Random extra Flashcards
What is cushing reflex?
Bradycardia and HTN, then eventually apnoea
Indicates raised ICP
What drug shouldn’t you give in suspected lymphoma?
Steroids as may effect biopsy
Function of the foramen ovale
Bypasses foetal lungs
On AXR is gas outside the lumen of bowel ever normal?
no, may have <7days after abdo surgery. If not, perforation
Leg pain relieved by sitting is more likely to be intermittent claudication or spinal stenosis?
Spinal stenosis- ‘neurogenic claudication’
Azathioprine SE to be aware of in certain patients? Must check this status before prescribing
Pancytopenia in thiopurine methyltransferase (TPMT) deficiency
HNPCC is also known as?
Lynch syndrome
What is Li-Fraumeni syndrome?
Mutation in the tumour suppressor p53 gene, causes a predisposition to cancers, but particularly sarcomas, breast cancer, leukaemias and adrenal gland tumours.
What is Von Hippel Lindau disease?
causes a cancer predisposition, commonly phaeochromocytoma, renal cell carcinoma and haemangioblastoma.
How long should you wait between inhaler doses for asthma?
30s
How do you manage red man syndrome associated with vancomycin?
cessation of the infusion, and when symptoms have resolved, recommencement at a slower rate. In patients who are more symptomatic antihistamines can be administered, and may require intravenous fluids if the syndrome is associated with hypotension.
What is given prophylactically to prevent bleeding in oesophageal varices?
Non-cardioselective beta blockers e.g. propanolol
How long before endoscopy should PPIs be stopped
2weeks
What is Sister Mary Joseph node?
Sister Mary Joseph node - metastatic umbilical lesion - is an important finding in advanced malignancy.
Painful palpable umbilical node
What is peabody sign?
In DVT- positive test indicated by calf muscle spasm occurring on elevation and foot extension of the affected leg
Rate of insulin infusion in DKA
0.1u/kg/hr
What does seborrhoeic dermatitis resemble and what is the treatment?
- Eczematous on scalp/other sebumy areas
- topical ketoconazole
Analgesia of choice in renal colic?
Diclofenac IM/PR
non caseating granulomas with epithelioid cells on biopsy indicates what?
Sarcoid
What is glucocorticoid effect of steroids vs mineralocorticoid?
Gluco = anti inflammatory
Mineralo= fluid retention
This is clinically relevant as there are some situations where it is important to combine high glucocorticoid (anti-inflammatory) activity with minimal mineralocorticoid (fluid-retention) effects. A good example is the use of dexamethsone for patients with raised intracranial pressure secondary to brain tumours.
What is glucocorticoid effect of steroids vs mineralocorticoid?
Gluco = anti inflammatory
Mineralo= fluid retention
This is clinically relevant as there are some situations where it is important to combine high glucocorticoid (anti-inflammatory) activity with minimal mineralocorticoid (fluid-retention) effects. A good example is the use of dexamethsone for patients with raised intracranial pressure secondary to brain tumours.
Random blood glucose level diagnostic of diabetes?
> 11mmol/L
Random blood clugose level diagnostic of diabetes?
> 11mmol/L
What can precipitate autonomic dysreflexia in spinal injury patient?
Blocked catheter
Faecal loading
Presentation of autonomic dysreflexia?
Excessive hypertension
Flushing and sweating above level of SC injury
May have reflex bradycardia (this indicates a dysreflexia not an endocrine cause which might have tachycardia)
Anorexia nervosa can precipitate what endocrine problem in some people?
Hypothyroid
Anorexia nervosa can precipitate what endocrine problem in some people?
Hypothyroid
Elevated TSH with normal T4 is what?
subclinical hypothyroid
What is sick euthyroid and what TFT results?
Caused by systemic illness- low T4 and T3, normal or low TSH
sensitivity/specificity of Kernig’s sign?
Helpful if positive but doesn’t r/o meningitis
What electrolyte derangement can pneumonia and legionella cause?
hyponatraemia
What chest infections cause diffuse shadowing?
Miliary TB and atypical pneumonia
How might atypical pneumonia present (4)
Dry cough
Diffuse infiltrate on CXR
Normal WBCs
Abnormal LFTs
What types of cancer are you at increased risk of after EBV? (2)
Nasopharyngeal adenocarcinomas
Burkitt’s lymphoma
Erythema migrans rash is associated with which disease? What does it look like?
Lyme disease
Target lesion
Ziehl-Neelsen stain for acid fast bacilli used for what?
TB
A new stroke patient with a temperature- look for what?
Endocarditis
Most pro-clotting abnormalities are likely to cause venous clots, apart from which one?
Antiphospholipid syndrome- arterial
Migraine with aura more or less likely to have patent foramen ovale?
More
Painless jaundice and palpable gallbladder in an older patient is _______ until proven otherwise
pancreatic cancer
BRCA2 and PLAB2 mutations are associated with which abdominal carcinoma?
Pancreatic
What is troussaeau’s sign?
Sign of malignancy
Migratory thrombophlebitis/recurrent
What is courvoisier’s sign
Enlarged, palpable gallbladder that is NOT tender (pancreatic cancer)
New onset diabetes in an older person might indicate what cancer?
pancreatic
CA125
Ovarian
Ca19-9
Panc
Ca 15-3
Breast
CEA
Colorectal
AFP
hepatocellular carcinoma, teratoma
S-100 tumour marker
melanoma, schwannoma
Bombesin tumour marker
small cell lung ca, gastric, neuroblastoma
What is Kussmaul’s sign?
Raised JVP that doesn’t fall with inspiration - constrictive pericarditis
dyspnoea, peripheral oedema and positive Kussmaul’s sign and recent cardiac intervention
Constrictive pericarditis
haematuria, sensory hearing loss and ocular disturbances=?
Alport’s syndrome
Renal problems 1-2 days after URTI?
IgA nephropathy
Renal problems 1-2 weeks after URTI?
Post-strep glomerulonephritis
Which lymphoma causes pain on alcohol consumption?
Hodgkin’s
Which lymphoma has Reed-Sternberg cells?
Hodgkin’s
What is in granulomatous nodules?
Macrophages
Gold standard diagnosis for sarcoid?
Biospy histology- non caseating granulomas w epithelioid cells.
What is lofgren’s syndrome?
A specific triad of presentation of sarcoid
Erythema nodosum
Polyarthralgia
Bilateral hilar lymphadenopathy
Treatment for sarcoid
None/oral steroids 6-24m
Second line MTX or azothioprine
Rarely lung transplant is indicated
Gout is a sign of what in diabetes?
Insulin resistance
What does the number in a brand of insulin mean e.g. humalin M3?
how much of it is fast acting
M= mix
3= 30% fast acting
How do you know you’re giving enough thyroxine?
Aim for lower half of TSH normal range (the lower half is 0.2-2.0)
adrenal cortex antibodies and 21-hydroxylase antibodies might be present in what?
Primary adrenal insufficiency (Addison’s disease)
What steroid is given in Addison’s to replace cortisol?
Hydrocortisone (glucocorticoid)
What steroid is given in Addison’s to replace aldosterone?
Fludrocortisone (mineralocorticoid)
What are the only two hormones released by the posterior pituitary?
Oxytocin and ADH
The dexamethasone suppression test is the test of choice for diagnosing what?
Cushing’s syndrome
How much steroid treatment warrants a tapered withdrawal?
more than 40mg prednisolone daily for more than one week, received more than 3 weeks treatment or recently received repeated courses
What is Sheehan’s syndrome?
also known as postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth.
Addison’s crisis is characterised by what blood gas result?
hyperkalaemic metabolic acidosis
What is nelson’s syndrome?
Rare invasive pituitary adenoma that occurs after bilateral adrenal gland removal for Cushing’s.
What is the most important modifiable risk factor for the development of thyroid eye disease
Smoking
When should thyroid eye disease be referred for urgent ophthal review?
Unexplained vision decreased
Change in colour vision in one or both eyes
History of globe subluxation
Obvious corneal opacity
Cornea still visible when eyelids closed
Disc swelling
skin sx of leprosy
depigmentation and loss of sensation.
legionella can cause what results in electrolytes and LFTs?
hyponatraemia and deranged LFTs
Treatment for MRSA pre surgery?
nasal mupirocin and chlorhexidine for skin
Role of loop diuretics in HF- symptom management or improve survival?
Symptomatic relief only
Raised urea:Cr ratio indicates what sort of AKI?
Pre-renal
What is the effect of pre-renal uraemia on sodium?
kidneys hold on to sodium to preserve volume
Which IBD is lead pipe colon in
UC
Definitive management of infective endocarditis causing congestive cardiac failure
Urgent valve replacement
treatment for active TB
RIPE:
For first 2 months:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Next 4 months:
Rifampicin
Isoniazid
Latent TB Rx
3 months of isoniazid (with pyridoxine) and rifampicin
OR
6 months of isoniazid (with pyridoxine)
what is complex regional pain syndrome
neurological and related symptoms which typically occur following surgery or a minor injury
type I (most common): there is no demonstrable lesion to a major nerve
type II: there is a lesion to a major nerve
Action of calcitonin
Inhibits PTH
Which type of thyroid cancer is associated with MEN2?
Medullary
Type I MEN cancers
Parathyroid
Pituitary
Pancreas
Type IIa MEN cancers
Parathyroid
Phaeochromocytoma
Medullary thyroid ca
Type IIb MEN cancers
Phaeochromocytoma
Medullary thyroid ca
Genes effected in MEN?
MEN I- MEN1 gene
MEN IIa and IIb- RET oncogene
Philadelphia chromosome - t(9:22) is associated with which haematological malignancy?
CML
C-peptide is only present with endogenous or exogenous insulin?
Endogenous only- so if C-peptide raised then it is from endogenous insulin (but could be from an OD of an antihyperglycaemic such as gliclazide)
aphasia means which hemisphere is affected? Which artery?
Their dominant one (but left is more likely overall, even in left handed)
MCA supplies Broca’s and Wernicke’s areas
Pseudogout appearance on xray
chondrocalcinosis
in the knee this can be seen as linear calcifications of the meniscus and articular cartilage
discrete, non-tender, highly mobile breast lumps
fibroadenoma
Fibroadenosis aka
fibrocystic disease
If someone has been catheterised for chronic retention should you TWOC them?
No, usually due to prostatic hyperplasia so don’t TWOC until TURP done
