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FINALS medicine > Random extra > Flashcards

Random extra Flashcards

1
Q

What is cushing reflex?

A

Bradycardia and HTN, then eventually apnoea

Indicates raised ICP

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2
Q

What drug shouldn’t you give in suspected lymphoma?

A

Steroids as may effect biopsy

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3
Q

Function of the foramen ovale

A

Bypasses foetal lungs

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4
Q

On AXR is gas outside the lumen of bowel ever normal?

A

no, may have <7days after abdo surgery. If not, perforation

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5
Q

Leg pain relieved by sitting is more likely to be intermittent claudication or spinal stenosis?

A

Spinal stenosis- ‘neurogenic claudication’

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6
Q

Azathioprine SE to be aware of in certain patients? Must check this status before prescribing

A

Pancytopenia in thiopurine methyltransferase (TPMT) deficiency

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7
Q

HNPCC is also known as?

A

Lynch syndrome

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8
Q

What is Li-Fraumeni syndrome?

A

Mutation in the tumour suppressor p53 gene, causes a predisposition to cancers, but particularly sarcomas, breast cancer, leukaemias and adrenal gland tumours.

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9
Q

What is Von Hippel Lindau disease?

A

causes a cancer predisposition, commonly phaeochromocytoma, renal cell carcinoma and haemangioblastoma.

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10
Q

How long should you wait between inhaler doses for asthma?

A

30s

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11
Q

How do you manage red man syndrome associated with vancomycin?

A

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.

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12
Q

What is given prophylactically to prevent bleeding in oesophageal varices?

A

Non-cardioselective beta blockers e.g. propanolol

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13
Q

How long before endoscopy should PPIs be stopped

A

2weeks

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14
Q

What is Sister Mary Joseph node?

A

Sister Mary Joseph node - metastatic umbilical lesion - is an important finding in advanced malignancy.
Painful palpable umbilical node

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15
Q

What is peabody sign?

A

In DVT- positive test indicated by calf muscle spasm occurring on elevation and foot extension of the affected leg

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16
Q

Rate of insulin infusion in DKA

A

0.1u/kg/hr

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17
Q

What does seborrhoeic dermatitis resemble and what is the treatment?

A
  • Eczematous on scalp/other sebumy areas

- topical ketoconazole

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18
Q

Analgesia of choice in renal colic?

A

Diclofenac IM/PR

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19
Q

non caseating granulomas with epithelioid cells on biopsy indicates what?

A

Sarcoid

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20
Q

What is glucocorticoid effect of steroids vs mineralocorticoid?

A

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.

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21
Q

What is glucocorticoid effect of steroids vs mineralocorticoid?

A

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.

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22
Q

Random blood glucose level diagnostic of diabetes?

A

> 11mmol/L

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23
Q

Random blood clugose level diagnostic of diabetes?

A

> 11mmol/L

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24
Q

What can precipitate autonomic dysreflexia in spinal injury patient?

A

Blocked catheter

Faecal loading

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25
Q

Presentation of autonomic dysreflexia?

A

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)

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26
Q

Anorexia nervosa can precipitate what endocrine problem in some people?

A

Hypothyroid

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27
Q

Anorexia nervosa can precipitate what endocrine problem in some people?

A

Hypothyroid

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28
Q

Elevated TSH with normal T4 is what?

A

subclinical hypothyroid

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29
Q

What is sick euthyroid and what TFT results?

A

Caused by systemic illness- low T4 and T3, normal or low TSH

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30
Q

sensitivity/specificity of Kernig’s sign?

A

Helpful if positive but doesn’t r/o meningitis

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31
Q

What electrolyte derangement can pneumonia and legionella cause?

A

hyponatraemia

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32
Q

What chest infections cause diffuse shadowing?

A

Miliary TB and atypical pneumonia

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33
Q

How might atypical pneumonia present (4)

A

Dry cough

Diffuse infiltrate on CXR

Normal WBCs

Abnormal LFTs

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34
Q

What types of cancer are you at increased risk of after EBV? (2)

A

Nasopharyngeal adenocarcinomas

Burkitt’s lymphoma

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35
Q

Erythema migrans rash is associated with which disease? What does it look like?

A

Lyme disease

Target lesion

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36
Q

Ziehl-Neelsen stain for acid fast bacilli used for what?

A

TB

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37
Q

A new stroke patient with a temperature- look for what?

A

Endocarditis

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38
Q

Most pro-clotting abnormalities are likely to cause venous clots, apart from which one?

A

Antiphospholipid syndrome- arterial

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39
Q

Migraine with aura more or less likely to have patent foramen ovale?

A

More

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40
Q

Painless jaundice and palpable gallbladder in an older patient is _______ until proven otherwise

A

pancreatic cancer

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41
Q

BRCA2 and PLAB2 mutations are associated with which abdominal carcinoma?

A

Pancreatic

42
Q

What is troussaeau’s sign?

A

Sign of malignancy

Migratory thrombophlebitis/recurrent

43
Q

What is courvoisier’s sign

A

Enlarged, palpable gallbladder that is NOT tender (pancreatic cancer)

44
Q

New onset diabetes in an older person might indicate what cancer?

A

pancreatic

45
Q

CA125

A

Ovarian

46
Q

Ca19-9

A

Panc

47
Q

Ca 15-3

A

Breast

48
Q

CEA

A

Colorectal

49
Q

AFP

A

hepatocellular carcinoma, teratoma

50
Q

S-100 tumour marker

A

melanoma, schwannoma

51
Q

Bombesin tumour marker

A

small cell lung ca, gastric, neuroblastoma

52
Q

What is Kussmaul’s sign?

A

Raised JVP that doesn’t fall with inspiration - constrictive pericarditis

53
Q

dyspnoea, peripheral oedema and positive Kussmaul’s sign and recent cardiac intervention

A

Constrictive pericarditis

54
Q

haematuria, sensory hearing loss and ocular disturbances=?

A

Alport’s syndrome

55
Q

Renal problems 1-2 days after URTI?

A

IgA nephropathy

56
Q

Renal problems 1-2 weeks after URTI?

A

Post-strep glomerulonephritis

57
Q

Which lymphoma causes pain on alcohol consumption?

A

Hodgkin’s

58
Q

Which lymphoma has Reed-Sternberg cells?

A

Hodgkin’s

59
Q

What is in granulomatous nodules?

A

Macrophages

60
Q

Gold standard diagnosis for sarcoid?

A

Biospy histology- non caseating granulomas w epithelioid cells.

61
Q

What is lofgren’s syndrome?

A

A specific triad of presentation of sarcoid

Erythema nodosum

Polyarthralgia

Bilateral hilar lymphadenopathy

62
Q

Treatment for sarcoid

A

None/oral steroids 6-24m

Second line MTX or azothioprine

Rarely lung transplant is indicated

63
Q

Gout is a sign of what in diabetes?

A

Insulin resistance

64
Q

What does the number in a brand of insulin mean e.g. humalin M3?

A

how much of it is fast acting

M= mix

3= 30% fast acting

65
Q

How do you know you’re giving enough thyroxine?

A

Aim for lower half of TSH normal range (the lower half is 0.2-2.0)

66
Q

adrenal cortex antibodies and 21-hydroxylase antibodies might be present in what?

A

Primary adrenal insufficiency (Addison’s disease)

67
Q

What steroid is given in Addison’s to replace cortisol?

A

Hydrocortisone (glucocorticoid)

68
Q

What steroid is given in Addison’s to replace aldosterone?

A

Fludrocortisone (mineralocorticoid)

69
Q

What are the only two hormones released by the posterior pituitary?

A

Oxytocin and ADH

70
Q

The dexamethasone suppression test is the test of choice for diagnosing what?

A

Cushing’s syndrome

71
Q

How much steroid treatment warrants a tapered withdrawal?

A

more than 40mg prednisolone daily for more than one week, received more than 3 weeks treatment or recently received repeated courses

72
Q

What is Sheehan’s syndrome?

A

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.

73
Q

Addison’s crisis is characterised by what blood gas result?

A

hyperkalaemic metabolic acidosis

74
Q

What is nelson’s syndrome?

A

Rare invasive pituitary adenoma that occurs after bilateral adrenal gland removal for Cushing’s.

75
Q

What is the most important modifiable risk factor for the development of thyroid eye disease

A

Smoking

76
Q

When should thyroid eye disease be referred for urgent ophthal review?

A

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

77
Q

skin sx of leprosy

A

depigmentation and loss of sensation.

78
Q

legionella can cause what results in electrolytes and LFTs?

A

hyponatraemia and deranged LFTs

79
Q

Treatment for MRSA pre surgery?

A

nasal mupirocin and chlorhexidine for skin

80
Q

Role of loop diuretics in HF- symptom management or improve survival?

A

Symptomatic relief only

81
Q

Raised urea:Cr ratio indicates what sort of AKI?

A

Pre-renal

82
Q

What is the effect of pre-renal uraemia on sodium?

A

kidneys hold on to sodium to preserve volume

83
Q

Which IBD is lead pipe colon in

A

UC

84
Q

Definitive management of infective endocarditis causing congestive cardiac failure

A

Urgent valve replacement

85
Q

treatment for active TB

A

RIPE:

For first 2 months:

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Next 4 months:

Rifampicin
Isoniazid

86
Q

Latent TB Rx

A

3 months of isoniazid (with pyridoxine) and rifampicin

OR

6 months of isoniazid (with pyridoxine)

87
Q

what is complex regional pain syndrome

A

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

88
Q

Action of calcitonin

A

Inhibits PTH

89
Q

Which type of thyroid cancer is associated with MEN2?

A

Medullary

90
Q

Type I MEN cancers

A

Parathyroid

Pituitary

Pancreas

91
Q

Type IIa MEN cancers

A

Parathyroid

Phaeochromocytoma

Medullary thyroid ca

92
Q

Type IIb MEN cancers

A

Phaeochromocytoma

Medullary thyroid ca

93
Q

Genes effected in MEN?

A

MEN I- MEN1 gene

MEN IIa and IIb- RET oncogene

94
Q

Philadelphia chromosome - t(9:22) is associated with which haematological malignancy?

A

CML

95
Q

C-peptide is only present with endogenous or exogenous insulin?

A

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)

96
Q

aphasia means which hemisphere is affected? Which artery?

A

Their dominant one (but left is more likely overall, even in left handed)

MCA supplies Broca’s and Wernicke’s areas

97
Q

Pseudogout appearance on xray

A

chondrocalcinosis

in the knee this can be seen as linear calcifications of the meniscus and articular cartilage

98
Q

discrete, non-tender, highly mobile breast lumps

A

fibroadenoma

99
Q

Fibroadenosis aka

A

fibrocystic disease

100
Q

If someone has been catheterised for chronic retention should you TWOC them?

A

No, usually due to prostatic hyperplasia so don’t TWOC until TURP done

FINALS medicine (8 decks)

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