Random 2 Flashcards
What is koebnerisation?
koebnerisation or the Koebner phenomenon occurs when new skin lesions occur on sites of previous trauma (e.g. scratches, stings or bites)
occurs in psoriasis (can also occur in vitiligo)
Cabergoline MoA
DA agonist
Octreotide MoA
somatostatin analogue
Which airway device can protect the airway from gastric contents?
only the tracheal tube can seal the trachea off and protect against aspiration
screening test for haemochromatosis
transferrin saturation
Fasting before surgery
2h for clear liquids
6h for solids
-> Standard national guidelines for elective patients with no
problems affecting gastric emptying. Too long a period of fasting is
unnecessary whilst residual solid food in the stomach poses a big risk ofaspiration/asphyxiation.
define discrimination
Discrimination is the unjust or prejudicial treatment of different categories of people.
Which test has the highest specificity for RA?
anti-CCP
Malaria with cerebral involvement - subtype?
Cerebral involvement makes falciparum more likely.
Which malaria parasite causes the most severe disease?
Plasmodium falciparum
anastamotic leak post surgery timeframe
would happen soon after surgery
-> if a patient is presenting with symptoms months later, this is most likely not the cause
maintainance fluid in someone with cardiac disease
20-25 ml/kg/24h
management of delirium
- Identify and manage possible underlying causes; effective communication and reorientation
- if agitated: try verbal de-escalation; low dose haloperidol is first line medication
Myasthenia gravis - how to monitor respiratory function?
FVC
first line initial treatment of sinus bradycardia
atropine IV
A 62 year old man develops acute pain, redness, swelling and warmth of his
right first metatarsophalangeal joint. He has a history of gout and
hypertension. His medications are allopurinol, amlodipine and ramipril.
His eGFR is >60 mL/min/1.73 m2
(>60).
Which is the most appropriate next step in his management?
A. Change allopurinol to febuxostat
B. Start naproxen
C. Stop allopurinol
D. Stop amlodipine
E. Stop ramipril
B
The patient has acute gout. The immediate
management would be to commence an NSAID.
Commonest organism in leg cellulitis
Streptococcus is the most common pathogen
in leg cellulitis (including in patients with diabetes).
-> strep pyogenes mainly
less commonly:
- staph A
- Pasteurella multocida
Main lymphatic drainage of the ovary?
para-aortic nodes
The iliac nodes are less frequently involved.
Presentation of uveitis
red eye
headache
visual disturbance
small pupil
pupil may be irregular
photophobia
How long does it take for prothrombin complex concentrate to reverse the anticoagulant effects of warfarin?
in minutes
Asystole - which med?
adrenline
the only recommended medication in asystole
What medication should all patients with metallic heart valves be on?
aspirin + warfarin
LMWH may be used for bridging
at the moment there is no place for DOACs (yet)
What would be the reason for normal sats in an unwell patients after a housefire?
carboxyhaemoglobin
Co bound to Hb
(affinity of CO is 200x that of O2)
stain in haemochromatosis
(Perl’s) Prussian blue
What is a boxers fracture?
break in the neck of the 5th metacarpal
describe a BCC
describe a SCC
BCC: pearly, rolled edges, ulceration, telangiectasia, pigmentation
SCC: firm, flesh coloured keratotic papules or plaques, smooth nodules, thick cutaneous horn and ulceration (faster growing)
describe eczema herpeticum
- different than normal eczema
- circular, depressed, ulcerated lesions
- eroded
- monomorphic punched out erosions 1-3 mm diameter
-> manage with aciclovir (children should be admitted for IV aciclovir)
Mx of airway burns
intubate ASAP!
this is because pts with burns damage to their airway can develop oedema very rapidly which is life threatening
constant leaking of urine spot dx
vesicovaginal fistula
Which substance is the primary factor facilitating platelet adhesoin?
Von Willebrand factor
What is the commonest complication of meningitis ?
sensorineural hearing loss
Oxybutynin MoA
competitive ACh R antagonist
-> anitmuscarinic
damage of which nerve causes winging of the scapula?
long thoracic nerve
sx of axillary nerve damage
- loss of sensation over the deltoid area (patch)
- pain
- shoulder weakness (esp. when lifting arm up)
What electrolyte abnormality is seen in TURP syndrome?
hyponatraemia
Features of alcoholic cardiomyopathy
- dilated cardiomyopathy (could cause MR)
- can have pancytopenia
(Past Paper Question)
Features of Morton’s neuroma
associated with athletes, tight footwear
neuroma between 3rd and 4th toe is the commonest
causes sharp burning pain in the ball of the foot
thickening of the tissue around one of the nerves leading to your toes
Charcot’s triad
RUQ pain
fever
jaundice
-> ascending cholangitis
What does the SMA supply?
midgut
-> from the major duodenal papilla (of the duodenum) to the proximal 2/3 of the transverse colon
lower back pain, not related to movement, normal MSK exam… next Ix?
USS
could be a AAA
Herceptin fancy name
trastuzumab
hydatid of Morgagni
small embryological remnant at the upper pole of the testis.
(Torsion of the hydatid is of no consequence in itself except that it presents a similar picture to torsion of the testis which is a surgical emergency)
SJS vs TEN
now thought to be variants of the same condition
it is a rare, unpredictable reaction to medication
- SJS: Stevens Johnson syndrome skin detachment <10% BSA
- TEN: toxic epidermal necrolysis skin detachment >10% BSA (or >30% BSA )
Detachment between 10% and 30% of BSA is also known as SJS/TEN overlap syndrome
S comes before T in the alphabet so SJS is less surface than TEN
large binucleate cells with prominent nuclei dx?
What is another name for these cells ?
Hodgkin’s lymphoma
= Reed Sternberg cells
Describe what Reed Sternberg cells look like
large binucleate cells with prominent nuclei
What effect do benzodiazepines have on respiratory rate ?
reduce
you need a bigger dose but they can suppress the RR (sometimes they are used to intubate people)
Faget’s sign
relative bradycardia with fever
seen in typhoid fever
Management of BPH
1st line: alpha blocker
2nd line: 5 alpha reductase inhibitor
Surgical options include TURP
where is a thyroglossal cyst found?
midline
what is a cystic hygroma?
birth defect that appears as a sac-like structure with a thin wall that most commonly occurs in the head and neck area of an infant.
First line abx in cholera
doxycycline
Which common drug should you avoid when taking clarithromycin?
statins -> can accumulate
Summarise the different stages of clinical trials
0: exploratory studies, very small number of participants and aim to assess how a drug behaves in the human body.
I: safety assessment (determines SE prior to larger studies, conducted on healthy volunteers)
II: assess efficacy; involves a small number of patients affected by a particular disease. IIa is for optimal dosing and IIb for efficacy assessment
III: new treatment compared with current treatment, involves 100s- 1000s people often as part of a RCT
IV: Postmarketing surveillance (monitors for long-term effectiveness and SE)
smear cells diagnosis
CLL
medication that decreases the amount of urinary protein
ACE-i
management of amoebiasis / entamoeba histolytica
oral metronidazole
also agent for intraluminal cysts (diloxanide furoate)
(the disease can range from asymptomatic to mild diarrhoea to entamoebic dysentery)
commonest complication of meningitis
SN hearing loss
abx for meningitis
intravenous ceftriaxone but use cefotaxime if administering calcium- containing infusions.
statin adjustments with muscle pain and raised CK
> 5x ULN -> stop
<5x ULN -> reduce
Mx of PE in severe renal impairment (eGFR <15/min)
LMWH instead of DOAC (double check this at MDT)
what is erythema multiforme associated with?
herpes simplex
MYCOPLASMA PNEUMONIAE
fungal infections
complications of mycoplasma pneumoniae
erythema multiforme
cold AIHA (cold agglutinins IgM may cause haemolytic anaemia/thrombocytopaenia)
can also lead to meningitis, pericarditis, myocarditis, hepatitis, pancreatitis, acute glomerulonephritis, bullous myringitis (tympanic membrane)
Management of SBP
IV cefotaxime
also offer prophylactic oral ciprofloxacin or norfloxacin in people with cirrhosis and ascites with protein 15g/L or less until ascites has resolved
features of WPW on ECG
short PRi
slurred upstroke of QRS (delta wave)
widened QRS b
management of WPW
definitive: radiofrequency ablation of the accessory pathway
medical: amiodarone, flecainide, sotalol**
**avoid if pt also has AF
Name an LTRA
montelukast
tiotropium drug class
LAMA
long acting muscarinic antagonist
Which electrolyte abnormalitites do you see in refeeding syndrome?
hypophosphataemia
hypokalaemia
hypomagnesaemia (may predispose to torsades de pointes)
What causes U waves on ECG? How are they described?
small deflection immediately following the T-wave
most common: severe hypokalaemia, bradycardia
but also: hypocalcaemia, hypomagnesaemia, hypothermia, raised ICP….
Barthel index
score done after stroke to assess ability to do ADLs, how dependent/independent someone is
score for risk of pressure ulcers
waterlow
meds for focal seizures
lamotrigine o levetiracetam are 1st line
second line: carbamazepine, oxcarbezepine or zonisaide
meds for generalised tonic clonic seizures
male: sodium valproate
female: lamotrigine or levetiracetam
Which CCBs should be used in angina?
rate limiting
e.g. diltiazem or verapamil (if used as monotherapy)
if used in combination with a beta blocker, then use a longer acting dihydropyridine CCB like amlodipine or MR nifedipine
Which CCBs are ND and dihyrdopyridine?
ND: diltiazem, verapamil (rate limiting)
D: amlodipine, nifedipine
Which cardiac marker rises 1st after MI?
myoglobin
(rises after 30 minutes)
Management of BV in pregnancy
oral metronidazole
BV increases the risk of preterm labour, low birth weight, chorioamnionitis and late miscarriage -> treat!
Bacteria described as curved rod - dx and mx?
campylobacter
give clarithromycin
Management of normal pressure hydrocephalus
ventriculoperitoneal shunting
10% of pts with shunts expereince significant complications such as seizures, infection and intracerebral haemorrhgaes.
CK in PMR
normal
MS hypersensitivity type
IV (cell mediated)
Abx for prostatitis
ciprofloxacin
(or another quinolone)
Tamsulosin drug class
alpha blocker
finasteride drug class
5 alpha reductase inhibitor
Mx of acute closed angle glaucoma
- eye drops (direct parasymphatomimetic e.g. pilocarpine), beta blocker (e.g. timolol) and alpha 2 agonist (e.g. apraclonidine)
- IV acetazolamide (reduces aqueous secretions)
- some guidelines use topical steroids to reduce inflammation
- Laser irridiotomy is the DEFINITIVE management
mx of PE in a hemodynamically unstable patient
thrombolysis
rash in adults incl palms and soles with lymphadenopathy - likely to be syphilis
syphilis
mx of chlamydia in pregnancy
azithromycin 1g stat is the drug of choice
can also use erythromycin or amoxicillin
discuss the benefits and risks of the treatment with the patient
Which fungus most commonly causes athletes foot?
fungi from the genus trichophyton
1st line mx of athletes foot
topical terbinafine or imidazole or undecenoate
which nerve is responsible for wrist extension and finger extension?
radial nerve
motor function of median nerve
pronation of the forearm
flexion of the wrist
flexion of the digits
motor function of the ulnar nerve
majority of intrinsic hand muscles
anterior forearm:
flexes the ring and little fingers at the DIP
flexes and adducts the hand at the wrist
Sx of parietal lobe seizures
paraesthesia
sx of occipital lobe seizures
floaters/flashes
frontal lobe seizure sx
head/leg movements
posturing
post-ictal weakness (Todd’s paresis)
Jacksonian march
temporal lobe seizure signs
may be with or without impaired awareness
aura occurs in most patients (this is actually a focal seizure that then progresses to a generalised seizure in tonic clonic - fun fact)
- seizures usually last around 1 min
- automatisms (e.g. lip smacking, grabbing, plucking) are common
status epilepticus - what do you give if IV loraz 2x did not suffice?
IV phenytoin
First line for myoclonic seizures in females
levetiracetam
(taM -> Myoclonic)
first line for tonic/atonic seizuers in females
lamotrigine
AmoT - A/T
Which medication for absence seizures?
ethosuxamide (in males and females)
AbsencE -> ethosuxamide
acute alcohol intake and risk of hepatotoxicity in paracetamol OD
interestingly, acute alcohol intake reduces the risk of hepatotoxicity
chronic alcohol intake increases the risk
male with focal seizures mx
lamotrigine or levetiracetam
both in males and females
Summarise anti-epileptic mx in males and females
Males: Sodium valproate for everything except:
- focal: lamotrigine/levetiracetam
- absence: ethosuxamide
Females: lamotrigine/levetiracetam for everything except:
- absence: ethosuxamide
- in myoclonic levetiracetam > lamotrigine
- in tonic /atonic LevetiAceTam > lamotrigine
What is juvenile myoclonic epilespy?
classically associated with seizures in the morning or following sleep deprivation
typically affects teenage girls and includes a combination of absence seizures, generalised tonic clonic seizures and myoclonic seizures
stopping antiepileptic meds
can be considered if seizure free for >2y and done over 2-3 months
features of acute interstitial nephritis
fever
rash
arthralgia
eosinophilia
mild renal impairment
HTN
causes of acute interstitial nephritis
- Drugs (commonest!)
- penicillin
- rifampicin
- NSAIDs
- allopurinol
- furosemide
Systemic disease (SLE, sarcoidosis, Sjogrens)
Infection (Hanta virus, staphylococci)
Haemolytic uraemic syndrome
generally seen in young children
triad:
- AKI
- microangiopathic haemolytic anaemia
- thrombocytopaenia
E coli 0157:H7 is the textbook cause
other causes:
- HIV infection
- pneumococca linfection
- rare: SLE, drugs, cancer
mx: supportive
(plasma exchange in severe cases)
What is the commonest site of pressure ulcers?
sacrum
Which fluid avoid in acidosis?
saline
more acidic than Hartmann’s
vocal resonance in empyema and pneumonia
reduced in empyema
increased in pneumonia
Features of Vitamin B12 deficiency
macrocytic anaemia
sore tongue and mouth
neurological disorders
- loss of proprioception and vibration sensation
- distal paraesthesia
mood disturbance
you see the neuro features more in B12 than in folate deficiency
drug induced interstitial nephritis - when after abx do you get it?
it is rare!
would not appear before 4-7 days of abx exposure
classic location for venous ulcers
medial and lateral malleolus
features of nephrotic syndrome
hypoalbuminaemia
proteinuria
oedema
hypercholesterolaemia
Urine sodium clinical significance
useful to differentiate renal vs extrarenal cases of sodium loss in hypovolaemic hyponatraemia
Values >20mmol/L -> suggest renal sodium loss.
Useful to help confirm SIADH (>40mmol/L)
zolendronate route of administration
IV only
reserved for those who do not tolerate oral bisphosphonates
what causes flashes in retinal detatchment
the separating vitreous will tug on the surface of the retina and create a mechanical depolarization of the axons running through the nerve fiber layer of the retina -> this leads to flashing lights
What is atelectasis
common post op complication
basal alveolar collapse can lead to respiratory difficulty
caused when airways become obstructed by bronchial secretions
presents as dyspnoea about 72h post op
-> upright positioning and chest PT to manage
management of SBO due to adhesions
drip and suck - conservative management
- IV fluids + NG tube
this is successful in 65-80% pts
if not successful, get surgeons involved
IV abx are NOT indicated in cases managed conservatively
blood test findings in DIC
thrombocytopenia
prolonged PT and APTT
low plasma fibrinogen
elevated D-dimer
may have microangiopathic abnormalities on blood smear
Why cricoid pressure pre intubation?
to prevent gastric contents in a patient who is not fasted or has abdominal problems from passing higher up and obstructing the airway
pericardial effusion on ECG
low voltage complexes on ECG
risks of exercising despite exertional chest tightness
indicates a high likelihood if IHD
vigorous exercise runs the risk of a significant ischaemic event e.g. MI or arrythmia
dose of steroid in malignant spinal cord compression
16 mg IV dexamethasone
followed by 8 mg BD
how to differentiate lithium toxicity from neuroleptic malignant syndrome?
lithium toxicity:
- confusion
- coarse tremor
- jerking leg movements
-> may be precipitated by dehydration secondary to D&V
NMS:
- fever
- rigors
- autonomic lability (HTN, tachycardia, tachypnoea)
- agitated delirium with confusion
management of primary biliary cirrhosis
- ursodeoxycholic acid (increased elimination of retained bile acids and reduces toxicity)
- colchicine or methotrexate can be used in pts who don’t respond to UDCA
also manage sx :
- pruritus (e.g. colestyramine)
- metabolic bone disease: calcium and vit D
- portal HTN: b-blockers, banding of varices, TIPS
Liver transplant in end stage
who gets PBC?
middle aged women most commonly
9:1 (f:m)
associated with other AI diseases, may have Sjogrens, Raynauds, arthritis
sx of PBC
which ix?
fatigue, may have no signs
later: jaundice, pale stool, dark urine, hepatomegaly, xanthomas, ascites, signs of liver disease
may be found incidentally on bloods with
- raised ALP
- raised cholesterol
AMA-M2 +ve
liver biopsy to diagnose
pathophys of PBC with PSC
PBC: inflammation and progressive destruction of the small and medium intrahepatic bile ducts leading to chronic cholestasis -> cirrhosis
-> most commonly in middle aged women (9:1)
-> AMA-M3
PSC: progressive inflammation and fibrosis of intrahepatic and extrahepatic bile ducts
-> more common in males (2:1), associated with UC
-> associated with increased risk of cancer (cholangiocarcinoma)
-> pANCA
Mx of PSC
- no curative treatment
-sx control: e.g. cholestryramine for pruritus, fat soluble vitamins for deificiency, calcium and vit D,
- UDCA may be used (but evidence not as strong as for PSC)
- stenting to relieve obstruction
- liver transplantation for end stage disease
+ve markers in
- PSC
- PBC
- AIH
PSC: p-ANCA
PBC: AMA-M2
AIH type 1: SMA, ANA
AIH type 2: LKM1, ALC1
meds in VT/VF alongside defib
adrenline 1mg
amiodarone 300 mg IV
pt with fall and head injury, on DOAC, GCS14
what next?
A. C spine immobilisation
B. CXR
C. CT head
D. IV prothrombin complex
E. IV vit K
A. C spine immobilization
this is because in trauma patients the sequence is
Airway
C-spine
which TB abx causes red secretions?
rifampicin
where are paneth and goblet cells geerally found?
in the small intestine
typical ABG in acute T2RF
hypoxaemia
CO2 retention
acidosis
features of post streptococcal glomeruloephritis
7-14 d post strep A infection
- haematuria
- fatigue
- proteinuria (+/- oedema)
- headache
- malaise
- HTN
bloods may show a raised anti-streptolysin O titre (confirms recent streptococcal infection)
- low C3
anion gap formula
(Na+ + K+) - (Cl- + HCO3-)
normal is 10-18 mmol/L
What investigation for Addisons?
plasma cortisol and ACTH
can a pt have septic arthritis with a -ve gram stain?
yes
50% WILL BE POSITIVE
key difference cholangitis and cholecystitis
in cholangitis you get jaundice and the cholestatic LFTs and GGT would be up
TCA posioning wihtin 30 mins mx?
activated charcoal
Pt with T2DM and CKD not controlled on mteformin - which drug should you add ?
Sitagliptin (DPP4 inhibitor)
SGLT2 inhibitors are not licensed - however known to be beneficial
route of administration of GLP-1 analogues
sc injection (e.g. liraglutide)
given weekly or daily
When would you repeat U&Es in a Creatinine raise rather than stoppingthe medicatrion?
if the patient has a <30% increase in serum creatinine
-> at this level no indication to change treatment, repeat renal function in 2-4 weeks instead
what is frozen shoulder?
= adhesive capsulitis
presents with dull shoulder pain
the pain often disturbs sleep
followed by stiffness and loss of shoulder mobility
unlikely in pts <40yo or >70yo -> more likely to be rotator cuff tear or glenohumeral OA
subacromial bursitis or rotator cuff tendinopathy often complain of activity related symptoms
Pt with acute abdomen following abdo surgery - what ix?
CT scan (usually with contrast)
this will provide diagnostic information and help plan further management
does furosemide help reduce hyperkalaemia?
yes
tamoxifen effect on VTE risk
increases VTE risk
Horner syndrome
miosis (small pupil)
partial ptosis
facial anhidrosis
results from interruption of the ipsilateral SNS supply to the head, eye and enck
most cases are idiopathic but some conditions such as brainstem stroke, carotid dissection and neoplasms are occasionally identified as the cause.
APTT and platelets in anti-phospholipid syndrome
paradoxically prolonged
+ low platelets
NNT formula
1/ARR
How do you calculate likelihood ratio?
Likelihood ratio for a positive test result = sensitivity / (1 - specificity)
alternative to oral metronidazole in BV
topical clindamycin 2%
which antibiotic to close contacts of someone with meningitis?
ciprofloxacin oral
abx for legionella
Macrolides such as clarithromycin are used to treat Legionella
Organisms causing post splenectomy sepsis
Streptococcus pneumoniae
Haemophilus influenzae
Meningococci
Mx of hiccups in palliative care
chlorpromazine or haloperidol
good first line anti-emetic for intracranial causes of N&V
Cyclizine is a good first line anti-emetic for intracranial causes of nausea and vomiting
which chemo agent causes haaemorrhagic cystitis?
cyclophosphmide
Which chemo agent causes lung fibrosis?
bleomycin
Which chemo agent that is used in the management of lymphoma causes peripheral neuropathy?
vincristine
where in the lung is adenocarcinoma generally?
causes peripheral lesions
What causes Hyaline casts in urine?
loop diuretics
e.g. furosemide
Mx of anterior uveitis
urgent referral to specialist
Anterior uveitis is most likely to be treated with a steroid (drops) + cycloplegic (mydriatic) drops
Herpes zoster ophthalmicus (HZO)
- reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve.
-> ~10% of case of shingles.
What do pilocarpine eye drops do?
CONSTRICT the pupil
immediate management of acute angle-closure glaucoma
by causing the pupil to constrict allowing for drainage of aqueous humour.
Why should contact lens wearers be sent to opthal ASAP with red eye?
Contact lens wearers who present with a red painful eye should be referred to eye casualty to exclude microbial keratitis
Summarises the CKD stages
CKD stage GFR range
1 Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)
2 60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)
3a 45-59 ml/min, a moderate reduction in kidney function
3b 30-44 ml/min, a moderate reduction in kidney function
4 15-29 ml/min, a severe reduction in kidney function
5 Less than 15 ml/min, established kidney failure - dialysis or a kidney transplant may be needed
Six of gastroparesis
- erratic blood glucose control
- bloating
- vomiting
- early satiety
pupil in surgical CN III palsy
dilated (mydriasis)
ipratropium drug class
SAMA
Examples of LABAs
examples of SAMAs
LABA: Formoterol and salmeterol
SAMA: ipratropium
Which one is Broca which Wernicke and which lobes are they?
Spoken word is heard at the ear. This passes to Wernicke’s area in the temporal lobe (near the ear) to comprehend what was said. Once understood, the signal passes along the arcuate fasciculus, before reaching Broca’s area. The Broca’s area in the frontal lobe (near the mouth) then generates a signal to coordinate the mouth to speak what is thought (fluent speech).
Pneumothorax high risk features
- haemodynamic instability
- pronounced hypoxia
- bilateral pneumothorax
- pre-existing pulmonary pathology
- > 50 years old with significant smoking history
- haemothorax
Diving and flying after pneumothorax
Diving -> permanently avoid unless had bilateral surgical pleurectomy and has normal lung function and chest CT scan postop.
Flying -> absolute contraindication; may fly 2 w post succesful drainage or 1w post check x-ray
Which diabetic medication can be used by obese patients who are pre-diabtetic to help lose weight?
how is it given?
liraglutide (GLP-1 analogue)
-> once daily SC injections
medial epicondylitis
- pain and tenderness localised to the medial epicondyle
- pain is aggravated by wrist flexion and pronation
- symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
lateral epicondylitis
- worsening symptoms when the wrist is extended and supinated as the wrist extensors are contracted, aggravating the point of their insertion at the lateral epicondyle of the humerus.
Felty’s syndrome
splenomegaly + neutropenia in a patient with rheumatoid arthritis.
Describe colles fracture
Colles’ - Dorsally Displaced Distal radius → Dinner fork Deformity
can be caused by FOOSH
prevention of seizures in end of life care
buccal midazolam
