Random Facts Flashcards
1
Q
Side Effects of Steroids
A
Weight gain Osteoporosis Avascular necrosis (AVN) Cataracts, glaucoma Peptic ulcer disease (PUD) Susceptibility to infection Easy bruising Acne Hypertension Hyperlipidemia Hypokalemia Hyperglycemia Mood swings
2
Q
Bornholm disease/pleurodynia
A
Uncommon infection of intercostal muscles by Coxsackie B virus.
Causes severe stabbing chest pain. Pleuritic and worse with movement.
Associated with fever, malaise, and headaches.
3
Q
Causes of Mononeuritis Multiplex
A
1) diabetes
2) vasculitis
4
Q
2 diameters of NGT - their purpose
A
Smaller - for giving
Larger - for sucking
5
Q
Steroid use in premature babies
A
Help to grow
Matures type 2 pneumocytes to reduce surface tension and aid breathing
6
Q
What is the Ross procedure?
A
Diseasedaortic valveis replaced with the person’s ownpulmonary valve.
A pulmonaryallograft(valve taken from acadaver) is then used to replace the patient’s own pulmonary valve.
For common in children.
7
Q
Chiari malformation
A
Structural defect where cerebellum +/- brain stem tissue extends into the foramen magnum
8
Q
2 things to ask before interpreting ECG
A
1 - pain?
2 - HTN?
Most common cause of LVH is HTN.
Shows upas high voltages
9
Q
When can you have ectopic rupture or D/C?
A
7-9 weeks.
Need the mass to be big enough either to cause rupture or to scrape.
10
Q
Bacterial vs viral illness
A
Bacterial - constitutional symptoms
Viral - coryzal symptoms, esp sore throat, runny nose
11
Q
What investigations to rule out SAH?
A
CT brain and then LP - rules out 99%
If still suspicious, do MRI.
LP preferably done within 24hrs .
Expect blood in all tubes.
4th tube looking for xanthochromia. Must be wrapped in foil.
12
Q
Dimples of Venus correlate to?
A
Sacroiliac joints.
They directly overlie them.
13
Q
How long can viral cough last for?
A
2-3 months
14
Q
Therapeutic dose of clexane
for DVT
A
1.5mg/kg daily
or
1mg/kg bd
15
Q
How can we clinically assess for jaw dislocation or #?
A
Look at alignment of teeth
Look for any hematomas in/under the gum
16
Q
Iron tablets - what can they cause?
A
Black stools without the offensive smell
17
Q
Intra-uterine hematoma
what are we worried about besides the baby?
A
Rh -ve mother
Rh +ve baby
Creation of Abs that attack the next baby
18
Q
Iliac crest correlates to
A
L4-5 interspinal space
19
Q
How to treat panadol OD?
A
N-Acetylcysteine as IV infusion or oral.
NAPQI (metabolite) accumulates within the body in OD.
NAPQI is conjugated by glutathione, but in excess, glutathione reserves are not sufficient. NAPQI interact with hepatic enzymes and damage liver.
Acetylcysteine acts to maintain or replenish depleted glutathione reserves in the liver and enhance non-toxic metabolism of acetaminophen.
20
Q
Levels of Hb we can tolerate
before transfusion
A
70 - young
100 - old/other co-morbidities
21
Q
Accessory pathway in wPw
A
Bundle of Kent
22
Q
Why do we ask about amphetamine use in seizures?
A
Can cause arrhythmias and spasms
23
Q
DVT, PE in young person
A
Think:
- Prothrombotic state/coagulopathies
- Left to Right heart shunts
24
Q
Otolith catastrophe
A
Sudden ‘drop attacks’ in the context of Meniere’s disease.
During attacks, the patient falls to the ground in the absence of vertigo, loss of consciousness or malaise.
Late in the stage of Meniere’s.
25
What raises Lactate levels?
Anaerobic rest
Adrenaline - causes increases metabolic rate.
Diverts blood away from non essential organs. Anaerobic rest for those organs.
26
Investigations when suspecting SBO
CT Abdo
With IV and oral contrast
Looking for transition point in oral contrast
27
Causes of ascites in a CLD patient
1. further decompensation
2. non compliance with medications
3. hepatic vein thrombus
4. malignancy causing a resistant ascites
28
Which murmurs become louder with Valsaver?
HOCM and click of MVP
| all other murmurs become softer
29
Causes of low voltages on ECG?
```
Pericardial effusion
Dilated cardiomyopathy (walls are thinner)
```
30
How long do you have with testicular torsion to act?
Adult - 6hrs
Child - 12 hrs
(want to preserve function: spermatogenesis and hormone production)
31
Common causes of raised Aa gradient
V/Q mismatch
| Right to left shunt (intrapulmonary or cardiac)
32
Which is more sensitive V/Q scan or CTPA?
CTPA will only tell you about PE's that are proximal.
| Need V/Q scan to look for more distal PE's
33
Long term overdose of Insulin
Can have hypo-unawareness
Body gets use to stress response (adrenaline release).
Then get a blunted response to hypos
34
Side effects of Rifampicin
Red urine
Tears
Interacts with NOAC and warfarin (up regulates hepatic metabolism - CYP3A4 )
35
Relationship between rifampicin and flucloxacillin
Adding Rifampicin can lower the dose of flucloxacillin used.
| Avoiding intra-hepatic cholestasis and allergies.
36
Vasopressors used commonly in anaesthetics
Ephedrine
Metaraminol
Rare cases: NA
37
Empirical one-off Rx for gonococcal urethritis
Ceftriaxone 500mg IM
| Azithromycin 1g PO
38
Painless ulcer on penis?
Syphilis
| Primary Chancre
39
What test can we do to determine pancreatic exocrine insufficiency?
Low levels of faecal pancreatic elastase
40
CREON?
Pancreatic Enzyme Replacement Therapy
41
Which part of duodenum do you get PUD?
1st part of duodenum
42
Test in Autoimmune pancreatitis
IgG4 - RAISED
| accumulation of IgG4 in pancreas causing a mass --> blockage
43
Common causes of pancreatitis (clinically)
```
GET
Autoimmune
ERCP
Methotrexate
Prednisolone
```
44
Lipase levels in pancreatitis
>1000
Below that, think:
renal colic, renal failure, gastritis, ovarian pathology
45
Contrast the pain location in Cholangitis and Biliary colic
Cholangitis - RUQ
| Biliary colic - Epigastric
46
What does a drop >0.1 in PCV mean in someone receiving fluid resus?
Quite dehydrated as the pt is requiring lots of fluid resuscitation.
47
Why do Xray in Pancreatitis?
Looking for fat saponification and effusion around the pancreas
48
Diagnostic features of someone who does not clinically fit the picture of pancreatitis?
Epigastric pain and fat stranding around the pancreas.
49
How does ERCP cause pancreatitis?
1. Backwash of contrast or pressure into the pancreatic duct
| 2. Repeat cannulation causing trauma
50
Management of someone with Pancreatitis
IVT
ADC
PPI
Analgesia
51
Normal wall thickness of gallbladder
52
Level of bilirubin at which you cannot perform CT IVC
Bilirubin >30
| As the contrast, biliscopin will not be excreted.
53
Indications for CT IVC
Visualising bile leaks
| Looking for stones
54
2 types of AAA
Suprarenal or Infrarenal.
Difficult to operate on suprarenal AAA as cannot reattach the arteries back onto the aorta. Will electively perform EVAR.
In emergency situations, tend to palliate.
55
RUQ USS
| What do you look for?
```
Liver
Gallbladder
Biliary tree
Kidneys
Pancreas
```
56
What do check in exam of #?
1. tenderness
2. deformity
3. swelling
4. temperature
5. abnormal mobility and crepitus
6. loss of function
7. neurovascular status
57
How to calculate the the eGFR
Cockcroft-Gault equation
58
Dose of suxemethonium
1-2mg/kg of TBW
59
Why might you get a derm consult in setting of ablative therapy (chemo)
Skin cancers may transform.
Any dormant malignancies may activate.
Thus should get a skin check for things like SCCs etc.
60
Which type of leukaemia are more likely to cause splenomegaly?
Monocytic/monoblastic
| Acute erythroid
61
Why might you inspect skin in acute leukaemia?
Looking for skin infiltrates (leukaemic deposits in skin which look like papules)
Also known as chloromas
More common in myeloid > lymphoid
62
Valganciclovir used for?
CMV prophylaxis
| Do serology to check status.
63
Why check CMV serology status?
When giving blood products - do they need CMV-ve products?
| Do they have dormant CMV? Must check before we immunosupress for fear of activation.
64
What can be used to treat oral thrush?
Amphotericin B mouth lozenges
65
Why worry about oral mucosa in leukaemic pts?
Because of the combo of neutropenia + chemo:
high risk of candida infections
mouth pain
nutrition also affected
Therefore do regular inspection of the mouth.
66
Why start allopurinol in someone with Leukaemia?
Large tumour burden --> hyperuricemia --> may precipitate gout
Also help prevent tumour lysis syndrome
67
What parameters do you look at for tumour lysis monitoring?
LDH
Urate
Potassium
eGFR
68
What type derangement can thiazide diuretics cause?
increase BSL
| hyperuricaemia
69
Who do we need to dose adjust Clexane in?
Renal impairment
| Obese or small ppl
70
In who do we need to monitor clexane?
| with anti-factor Xa levels
renal impairment
| someone who has a propensity to bleed from a site (PUD)
71
Difference in Mx in someone with proximal or distal DVT
Proximal - greater risk of PE
| Distal - may not treat medically if small and not really symptomatic but are close to hospital and sensible.
72
3 type of Myeloproliferative disorders
1. Polycythemia Rubra Vera
2. Myelofibrosis
3. Essential thrombocythemia
Commonly associated with JAK2 mutation
73
1 cause of acquired anti-thrombin deficiency
Nephrotic syndrome
| The MW of the protein is such that it can leak.
74
Why might morphine be used in APO?
Dilates the abdominal great veins and decreases preload.
75
What is entorox used for?
Analgesic gas - used commonly in paeds
76
Someone bleeding profusely?
Direct pressure on bleeding vessel
77
What predisposes a Pathological #?
Osteoporosis
Bone tumours
Paget disease
Osteogenesis imperfecta
78
Which Ca's most commonly go to bone?
Breast
Prostate
Bowel
79
Contraindication in tranexamic acid use
Lowers seizure threshold.
| Avoid in epilepsy
80
What 2 drugs when given too quickly can cause ototoxity?
Frusemide IV
| Gentamicin IV
81
Side effects of morphine in anaesthetics
Broncho-constriction
| Vasodilation (via histamine release)
82
Time for IV morphine to take effect?
10 mins
83
Anti-emetic options
Metoclopramide
Ondansetron
Dexamethasone (prophylaxis)
Droperidol 1mg
84
Side effect of Panadol IV
Drops blood pressure
85
What can be used for Analgesia?
```
Mg
Local anaesthetic
Panadol
NSAID
Opiate
TCAs
Gabapentin
Pregabalin
Tramadol
clonidine
```
86
What are the 3 actions of Tramadol
1. Partial agonist at mu receptors
2. alpha agonist
3. 5HT3 receptor
(last 2 actions are in the descending pathways)
87
What would monitors show if there was a large fat embolus?
Drop in CO2 that is expired
88
Lung Primaries metastasise to?
Other parts of lung
Adrenals
Bone
Sometimes liver
89
Which Cancers metastasise to bone?
```
Breast
Prostate
Lung
Melanoma
Thyroid
Kidney
```
90
1st line therapy for TB
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
91
Regimen for HAART
2 NRTI + PI
| 2 NRTI + NNRTI
92
Where does breast Ca metastasise to?
Bone
Liver
Lung
93
Which diuretics precipitate gout?
Loop
Thiazides
Reduce urate excretion by both directly and indirectly increasing urate reabsorption and decreasing urate secretion
94
Most common cause of LLQ pain?
Diverticulitis
95
Midgut ends where?
2/3 along transverse colon
96
Ligamentous injury or fracture?
Test vibration - hurts bad in fracture. Not so much in ligament injury.
Change in position also does not change fracture pain.
97
What sign may you see radiologically with pneumoperitoneum?
Rigler's sign
| When air is present on both sides of the intestine --> get a double wall sign.
98
Femoral hernias more common in...
little old ladies
99
Toxic megacolon
dilated bowel with translocation of material
100
Differentiate LB and SB radiologically
Location
Diameter
Haustra vs Valvulae Conniventes (plicae circulares)
101
Lower abdo pain in female.
| DDx
```
Appendicitis
Diverticulitis
Cyst rupture
Retrograde menstruation
Ectopic
PID
```
102
Location of pain for fore/mid/hind gut?
Foregut - epigastric
Midgut -periumbilical
Hindgut - lower abdomen
103
Describe Shenton's line
Shenton's line is formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus.
Help to pick NOFs
104
Bechets triad
Apthous ulcers
Genital ulcers
Uveitis
105
Dark urine DDx
Myoglobinuria (rhabdo)
Haemoglobinuria (Hemolysis)
Hyperbilirubinemia
106
How would hemolysis show in blood?
haptoglobin low
107
Primaries that metastasise to lung
breast
pancreas
kidney
skin
108
Expected CO2 formula for compensation for metabolic acidosis
HC03 x 1.5 + 8 +/- 2
109
Do the following causes alkalosis or acidosis?
Liver failure
Renal failure
Sepsis
Liver failure - alkalosis (loop diuretics, aldosterone)
Renal failure - acidotic
Sepsis - acidotic (shock, lactic acid build up)
110
Normal Anion gap?
111
For every drop of 0.1 in pH, how much does K go up by?
0.5 increase
112
Rigors imply?
Sepsis
| Think bacteria, influenza, HIV, vasculitis
113
Would you expect to see radiological changes in septic arthritis
Not in acute setting.
| If after several weeks, may see osteopenia
114
What does decreased haptoglobin suggest?
1. intravascular hemolysis: with increased reticulocyte count and a decreased haemoglobin and hematocrit.
2. extravascular hemolysis: haptoglobin can be normal and the reticulocyte count is increased
115
Prophylaxis for vatical bleeding
1. propranolol
| 2. band ligation
116
2 benefits if ascitic fluid analysis
1. diagnose Spont Bact. Peritonitis (pmn count > 250)
| 2. diagnose portal hypertension (SAAG > 11 g/L)
117
how does portal hypertension manifest?
1. ascites +/- SBP
| 2. vatical +/- bleeding
118
Ddx for upper GI bleed
```
– Peptic ulcer disease
– Varices
– Esophagitis
– Mallor-Weiss tear
– Other: cancer, angiodysplasia/AVM
```
119
Causes of Cushing's syndrome
1. anterior pituitary adenoma (cushion's disease)
2. paraneoplastic (SCC of lung)
3. primary adenoma/carcinoma of adrenals
4. iatrogenic
120
3 antidotes to know?
1. NAC - for paracetamol OD
2. Flumazenil - benzodiazepine GABA receptor antagonist
3. Naloxone - opioid antagonist
121
Back pain and fever?
Epidural abcess until proven otherwise
| Can cause paralysis if ignored
122
Treatment for toxoplasmosis
sulphadiazine + pyremethamine
123
Cushing reflex
Impending herniation
Increased BP
Bradycardia
Cheyne stokes breathing
124
Wernicke's encephalopathy
Vitamin B1 deficiency (thiamine)
ataxic gait
encephalopathy (confusion)
oculomotor deficiency
125
Normal pressure hydrocephalus triad
urinary incontinence
gait disturbance
dementia
126
Side effect of tetracycline in breastfeeding
Stains teeth
127
Insulin use post MI
Improves survival in hyperglycaemia setting.
Sliding scale 24hrs post
3months insulin subcut
128
Delirium tremens
Most severe form of ethanol withdrawal
Confusion, hallucinations
high mortality
129
Neuropathy distinctions
Diabetic: peripheral sensory
B12: Vibration and proprioception
CIDP: large fibre and areflexia
Syringomyelia: pain and temp in UL
130
Anti-endomysial Abs
Coeliac disease
131
Sign of hyperventilation
Carpal spasm
132
hypogonadotrophic hypogonadism and anosmia
Kallman's syndrome
| Failure of migration of the olfactory neurones and GnRh neurones during development.
133
Phenytoin side effects
peripheral sensory neuropathy
cerebellar ataxia
hirsutism
gum hypertrophy
134
Neural tube defects
Valproate
| Supplement with folate!
135
CLL and immunodeficiency
CLL is commonly complicated by panhypogammaglobulinaemia
136
Seroconversion illness HIV
widespread macular rash
pharyngitis
generalised lymphadenopathy
137
Amoidarone induced hypothyroidism
amiodarone induced hypothyroidism which inhibits the peripheral conversion of T4 to T3.
138
Hypercalcemia seen in...
multiple myeloma, hyperparathyroidism and hyperthyroidism
139
Upper lobe fibrosis
Ankylosing spondylitis
140
How to differentiate Myasthenia from Lamber Eaton?
Weakness tends to improve after a few minutes of muscular contraction, and absent reflexes return in Lambert eaton whereas in MG, muscles fatigue with use.
141
Valsava
First ask if you can do one - pt may be unstable
1. breath in and push against my hand that's flat ons stomach
2. squat
3. reinforcement
4. syringe
5. blow out of nose that's squeezed closed
142
What should you do in a pt with AF on examination?
take radial pulse and auscultate heart at the same time.
| Not all contractions may be transmitted into a pulse
143
Major side effect of verapamil
constipation
144
Amiodarone effect on warfarin
increases effective dose
145
2 antibodies to look for in scleroderma
anti-centromere
| anti-topoisomerase (Scl 70)
146
Fluorinated Steroid
Also has prefix beta
Avoid on face
Can cause steroid rosacea
147
methotrexate crepitations
coarse creps in mid zone
148
MLH1 and MSH mutations are important in which syndrome?
Lynch
| Hereditary nonpolyposis colorectal cancer
149
Alcohol binge LFT pic
AST and GGT rise
150
Oxygen saturation 90
PaO2 = 60mmHg
151
Von Willebrand features
autosomal dominant
| affects APTT
152
Haemophilia inheritance
X linked recessive
153
MRSA
Healthcare workers
154
Courvoisier’s Sign
enlarged, palpable gallbladder in patients with obstructive jaundice caused by tumors of the biliary tree or by pancreatic head tumors
155
Pneumocystis features
symptoms progress over month
| cough is optional
156
Sigmoid volvulus
RIF pain
157
Sign of portal hypertension in cirrhosis
splenomegaly
158
Skin reactions in radiotherapy last for?
up to 3 weeks
| basal keratinocytes takes 3 weeks to generate new skin
159
Low DLCO
Interstitial pulmonary fibrosis (restrictive)
Emphysema (obstructive)
Anaemia, pulmonary vasc disease (normal)
160
Metacholine challenge test
diagnose asthma
161
Normal DLCO
Chest wall disease
| Neuromuscular disease
162
Optic neuritis
RAPD
Central scotoma
More often normal fundus (otherwise can be pale or swollen optic disc)
Can have colour defects - but only if acuity also affected
163
Fulminant Hepatitis
Hep B not Hep C
164
Chylothorax
One of the rare complications of CABG
Nick the thoracic duct.
Get chyle in drainage once you begin to eat fatty foods
165
ECG pattern in PE
SI QIII TIII pattern – deep S wave in lead I, Q wave in III, inverted T wave in III.
166
What might you see on CXR of aortic dissection?
widened mediastinum
| irregular aortic contour
167
Riddle's lobe
Anatomical variant of the right lobe of the liver
| Tongue like projection - may look like hepatomegaly
168
Dentate line
Divides the upper two thirds and lower third of the anal canal. Developmentally, this line represents the hindgut-proctodeum junction.
Superior rectal artery vs inferior rectal artery
Superior rectal vein vs inferior rectal vein
Visceral (inferior hypogastric plexus) vs. somatic (pudendal)
169
Chilaiditi sign
Large bowel btw the liver and diaphragm
| Appears as free gas with rugae underneath the diaphragm
170
Portal venous gas
Accumulation of gas in the portal vein and its branches.
Harbinger of death
Gas found more peripherally
171
Pneumobilia
Gas in biliary tree.
| Gas found more centrally in liver
172
4 types of calcification
Rim like - in wall of hollow viscus - e.g. cysts
Linear - in wall of tubular structures
Lamellar - stones
Amorphous - in solid organ
173
SBO
Dilated loops of bowel
> 2.5-3cm
> 5 air fluid levels on erect film
Proximal to obstruction - first to dilate
Overtime, all parts dilate
174
In ileus, what happens to the bowel?
Both small and large bowel are dilated
175
Where is the largest diameter in bowel?
Caecum - 9cm but thinnest. >15cm: impending perforation
Small bowel 3cm
Colon - 6cm
176
Imaging in LBO?
CT with rectal contrast
177
Apple core lesion
Stenosing annular colorectal carcinoma
178
Side effects of metronidazole
Severe nausea
Massive vomiting with alcohol consumption
Metallic taste in mouth
179
Difference in Prinzmetal and normal angina on ECG?
ST elevation and more leads affected.
cf.
ST depression usually limited to one vascular territory.
180
Considerations for MRI and previous SAH
Certain aneurysmal clips may be CI
181
Things to consider in a splenectomy pt
Left shift in neutrophils and thrombocytosis
Increased risk of thrombosis
low dose Abs for prophylaxis
182
Side effect go mycophenolate
Microangiopathic haemolytic anaemia
183
Where else can you get cysts in PKD?
```
liver
spleen
pancreas
ovaries
lung
```
184
Preop anaesthetic assessment of RA pt
Must image C-spine
| Instability from RA
185
Reiter's triad for reactive arthritis
arthritis
uveitis
urethritis
186
Behcet's triad
mouth ulcers
genital ulcers
uveitis
187
Most common cause of pneumoperitoneum
perforated peptic ulcer
188
Dengue symptoms
Fever, violent headache, and severe pains in the muscles and joints following an incubation period of 5-8 days, and lasts about 4-7 days
189
Troisier's sign
Clinical finding of a hard and enlarged left supraclavicular node (Virchow's node)
Virchow's node: where the lymphatic drainage of most of the body (from the thoracic duct) enters the venous circulation via the left subclavian vein.
190
Why does CKD increase CVD risk?
High PO4 leads to increased PTH levels.
| Ca released binds to PO4 and together they deposit in vessel walls
191
What do we use to treat Meniere's?
Betahistadine
| Increases bloodflow to vestibule
