Random Flashcards
What is the FAST scan for?
Looking for free fluid in the abdomen and thorax
Reddening and thickening of nipple and areola suggests what?
Paget’s disease of the breast
What things would suggest amyloidosis?
- Progressive weakness and SOB
- Loss of renal function
- Proteinuria
- Hepatosplenomegaly
- Middle aged patient
What are causes of postural hypotension?
- Antihypertensive
- Excessive alcohol
- Hypovolaemia
- Parkinsons/Multiple system atrophy
- Diabetic neuropathy
What are management options for postural hypotension?
- Education, high salt diet, bed tilts
- Fludrocortisone/Midodrine
How do penicillin antibiotics work?
Inhibit cell wall synthesis
How do bacteria build up resistance to penicillin antibiotics and what class of drugs can be added to these to help tackle this?
- Produce beta-lactamase
- Beta-lactamase inhibitors can be added
What are some reversible causes of dementia?
B12 deficiency, normal pressure hydrocephalus, hypoglycaemia, hypothyroidism
What are the signs of Alzheimers on CT?
- Cortical atrophy, ventricular enlargement, hippocampal atrophy
Risk factors for stress incontinence
- Pregnancy
- Childbirth
- Obesity
- Chronic constipation
- Post menopause
Non-drug management of stress incontinence
Pelvic floor exercises, stop smoking, weight loss, avoid caffeine
How does duloxetine help with urge incontinence?
SNRI, so inhibits the reuptake of noradrenaline
(NA) at the synapse, meaning there is increased NA available, and this increases the tone of the internal urethral sphincter
What should be sent for all women with a suspected UTI with haematuria?
Urine MSU
Which antibodies are most useful for vit B12 deficiency?
Intrinsic factor antibodies
How to calculate risk ratio?
Incidence amongst exposed population / Incidence amongst non-exposed population
What is the medication of choice for anti-epileptic drugs in end of life?
Midazolam
Management of anti-freeze ingestion
Fomepizole
Which drugs can cause hyperkalaemia?
- NSAIDS
- ACE
- Potassium sparing diuretics
- LMWH
- Ciclosporin
- Beta blockers
Inheritance of hereditary haemorrhagic telangiectasia
Autosomal dominant
What should be avoided in patients with possibility of basal skull fracture?
Nasopharyngeal airway -> use orophyaryngeal
What should not be done in ABCDE with patients with potential C spine instability?
head tilt-chin life -> do jaw thrust instead
When does secondary syphillis signs present?
Around 4-6 weeks after primary painless ulcer (chancre)
dry eyes and mouth, urinary retention, hyperthermia and tachycardia. Hypotension and altered consciousness
TCA overdose
Amiodarone monitoring?
TFTs and LFTs every 6 months
What are the different stages of clinical tria;s?
Stage1 - safety assessment on health volunteers
Stage 2 assess efficacy in population affected
Stage 3 - RCT, large scale trial
Stage 4 -post marketing surveillance looking for long term effectiveness
Gram neg vs gram positive
Gram negative - stain pink (layer of peptidoglycan which prevents retaining stain)
Gram positive - purple
What LFT marker would be raised in prostate cancer?
ALP
How does aspirin poisoning cause on blood gases?
Respiraotry alkalosis then metabolic acidosis
What is the management of TCA overdose?
- Activated charcoal if within 1 hour
- Sodium bicarb if any arrhythmias/prolonged QRS/hypotension
Blue lines on gum margin?
Lead poisoning
Management of an anaphylactoid reactions to acetylcysteine?
Stop infusion and restart at lower rate
What is the management of intermittent testicular torsion?
Orchidopexy
What should be given to patients with Pseudomonas with CF?
Oral Ciprofloxacin
What is the recovery with minimal change?
Full recovery with later recurrent episodes potentially
How would mesenteric adenitis present?
Secondary to a viral infection
What should be measured prior to starting TB treatment?
LFTs
What are some side effects of steroids?
- Osteoporosis
- Weight gain
- DM
- Candida
- Pancreatitis
Electrolyte abnormality with malignancy?
Hypercalcaemia
Risk of correcting hyponatraemia too quickly?
Osmotic demyelination/central pontine demyelination
Risk of correcting hypernatraemia too quickly?
Cerebral oedema
Treatment for human/animal bites?
Co-amoxiclav
Management of asymptomatic bacteruria in catheterised patient?
Nothing
If symptoms, treat with 7 day course
BRCA2 mutation is associated with what?
Prostate cancer in men
Most common and early symptom with neoplastic spinal cord compression?
Back pain
PET scans deomstrate what?
Glucose uptake
What can be used to suppress N+V in intracranial tumours?
Dexamethasone
How to test for exogenous insulin?
Measure c-peptide, this would not be in exogenous insulin
What are core requirements of DOLS?
- Avoid if possible
- In patients best interest
- Only for immediate intervention required
- For as short a time period as possible
Erectile dysfunction management when sildenafil is C/I?
Intracavernosal prostaglandins
Painless jaundice + weight loss + lump under skin
Think pancreatic cancer -> lump is Trousseau sign of malignancy
multiple ring enhancing lesions in someone with HIV?
Toxoplasmosis infection -> administer sulfadiazine with folate
How to calculate serum osmolality
Serum osmolality is 2 x(Na) + Urea + glucose
Which neuropathic pain agent is the one of choice in patients with renal disease?
Amitriptyline
How to help oral candida caused by steroid inhalers?
Take ICS using large volume spacer
Rash with folliculitis on chest?
Sign of late HIV infection
pale cream coloured nodules on both
elbows and medial aspects of the upper eyelids
Xanthomas -> Hyperlipidaemia
What is the most severely impaired part of cognition in dementia?
Short term memory
What makes c diff so difficult to destroy?
Spore formation - they are resistant to environmental stressors and persist for months
When is bariatric surgery indicated?
BMI > 40 or BMI > 35 with comorbidities such as diabetes and HTN
When can orlistat be given?
- BMI > 35 or >28 with specific risk factors
What must be lost when commencing orlistat?
Minimum 5% of body weight within the first 3 months of starting
What is zolpidem?
A non-benzo hypnotic/sedative associated with falls
Which member of MDT can conduct initial assessment of pressure ulcers?
District nurses
What is the most common organism for diarrhoea in HIV patients?
Cryptosporidium parvum
What abnormality would be seen with EBV on blood cells?
Abnormal lymphocytosis
What are examples of AIDS defining illnesses?
- Cervical cancer
- Non Hodgkins
- CMV retinitis
- HIV related encephalopathy
- Cerebral toxoplasmosis
- Recurrent pneumonia
Why is plasmodium vivax prone to reactivation following initial infection?
It enters a dormant stage as liver hypnozoites whereas plasmodium falciparum does not
Gonorrhoea management if patient is refusing injection
oral cefixime + oral azithromycin
Treatment of asymptomatic bacterial vaginosis?
Nothing
What is the features of disseminated gonococcal infection?
- Tenosynovitis: trouble moving finger from bent position to straight
- Migratory polyarthritis
- Dermatitis: often rash around thighs
What is the management of shingles?
- oral Antivirals within 72 hours of onset
What can cause a false positive syphillis test?
‘SomeTimes Mistakes Happen’
SLE, TB, Malaria, HIV
Bilateral breast pain?
Think hormonal changes -> ?pregnany test
Management of QRISK > 10%
- Lifestyle modifications
- Statin consideration
All patients with a new diagnosis of anaphylaxis
Refer to allergy clinic
What will reactive arthritis show on gram staining?
No organism growth
Management of plantar fasciitis
Rest, stretching and weight loss if overweight
Tumour lysis syndrome electrolytes
Hyperuricaemia
Hyperkalaemia
Hyperphosphatemia
Hypocalcaemia
syphilitic gumma is a sign of what?
Tertiary syphillis
fever, rash and tachycardia, but there is crucially no wheeze and no hypotension
Jarisch-Herxheimer reaction -> treat with paracetamol
Chemotherapy patients are at increased risk of what?
Gout
MSM should be offered what?
Hep A vaccine
How to calculate serum osmolarity?
(2 x Na) + Urea + Glucose
People who test positive for MRSA should be offered what?
Nasal mupirocin + Chlorhexidine wash
What is refractory anaphylaxis?
- Resp/Cardio problems despite 2 doses of IM adrenaline
- Expert help for IV adrenaline should be considered
2nd line Abx for MRSA
Teicoplanin/Linezolid
When is sterilisation following a vasectomy confirmed?
After semen analysis shows azoospermia
Why should metformin be stopped before coronary angio?
Risk of lactic acidosis
What is used to suppress N+V with intracranial tumours?
Dexamethasone
When are NG tubes safe to use?
When pH <5.5 on aspirate
If >5.5, check placement
Widened QRS or arrhythmia in tricyclic overdose
Give bicarb
Patients who take a staggered paracetamol overdose (over >1 hour) should receive what?
N-acetyl-cysteine immediately regardless of paracetamol level
Chickenpox exposure in immunosuppressed?
Give immunoglobulins if not immune
Rheumatic fever can occur after what?
Post strep throat infection
Most common site of bone mets?
Spine
Side effects of chemo drugs?
Cisplatin - Ototoxicity/Nephrotoxicity
Cyclophosphamides - Haemorrhagic cystitis
Bleomycin - Lung fibrosis
Radiation to the pelvis can cause what?
Radiation proctitis
Radiation + difficulty swallowing + hoarseness
Radiation induced laryngeal oedema
What are the 4 end of life medications?
- Morphine for pain
- Hyoscine hydrobromide/Hyoscine butylbrombide/Glycopyrronium for secretions
- Haloperidol for N+v
- Midazolam for restlessness
Which cancers spread transcoelomic?
- Spread through peritoneal cavity and onto surface of organs covered by peritoneum
- Ovarian
- Mesothelioma
What is the most common spread of cancer mets?
Haematogenous
What is a common electrolyte imbalance seen in cancer patients?
Hypercalcaemia
WHO Pain ladder
- Non-opioids e.g. paracetamol, NSAIDs
- Weak opioids e.g. codeine, tramadol, dihydrocodeine
- Strong opioids e.g. morphine, oxycodone, buprenorphine, fentanyl
S/E of opoids
- Constipation
- Drowsiness
- Dry mouth
- Hallucinations
- N+V
- Risk of falls
- Erectile dysfunction
What is the preferred opioid in those with renal impairment?
Oxycodone -> mainly metabolised by liver
When would you make dose adjustments in those taking paracetamol?
- Renal impairment
- Weight <50kg
What can be considered for local neuropathic pain relief in those who do not want to take oral treatments?
Topical capsaicin cream
What is the most common cause of SVC obstruction?
Non small cell lung cancer
What is the drug of choice as first line for breathlessness in palliative care?
Morphine -> relieves dyspnoea and distress
BRCA2 can increase the risk of what cancers in men?
- Breast
- Prostate
What will the neutrophil count be in neutropenic sepsis?
<0.5
Thyroid nodule which does not take up iodine?
Papillary/Follicular carcinoma
Different types of variables
Continuous - range of values
Categorical - category
Discrete - specific value
Nominal - those with no specific order
WHO performance status
0 - normal
1 - restricted in strenuous activity
2 - can do self care and up and about for more than 50% of waking hours
3 - in bed/chair for >50% of day
4 - completely disabled and confined to bed/chair
Most common organism causing line infection?
Staph epidermidis
NICE reccommended tests for falls?
- Turn 180 test
- Timed up and Go test
Management of opioid induced constipation?
Osmotic + Stimulant
What class of drug is allopurinol?
Xanthine oxidase inhibitors
What age patients should have further investigations for secondary causes of HTN?
<40
What position should patients with anaphylaxis be encouraged to adopt?
Flat with legs raised to maximise venous return to heart
All patients with CD40 count <200 require what?
Anti-retroviral therapy
Co-trimoxazole
Baby born to mother infected with Hep B?
Give Hep B vaccine + HepB immunoglobulins
Colicky pain in malignancy with bowel obstruction?
Use antimuscarinic e.g. hyoscine butylbromide
Doxorubicin can cause what?
Cardiotoxicity -> cardiomyopathy
What is a risk factor for post op nausea and vomiting?
Female
Beta blocker overdose?
Atropine if bradycardic and unstable
Then Glucagon
How to convert codeine to morphine?
Divide by 10
