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