcus aureus in children and Escherichia coli in adults.
Management of pyogenic liver abscess
IV abx and image guided percutaneous drainage
What findings can you see on ECG in PE
- sinus tachy (commonest)
- S1Q3T3 (=a prominent S wave in lead I, a Q wave and inverted T wave in lead III)
What pathophysiological mechanisms lead to metabolic acidosis?
- increased production or ingestion of acid
- body can’t get rid of acid.
-excess loss of HCO3- (renal, GI)
What are the two main types of metabolic acidosis?
high anion gap MA
normal anion gap MA
name examples of causes of high anion gap MA
MUDPILES
M - methanol
U - uremia (e.g. in CKD, kidneys cannot secrete acid)
D - DKA
P - propylene glycol
I - isoniazid or iron overdose
L - lactic acidosis
E - ethylene glycol poisoning (oxalic acid, found in antifreeze)
S - salicylates
How do you calculate anion gap
Anion Gap = Na+ – (Cl- + HCO3-)
What is the commonest cause of normal gap metabolic acidosis?
diarrhoea
(loss of )
What are the causes of normal anion gap metabolic acidosis?
HARDASS
H - hyperalimentation
A - Addison disease
R - renal tubular acidosis
D - diarrhoea
A - acetazolamide
S - spironolactone
S - saline infusion
Causes of respiratory acidosis
Hypoventilation and accumulation of CO2
-> breathing slowly AS A COW
A - airway obstruction
S - sedative use or stroke
A - acute lung disease (e.g. pulmonary oedema)
C - chronic lung disease (e.g. COPD)
O - opioids
W - weakening of airway muscles (diaphragm/chest wall loss of function)
ABG in acute resp acidosis
low pH
normal or slightly raised HCO3-
ABG in chronic resp acidosis
pH is close to normal
HCO3- is v high because of compensation
causes of metabolic alkalosis
LAVA-UP (loss of H+ or gain of HCO3-)
L - loop diuretics
A - antacid use
V - vomiting
A-UP - aldosterone increase
causes of respiratory alkalosis
due to hyperventilation (more CO2 eliminated)
P - panic attacks
A - anxiety attacks
S - salicylates (early phase)
T - tumour (tumour in the brain can simulate respiratory centres)
P - PE
H - hypoxia
What is a J-pouch?
an ilio-anal anastomosis
the ileum is folded on itself and functions like a a rectum
this is then attached to the anus and collects stools before the person passes a motion
How can you tell which opening is proximal and distal when looking at a loop ileostomy?
the proximal (productive) end is spouted.
the distal end is flatter.
this is because the bowel contents irritate the skin so you want to spout them.
What is a urostomy?
it is used to drain urine from the kidneys and bypass parts of the urinary tract (ureters, bladder, urethra
the ureters drain into
requires can ileaal conduit
needed for example following cystectomy
How is a ileal conduit for a urostomy made?
- 15-20cm portion of ileum resected (and an end-to-end anastomosis is created to ensure normal functioning of the bowel.
- ends of ureters are anastomosed with this new ileal conduit
- a stoma is created (generally in RIF) that drains the urine - spouted to avoid skin irritation
- a urostomy bag is fitted (tightly fitted to avoid skin irritation)
what could a stoma in the RIF be?
ileostomy (end vs loop)
urostomy
Complications of stomas
- psychosocial impact
- skin irritation
- parastomal hernias
- loss of bowel distal to the stoma -> lesss water reabsorbed -> high output, dehydration, malnutrition
- constipation (colostomy)
- obstruction
- stenosis
- retraction (stoma sinks in the skin)
- prolapse (bowel telescopes through hernia site)
- bleeding
- granuloma formation
What is Bell’s palsy?
Bell’s palsy may be defined as an acute, unilateral, idiopathic, facial nerve paralysis.
The aetiology is unknown although the role of the herpes simplex virus has been investigated previously.
What group of people is Bell’s palsy more common in?
peak incidence 20-40 yo
pregnant women
Mx of Bell’s Palsy
give prednisolone if within 72h of onset
What findings of cavernosal blood gas analysis would you see in ischaemic priapirism?
low pO2
low pH
high pCO2
Ix to differentiate between ischaemic and non-ischaemic priaprism
cavernosal blood gas analysis
Which of these for long term secondary stroke prevention in a patient on aspirin and simvastatin who has AF?
A. apixaban
B. aspirin
C. aspirin and dipyridamole
D. clopidogrel
E. Ticagrelor
Apixaban
Pemberton sign
seen in SVC obstruction syndrome
when the patient lifts both arms up the faces becomes red and congested.
What is the sign called in patients with SVC obstruction where lifting the arms up leads to the head becoming red?
Pemberton’s sign
What is Leriche Syndrome?
triad:
1. Claudication of the buttocks and thighs (pain)
2. Atrophy of the musculature of the legs
3. Impotence (due to paralysis of the L1 nerve)
Due to atheromatous disease involving the iliac vessels. Blood flow to the pelvic viscera is compromised.
Causes of erythema multiforme
- viruses: herpes simplex virus (the most common cause), Orf*
idiopathic - bacteria: Mycoplasma, Streptococcus
- drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
- connective tissue disease e.g. Systemic lupus erythematosus
- sarcoidosis
- malignancy
What are the components of the CHA2DS2VASc score?
C - congestive HF (1pt)
H - HTN (1pt)
A2 - age 75+ (2pts)
D - diabetes mellitus (1pt)
S2 - previous stroke, TIA or thromboembolism (2pts)
V - vascular disease (1pt)
A - age 65-74 (1pt)
Sc - sex category (female) (1pt)
What type of medication is aminophylline?
it is a bronchodilator
Cautions and contraindications for prescribing loop diuretics
Cautions:
- hepatic encephalopathy
- hypokalemia
- hyponatraemia
- dehydrated / hypovolaemic
- lithium treatment (cause increased levels of lithium)
When do loop diuretics start working and how long is their effect?
start working within
- 1h (oral)
- 5 min (IV)
effects last for 6h
Give examples of loop diuretics
furosemide
bumetanide
What are the adverse effects of loop diuretics?
hypokalaemia
hyponatraemia
hypotension/low BP
AKI
urinary retention (because of increased production of urine that it can’t be passed quickly enough)
hyperglycaemia (worsens diabetic control)
gout exacerbation
ototoxicity
What time of day should loop diuretics be taken?
earlier in the day
if you give them later in the day, the patients will want to pass urine at night which will decrease the quality of sleep and can increase the risk of falls (especially in elderly patients)
lining of the loop of Henle
squamous eepithelial in the descending loop of Henle - very permeable to water
columnar epithelium in the thick ascending loop of Henle. not permeable to water. There is active transport of K+, Na+ and 2Cl- across the membrane
-> countercurrent multiplier
how do loop diuretics work?
inhibit the membrane co-transporters in the ascending loop of Henle
these actively transport K+, Na+ and 2Cl- from the lumen into the interstitial to be reabsorbed.
by inhibiting, there is less reabsorption of these electrolytes. Furthermore, the interstitial fluid is less concentrated, and therefore less water crosses the membrane from lumen to interstitial fluid in the descending loop of Henle and more fluid is peed out.
How does furosemide impact blood K+?
decreases
because it leads to increased secretion of K+ in the urine
(inhibits the membrane co-transporters in the ascending loop of Henle that are responsible for the reabsorption of K+, Na+ and 2Cl-.
What medication do you start someone who has had an MI on?
ACEi
beta blocker
dual antiplatelet
statin
Ethnicity consideration in patients with uncontrolled HTN on CCB
in patients of black-african or afro-carribean organon ARB > ACEi
Interpretation of results of 2-level PE Wells Score
PE likely - more than 4 points
PE unlikely - 4 points or less
What medication type is indapamide?
thiazide like diuretic
what is Nelson’s syndrome?
Nelson’s syndrome occurs due to rapid enlargement of a pituitary corticotroph adenoma (ACTH producing adenoma) that occurs after the removal of both adrenal glands (bilateral adrenalectomy) which is an operation used for Cushing’s syndrome.
Removal of both adrenal glands eliminates the production of cortisol, and the lack of cortisol’s negative feedback can allow any pre-existing pituitary adenoma to grow unchecked.
Continued growth can cause mass effects due to physical compression of brain tissue.
what syndrome are patients who have a bilateral adrenalectomy at risk of and how is this monitored?
Nelson’s syndrome
= rapid enlargement of pituitary corticotroph adenoma following bilateral adrenalectomy
monitoring of ACTH level and pituitary MRI are recommended 3-6 months after surgery and regularly thereafter.
Nelson’s syndrome is now rare because bilateral adrenalectomies are only used in extreme circumstances.
What masses may be palpable in pancreatic cancer?
- hepatomegaly (metastases)
- gallbladder (Courvoisier’s law)
- epigastric mass (primary)
What are the features of optic neuritis?
- unilateral decrease in visual acuity over hours or days
- poor discrimination of colours, ‘red desaturation’
- decreased contrast sensitivity
- pain worse on eye movement
- relative afferent pupillary defect
- central scotoma
What are the typical findings in testicular torsion?
- pain is usually severe and of sudden onset
- pain may be referred to the lower abdomen
- N&V may be present
on examination, there is usually a swollen, tender testis retracted upwards. - The skin may be reddened - cremasteric reflex is lost
- elevation of the testis does not ease the pain (Prehn’s sign)
Is the cremasteric reflex present or absent in testicular torsion?
loss of cremasteric reflex in TT
What are the causes of optic neuritis?
- multiple sclerosis: the commonest associated disease
- diabetes
- syphilis
What can you see on fundoscopy in optic neuritis?
- may be normal
- swelling of the optic nerve may be visible in a third of patients and is typically mild.
However, most patients have retrobulbar involvement therefore the optic nerve appears normal. Over time, the optic nerve will develop pallor.
Causes of splenomegaly?
Massive splenomegaly
- myelofibrosis
- chronic myeloid leukaemia
- visceral leishmaniasis (kala-azar)
- malaria
- Gaucher’s syndrome
Other causes (as above plus)
portal hypertension e.g. secondary to cirrhosis
lymphoproliferative disease e.g. CLL, Hodgkin’s
haemolytic anaemia
infection: hepatitis, glandular fever
infective endocarditis
sickle-cell*, thalassaemia
rheumatoid arthritis (Felty’s syndrome)
What causes Lateral medullary syndrome and what are the features?
also known as Wallenberg’s syndrome, occurs following occlusion of the posterior inferior cerebellar artery.
Cerebellar features
ataxia
nystagmus
Brainstem features
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
Which medications exacerbate myasthenia gravis?
- penicillamine
- quinidine, procainamide
- beta-blockers
- lithium
- phenytoin
- antibiotics: gentamicin, macrolides, quinolones, tetracyclines
What antibody is dermatomyositis associated with?
anti-Jo-1
features of Kartagener syndrome
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
testicles in kartagener’s syndrome
right testicle hangs lower than left due to situs inversus
usually the left testicle hangs lower
NICE criteria for AKI
NICE recognise any of the following criteria to diagnose AKI in adults:
- ↑ creatinine > 26µmol/L in 48 hours
- ↑ creatinine > 50% in 7 days
- ↓ urine output < 0.5ml/kg/hr for more than 6 hours
What are the features of retinitis pigmentosa?
- night blindness is often the initial sign
- tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
- fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
- FH
Why do you get tunnel vision in retinitis pigmentosa?
because the disease usually affects the peripheries of the retina
Summarise the grades of haemorrhoids
Grade I - Do not prolapse out of the anal canal
Grade II - Prolapse on defecation but reduce spontaneously
Grade III - Can be manually reduced
Grade IV - Cannot be reduced
What is Cushing’s triad?
triad seen in raised ICP
- Widening of the pulse pressure
- Respiratory changes
- Bradycardia
may also get cranial nerve palsies, compression of essential centres in the brain stem will occur. When the cardiac centre is involved bradycardia will often develop.
Is amylase level a prognostic value in acute pancreatitis?
Note that the actual amylase level is not of prognostic value.
Which tests should be done before starting amiodarone?
TFT
LFT
U&Es
CXR
Causes of IE
- Staphylococcus aureus ( commonest,
particularly common in acute presentation and IVDUs) - Streptococcus viridans (
historically most common, now only most common in in developing countries; endocarditis caused by these organisms is linked with poor dental hygiene or following a dental procedure) - coagulase-negative Staphylococci such as Staphylococcus epidermidis (commonest cause of IE within the first 2 months after valve surgery)
- Streptococcus bovis
associated with colorectal cancer
non-infective
- SLE (Libman-Sacks)
- malignancy: marantic endocarditis
How is local anaesthetic toxicity managed?
with 20% lipid emulsion
which nerve can be damaged during carotid endarterectomy?
hypoglossal nerve
classification for grading intra-capsular NOF #s
The Garden classification is helpful for grading intra-capsular fractures of the femoral neck.
rotation of leg in NOF # and dislocation
Out For Intense Disco
-> Outwards = Fracture
-> Inwards = Dislocation
Management of supraglottitis
urgent referral to ENT and anaesthetics
- sit upright
- may need oxygen 15L via non rebreathe mask
- nebulised adrenaline (1 in 1000) to reduce tissue oedema and inflammation
- IV or IM corticosteroids (e.g. dexamethasone)
- BROAD SPECTRUM ANTIBIOTICS (e.g. 3rd generation cephalosporin like ceftriaxone or cefotaxime)
may need ITU and intubation. Before incubation, should be warned and consented that tracheostomy may bee required.
who gets epiglottis and what pathogens cause it?
Bimodal distribution: children and adults 40-50yo
(now more common in adults)
Haemophilus influenza used to be the main cause but now vaccine
Now leading causes:
- Streptococcus pyogenes
- Streptococcus pneumoniae
in immunocompromised patients also consider HSV-1 and fungi as a cause.
Which cancer causes cannon ball metastases to the lungs?
renal cell carcinoma
What is the management of stable angina that is not managed on a beta blocker alone?
add a dihydropyridine CCB (amlodipine or nifedipine)
do not give a non-dihydropyridine CCB (verapamil, diltiazem) as there is a risk of severe bradycardia and hF
What are the different types of CCBs and what are their names?
Dihydropyridine CCB (amlodipine, nifedipine)
non-dihydropyridine (verapamil, diltiazem)
what condition is nicorandil used for?
angina
What type of drug is nicorandil and what is it used for?
it is a potassium channel activator and it is used for angina. it has a vasodilatory effect on coronary arteries.
What is the first line medication used for the management of bradycardia in an ALS scenario?
atropine 500 mcg IV
What is splanchnic blood flow?
Blood flow originating from the coeliac trunk, SMA and IMA
blood flow that supplies the abdominal viscera
How does terlipressin work in variceal bleeding?
causes vasoconstriction of dilated splanchnic vessels -> portal venous pressure and thus pressure in the bleeding varices
Acute management of variceal bleed
- A-E Mx including fluid resuscitation
- start patient on IV terlipressin and IV antibiotics
- OGD (endoscopic variceal band ligation)
Consideration for surgery in patients on long-term steroids (pred)
supplement with hydrocortisone pre-op
this is because there is a higher requirement of steroids due to the stress of surgery
the pt might not be able to produce adequate steroid amounts because their adrenals are suppressed from long-term steroid use
give supplemental hydrocortisone to prevent Addisonian crisis
What is the first line management of trigeminal neuralgia?
carbamazepine
(works by stabilizing the voltage-gated Na+ channels in neurons, which helps reduce the frequency and severity of the painful episodes.)
-> failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology
How is the trigeminal nerve assessed in the cranial nerve exam?
Sensory: light touch and pin-prick in V1 (forehead), V2 (cheek) and V3 lower jaw
Motor:
- palpate master when clenching jaw
- palpate temporaalis when clenching jaw
- open jaw against resistance (1 hand on back of head, one under chin)
-> (only V3 has motor component)
Reflex:
- jaw jerk
- corneal
Causes of trigeminal neuralgia
- idiopathic
- can also be due to compression of the nerve: tumours or vascular problems
Presentation of trigeminal neuralgia
- unilateral face pain
- electrical shock sensations followed by burning pain
- may come on spontaneously or be triggered by e.g. light touch, chewing, shaving, smoking, talking, brushing teeth
- episodes come on abruptly and last seconds, can have up to 100 episodes per day
- can be limited to one or more divisions of CN V
Peak incidence age for trigeminal neuralgia
60-70
red flags in trigeminal neuralgia -> suggesting serious underlying cause
- Sensory changes
- Deafness or other ear problems
- History of skin or oral lesions that could spread perineurally
- Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
- Optic neuritis
- FH of MS
- Age of onset <40
HbA1c target for T2DM (including the units)
48 mmol/mol
which tuning fork for Rinne and Weber?
512 Hz (short)
which tuning fork for neuro exam?
128 Hz (long)
tympanosclerosis vs otosclerois
in tympanosclerosis you have findings on otoscopy (areas that are not clear, e.g. white-cloudy thicker looking areas)
in otosclerosis, otoscopy is normal.
what causes otosclerosis?
genetic
runs in families
otitis media v glue ear on otoscopy
OM: bulging, red, inflamed, fluid level, pt feeling unwell and symptomatic
Glue ear: unresolved OM (eardrum settles - not bulging. not too red. There will still be a fluid level. Predominant sx will be hearing loss and ear fullness, not pain and infective sx).
When after a nose fracture would you want to see the patient?
7-14 days
-> manipulation should be before 14d
but you also want the swelling to go down.
What virus is most associated with oropharyngeal cancer?
HPV
(EBV for nasopharyngeal)
What drug class is useful for patients with an overactive bladder?
antimuscarinics
(e.g. oxybutynin)
Prostatitis - mx?
Prostatitis - quinolone for 14 days
e.g. ciprofloxacin
What is surgical emphysema?
subcutaneous emphysema
What % of gallstones are radio-opaque?
10%
What kind of BP cuff causes too low BP?
A cuff that is too big
Formula for MAP
MAP = diastolic pressure + 1/3 (pulse pressure)
PP = SBP - DBP
What is the mutation that causes Wilson’s diseases?
What is the inheritance pattern?
Autosomal recessive
ATP 7B gene mutation
(encodes for a membrane-bound copper-transporting ATPase -> defective protein in the disease)
What causes liver disease in Wilsons disease?
Why does it come and go?
recurrent bouts of aseptic hepatitis
(copper deposition -> reacts with hydrogen peroxide -> free radicals generated -> aseptic hepatitis)
What are the max points you can get in all categories of the GCS score?
E - 4
V - 5
M - 6
What stimulus should you give in testing M component of GCS score?
a central stimulus e.g. trapezius pinch or supraorbital notch pressure
-> do this for at least 10 seconds
What is the GCS score if someone is e.g. paralysed or has an ET tube?
NT (not testable)
for M / V in this example
Summarise the GCS score
E4: normal, eyes open
E3: opens eyes to sound
E2: opens eyes to pain
E1: no eye response
V5: orientated
V4: confused
V3: words
V2: sounds
V1: no verbal response
M6: obeys commands
M5: localises to pain
M4: normal flexion
M3: abnormal flexion
M2: extension
M1: no motor response
Features of life-threatening acute asthma (11)
- PEF <33% expected
- sats <92%
- PaO2 < 8kPa
- normal PaCO2 (4.6-6.0 kPa)
- altered conscious state
- exhaustion
- arrythmia
- hypotension
- cyanosis
- silent chest
- poor respiratory effort
Features of severe acute asthma
- PEF 33-50% of expected
- not able to complete sentences in one breath
- RR 25 or above
- HR 110 or above
Position of eye in 3rd nerve palsy
down and out
What does CN III innervaate
lid
pupil
muscles: MR IR SR IO
Which ocular muscles does CN III innervate?
MR
IR
SR
IO
What genetic condition is associated with bilateral vestibular schwannomas?
neurofibromatosis type 2
features of neurofibromarosis type 1
- Café-au-lait spots (>= 6, 15 mm in diameter)
- Axillary/groin freckles
- Peripheral neurofibromas
- Iris hamatomas (Lisch nodules) in > 90%
- Scoliosis
- Pheochromocytomas
features of neurofibromatosis type 2
- bilateral vestibular schwannomas
- Multiple intracranial schwannomas, mengiomas and ependymomas
What medication is viagra?
sildenafil
-> phosphodiesterase 5 inhibitor which is also used in the management of pulmonary hypertension
What antihypertensive management in aortic dissection?
IV labetalol
given in both type A and B dissections
Mx of aortic dissection
1) IV labetalol
2) urgent surgery in type A / I + II(?)
In what condition do you see electrical alterans?
cardiac tamponade
(alteration of QRS complex amplitudes)
What is electrical alterans and in what condition do you see it?
alteration of QRS complex amplitudes
cardiac tamponade
What are T1 and T2 MIs?
T1: atherosclerosic plaque rupture and thrombosis
T2: myocardial oxygen supply and demand imbalance in context of acute illness causing tachyarrhythmia, hypotension, hypoxia without atherothrombosis.
Lhermitte sign
tingling in hands when flexing neck
-> MS
Which nerve is at risk of damage in humeral shaft fractures?
radial nerve
What does a +ve Hoffmann’s test indicate
UMN dysfunction
What CK value would you expect to see in Rhabdomyolysis
> 10 000
Which nerve is responsible for the movement of the tongue? in a lesion, does the tongue deviate towards or away from the lesion?
Hypoglossal Nerve
damage causes the tongue to deviate towards the affected side (the stronger side will push the tongue towards that side)
(medical) Mx of Bowen’s disease
topical 5-FU (efudix cream)
which common medication should you stop before giving contrast?
metformin
1st line abx for MRSA cellulitis
vancomycin
Features of central retinal artery occlusion
sudden onset visual loss
Affarent pupillary defect
red spot on fundoscopy
What are the common origins of CO (re poisoning)
unvented fires and blocked fues
How does CO poisoning lead to death?
CO binds to the Hb molecule where oxygen would normally bind thereby reducing the oxygen carrying capacity of the blood
-> tissue hypoxia and death
Which medication to give and to avoid in neuropathic pain with eGFR <30 mL/min?
give: e.g. amitriptyline
avoid duloxetine in eGFR <30
Is albumin a useful marker of synthetic liver function?
it is a marker of synthetic liver function
not too useful in acute settings because albumin levels may no t show immediate changes in liver synthetic function in the setting of acute liver injury
What occurs in premature ventricular beats?
early depolarization of the ventricular tissue leading to early contraction -> sx are usually brief and self-limiting `
sx of premature ventricular beats
palpitations
thumping palpitations
sensation of sudden jump in the heart
causes of premature ventricular beats?
caffeine
tobacco
alcohol
MI
stimulants (e.g. methamphetamines, cocaine)
anxiety
heart disease (CAD, HF, cardiomyopathy, CHD)
What is sinus arrythmia?
normal variation in HR that occurs during breathing
(not associated with palpitations or sudden jumps in HR)
How to differentiate between BCC and SCC?
Both are cancers of keratinocytes.
BCC: raised pale border, shiny pearly surface, rolled edge, overlying telangiectasia
SCC: red (not pale); grows at a much faster rate than BCC
What would the surgical intervention of choice be in a patient with chronic distal aortic and bilateral common iliac occlusive disease be?
aorto-bifemoral bypass graft
strep pneumoniae under microscope appearance
gram +ve diplococci
Staph aureus appearance under microscope
cocci that form clusters
gram +ve
xanthoma vs xantholasma
xantholasma - around eye
xanthoma around skin
What memory is mainly impaired in dementia?
short term memory
Which medication to induce withdrawal bleed in patients with PCOS?
medroxyprogesterone
In what condition do you get a tapping apex beat ?
mitral stenosis
is senile calcification a cause of mitral stenosis?
no
commonest cause of mitral stenosis
RHD
auscultation in MS
loud 1st HS with opening snap
diastolic murmur
evidence of pulmonary oedema on auscultation
Selection bias
a general term describing the non-random assignment of patients to a study group
Which medication can cause grey skin?
amiodarone
which antiarrythmic are used in bradycardia?
atropine (500mcg doses, up to 3mg)
adrenaline
-> TC and TV pacing
What ECG abnormality/heart problem can macrolide abx cause?
How do you manage this?
torsades de pointes
-> give IV Mg self
macrolide example: clarithromycin, azithromycin, erythromycin
what effect on QTc does low K+ have?
hypokalaemia is a cause of long QT syndrome
Which antiarrythmics can be used for rhythm control in AF?
amiodarone
Flecainide
digoxin (only really for people with HF, not a very good anti arrhythmic, only works at rest and at low HR)
What dose of adrenaline should be given during a cardiac arrest?
1 mg
STEMI antiplatelet medication
if PCI = aspirin + prasugrel (P like PCI)
if thrombolysis: give fondauparinx (antithrombin) and ticagrelor post procedure
How quickly should a patient with NSTEMI and GRACE score >3 undergo coronary angiography?
within 72h of admission
Mx of cardiac tamponade
pericardiocentesis
How many mm indicates ST elevation?
What causes S3? In what conditions can you hear it?
- caused by diastolic filling of the ventricle
- normal if < 30yo (may persist in women up to 50yo)
- heard in LV failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and MR
Management of TCA OD with ECG chnages/hypotension
IV sodium bicarbonate
ECG features of TCA OD
- sinus tachycardia
- widening of QRS
- prolongation of QT interval
What wave on ECG is hypothermia associated with?
J waves
Can LBBB be normal?
no!
LBBB is never normal
What happens to T waves in Wellen syndrome?
deeply inverted T waves in V2-V3
QT in hypothermia
hypothermia causes long QT
Branches of the coeliac trunk
- common hepatic artery
- left gastric artery
- splenic artery
What does the SMA supply
the midgut:
- from the ampullary region of the second part of the duodenum
- to the splenic flexure of the large intestine.
Presentation of post-infection GN vs IgA nephropathy
IgA: visible haematuria a
few days after URTI
post-infectious GN: lag time of ~2w before
haematuria occurs and would be a less benign presentation if associated with
visible haematuria
treatment options for acute gout
colchicine
NSAIDs
oral or IV steroids
Can epidural/spinal anaesthesia be topped up?
epidural - yes
spinal - no
Which analgesic for major abdominal surgery in
respiratory disease should be avoided?
opioid, by whatever route
Action of ADH
stimulates synthesis of aquaporin-2 in the apical membrane of the collecting duct
which promotes water absorption.
Limit for ToP in the UK
24 w
-> however, if the foetus has a serious anomaly that would result in death or if there is risk of serious harm to the mother, the ToP can occur at any time of pregnancy.
What blood marker is elevated in NMS?
creatine kinase
Sx of LGV
discharge
lymphadenopathy
commonly causes proctitis (-> may include anal discharge)
pain on defaecation
tenesmus
pain on anal sex
What is spondylolisthesis?
a condition in which a vertebral body slips anteriorly in relation to the subjacent vertebrae.
may be asymptomatic
may cause lumbar pain on exertion, gait problems, radiculopathic pain or urinary incontinence.
What is spondylosis?
broad term to describe degenerative changes in the spine that may result in irritation and/or damage of the adjacent nerve roots or spinal cord.
In what direction does the disk slip in disk herniation?
posteriorly
CRP in Sjogrens
normal
features of avoidant personality disorder
social inhibition
feelings of inadequacy
hypersensitivity to criticism
strong desire for affection and acceptance
avoid social situations
few close relationships
often rely heavily on a single attachment figure
physical sx e.g. headaches, abdo pain in anxiety provoking situations
How do you calculate NNT?
1/ARR
ARR = risk in control group - risk in treatment group
Management of acute mania
2nd gen antipsychotic (e.g. olanzapine)
not lithium or sodium valproate! -> these are used for long term
In what age group is toddler diarrhoea common?
6 months - 5 years
usually resolves by age 5
Medical management of hepatic encephalopathy
1st line: lactulose (improves sx by decreasing the absorption of ammonia in the bowel)
rifaximin (reduces the number of ammonia producing intestinal bacteria)
endovaginal prostaglandin gel vs progesterone suppository
prostaglandin gel: used to ripen the cervix when it is not favorable
progesterone suppository: used to prevent preterm labour
Name a prostaglandin analogue that you would use to maintain a PDA
alprostadil
Indomethiacin drug class
NSAID
alprostadil drug class
prostaglandin E1 analogue
can ergometrine be used in hypertension?
no, it is essentially contraindicated
can exacerbate hypertension
Painful arc in shoulder abduction 80-120 degrees - dx?
subacromial bursitis
mx of rattly breathing in palliative care
hyoscine
an antimuscarinic medication for the management of respiratory secretions in dying patients
What can long menstrual cycles indicate?
that there are anovulatory cycles
the person may not be ovulating regularly
When do you perform paired and when unpaired T-tests?
- unpaired when they are two independent groups of data
- paired if it is the same group or item under two separate scenarios
both only in normal distribution
In a dying patient who wants to die on the ward they know who becomes unconscious with the son and the doctors thinking it would be better for the patient to die in hospice, where should the patient die?
the patients previous opinion is the most important factor when deciding here
The primary consideration are the patients wishes
EPSE parkinsonism treatment
procyclidine hydrochloride
Which team decides on the CPR status of the patient
the admitting team
findings in FAP
FH of CRC at a young age
hundreds of colorectal polyps
Medication to use for neuromuscular blockade
neostigmine
= cholinesterase inhibitor
(NM bloackde may be due to general anaesthetic)
what is doxapram used for>
acts on central an peripheral chemoreceptors to stimulate respiration but would have no effect on improving neuromuscular strength
Glycopyrronium drug class
antimuscarinic
Rocuronium drug class
neuromuscular blocking agent
MMSE interpretation
24+ is normal cognition
19-23 is mild cognitive impairment
10-18 is moderate cognitive impairment
<10 is severe cognitive impairment
Which joint does Osgood-Schlatter disease affect?
knee
What blood test for ?TLS
urate
uric acid levels
K+ also raised
check renal function too
What to give if a patient is not responding to fluid resus
noradrenaline infusion IV
Mother with varicella antibodies, older sibling has chickenpox, does the neonate need
a. admission
b. check baby antibody status
c. no action needed
d. treat with aciclovir
e. treat with zoster Ig
c. no action needed
This is because it is likely that the newborn has passive immunity to varicella since the mother has antibodies
description of fibroadenoma on pathology specimen analysis
duct like structures lined by regular, low columnar cells separated by loose fibrous tissue with well defined margins
what manouvre exacerbates the pain on otitis externa?
pulling the pinna
Cut-off endometrial thickness to investigate for cancer?
4mm
What causes exudate and what transudate?
exudate: increased permeability -> cancer, infection (pneumonia, cancer, TB, viral infection, autoimmune)
transudate: increased hydrostatic pressure or low plasma oncotic pressure (CHF, Cirrhosis, nephrotic syndrome, hypoalbuminaemia)
features of Horner syndrome
ptosis
miosis (constricted)
anhidrosis
