Random extra Flashcards by Alice Hanton

What is cushing reflex?

Bradycardia and HTN, then eventually apnoea

Indicates raised ICP

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What drug shouldn’t you give in suspected lymphoma?

Steroids as may effect biopsy

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Function of the foramen ovale

Bypasses foetal lungs

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

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

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

Spinal stenosis- ‘neurogenic claudication’

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

Pancytopenia in thiopurine methyltransferase (TPMT) deficiency

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HNPCC is also known as?

Lynch syndrome

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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.

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What is Von Hippel Lindau disease?

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

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How long should you wait between inhaler doses for asthma?

30s

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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.

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What is given prophylactically to prevent bleeding in oesophageal varices?

Non-cardioselective beta blockers e.g. propanolol

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How long before endoscopy should PPIs be stopped

2weeks

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What is Sister Mary Joseph node?

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

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What is peabody sign?

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

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Rate of insulin infusion in DKA

0.1u/kg/hr

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What does seborrhoeic dermatitis resemble and what is the treatment?

Eczematous on scalp/other sebumy areas

- topical ketoconazole

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Analgesia of choice in renal colic?

Diclofenac IM/PR

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non caseating granulomas with epithelioid cells on biopsy indicates what?

Sarcoid

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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.

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What is glucocorticoid effect of steroids vs mineralocorticoid?

Gluco = anti inflammatory

Mineralo= fluid retention

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Random blood glucose level diagnostic of diabetes?

> 11mmol/L

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Random blood clugose level diagnostic of diabetes?

> 11mmol/L

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What can precipitate autonomic dysreflexia in spinal injury patient?

Blocked catheter

Faecal loading

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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?

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?

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

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