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Phase 4 Question Knowledge > Random knowledge to review 2 > Flashcards

Random knowledge to review 2 Flashcards

1
Q

In what condition is donepezil CI?

A

Bradycardia

Donepezil can cause insomnia as well

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2
Q

Centor criteria?

A

CENTor criteria:

Cough absent
Exudates on tonsils
Nodes- tender cervical lymphadenopathy
Temperature>38

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3
Q

Transjugular Intrahepatic Portosystemic Shunt problem?

A

Last line for upper variceal bleed- bypasses the liver so can cause a build up of toxins that cause confusion

Causes the exacerbation of hepatic encephalopathy

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4
Q

What should all men with ED have checked?

A

Their testosterone levels

Also screen for underlying diabetes and cardiovascular disease

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5
Q

Treatment for benzodiazepine overdose?

A

Flumazenil

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6
Q

TB drugs memory aid?

A

RIPE ONGO
Rifampicin: Orange secretions
Isoniazid: Neuropathy
Pyrazinamide: Gout
Ethambutol: Optic Neuritis

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7
Q

How do you prevent the peripheral neuropathy from Isoniazid?

A

Pyridoxine (vitamin B6)

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8
Q

Ethambutol before treatment?

A

Check visual acuity before and during treatment as can cause optic neuritis

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9
Q

Osteoporosis blood derangement?

A

None

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10
Q

When are Howell-Jolly bodies found?

A

Post-splenectomy

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11
Q

At what fasting glucose should insulin be offered straight away for gestational diabetes?

A

> 7mmol/l

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12
Q

Is iron deficiency anaemia a cause of pruritis?

A

Yes

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13
Q

ADPKD drug treatment?

A

Tolvaptan

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14
Q

Letrozole vs Tamoxifen?

A

Tamoxifen for oestrogen receptor-positive breast cancer

Letrozole/anastrozole for oestrogen receptor-positive breast cancer in those after the menopause

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15
Q

What is a Jarisch-Herxheimer reaction?

A

Fever, rash, chills and headache following antibiotic administration for syphillis, also tachycardia and myalgia

Due to the rapid killing of Treponema pallidum and release of its endotoxins

Supportive management with antipyretics and it resolves within 24 hours

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16
Q

What is the first line treatment for syphillis?

A

IM benzathine benzylpenicillin

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17
Q

Treatment for septic arthritis?

A

Flucloxacillin or clindamycin for penicillin allergic

IV

4-6 weeks overall switch to oral antibiotics after 2 weeks

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18
Q
A
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19
Q

<3 months with fever over 38?

A

Refer for paediatric assessment

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20
Q

Visual hallucinations + dementia?

A

Lewy body dementia

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21
Q

Squint in child?

A

Refer to secondary care

Means eyes pointing in different directions

Can lead to amblyopia and uncorrects (brain prefers one eye)

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22
Q

How many tetanus jabs to be immune lifelong?

A

5

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23
Q

Is anus spared in UC?

A

Yes

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24
Q

Secretions treatment in palliative care?

A

Hyoscine hyrobromide or hyoscine butylbromide

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25
Q

What are the side effects of tamsulosin (alpha-1 adrenergic receptor antagonist)?

A

Dizziness and postural hypotension

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26
Q

What precipitiates lithium toxicity?

A

Dehydration

Renal failure

Drugs: diuretics (especially thiazides), ACEi/ARBs, NSAIDs and metronidazole

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27
Q

Features of lithium toxicity?

A

Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma

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28
Q

Lithium toxicity management?

A

Mild-moderate toxicity may respond to volume resuscitation with normal saline- IV fluids with isotonic saline

Haemodialysis may be needed if severe toxicity

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29
Q

HF management?

A

1st line: ACEi + BB
2n line: Aldosterone antagonist (spironolactone, eplerenone) or SGLT-2 (ie dapagliflozin) if HFrEF
3rd line: Ivabradine, sacubitril-valsartan (EF<35%), Digoxin (for symptomatic relief), Hydralizine + Nitrate (Afro-Caribbean)
Cardiac resynchronisation if wide QRS (LBBB)

+ Annual flu vaccine and one-off Pneumococcal vaccine

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30
Q

Warfarin interactions?

A

General factors that may potentiate warfarin-
Liver disease
P450 ezyme inhibitors
Cranberry juice
Drugs- NSAIDs

Inducers of the P450 system will decrease INR

Inhibitors will increase the INR

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31
Q

P450 inducers (decrease INR)?

A

Antiepileptics: phenytoin, carbamazepine

Barbiturates: phenobarbitone

Rifampicin

St John’s Wort

Chronic alcohol intake

Griseofulvin

Smoking (affects CYP1A2, reason why smokers require more aminophylline)

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32
Q

P450 inhibitors (increase INR)?

A

antibiotics: ciprofloxacin, clarithromycine/erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin

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33
Q

Can diabetic foot ulcers/diabetes lead to osteomyelitis?

A

Yes

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34
Q

Diverticular disease management?

A

Increase dietary fibre intake

Mild attacks managed conservativley with antibiotics

Absecess drained

Reccurrent episodes are indication for a segmental resection

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35
Q

Horner’s features?

A

Miosis

Ptosis

Anhidrosis (loss of sweating on one side)

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36
Q

Hip fracture treatments?

A

Intracapsular-
Undisplaced- internal fixation or hemiarthroplasty

Displaced- total hip replacement (arthroplasty) to all patients, sometimes hemiarthroplasty if not able to do much before injury

Stable intertrochanteric- dynamic hip screw

Subtrochanteric, reverse oblique or transverse- intermedullary device

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37
Q

Adrenaline doses?

A

Age Adrenaline dose
< 6 months 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
6 months - 6 years 150 micrograms (0.15 ml 1 in 1,000)
6-12 years 300 micrograms (0.3ml 1 in 1,000)
Adult and child > 12 years 500 micrograms (0.5ml 1 in 1,000)

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38
Q

What does india ink stain on CSF analysis in meningitis point towards?

A

Cryptococcus neoformans

Most common fungal infection of CNSWh

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39
Q

What is co prescribed when starting a GnRH agonists (Goserelin) for prostate cancer?

A

Anti-androgen- cyproterone acetate- prevent a rise in testosterone causing a tumour flare

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40
Q

RUQ pain?

A

RUQ pain only –> biliary colic
RUQ pain + fever –> acute cholecystitis
RUQ pain + fever + jaundice –> ascending cholangitis (Charcot’s triad)
Charcot’s triad + confusion + hypotension = Reynold’s pentad (more severe ascending cholangitis)

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41
Q

When should parents call an ambulance in febrile convulsions?

A

If it lasts longer than 5 minutes

Febrile convulsions occur between the ages of 6 months and 5 years

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42
Q

What is prescribed if recurrent febrile convulsions occur?

A

Benzodiazepine rescue medication

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43
Q

Palliative care- severe pain with CKD treatment?

A

Buprenorphine or fentanyl are the opioids of choice for pain relief in pallaiative care patients with severe renal impairment

Oxycodone is preferred in mild-moderate renal impairment

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44
Q

Hepatitis C investigation?

A

HCV RNA

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45
Q

Which thyroid treatment worsens thyroid eye disease?

A

Radioiodine treatment

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46
Q

Lower GI bleeding cause paeds?

A

Neonates- NEC or malrotation

Infants/young children- intussusception

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47
Q

Dopamine receptor antagonist examples?

A

Bromocriptine, ropinirole, cabergoline, apomorphine

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48
Q

MAO-B inhibitors example?

A

Selegiline

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49
Q

COMT inhibitors?

A

Entacapone, tolcapone

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50
Q

VTE prophylaxis in patients with nephrotic syndrome?

A

Low molecular weight heparin (LMWH)

Things like DOACs and Warfarin bind to proteins in the blood- decrease in these proteins in nephrotic syndrome

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51
Q

When must a culture (MSU) be sent for non-pregnant women in UTI?

A

If there is visible or non-visible haematuria

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52
Q

Vision loss associated with Charles-Bonnet?

A

Age-related macular degeneration (ARMD)

Distortion of straight lines/ reduced acuity are symptoms

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53
Q

When to start dapagliflozin?

A

QRISK over 10%, cardiovascular risk factors

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54
Q

HbA1c target for any drug which may cause hypoglycaemia?

A

53

Example drug would be a sulfonylurea

Also 53 for patients already on one drug but HbA1c has risen to 58

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55
Q

How do you assess drug sensitivities in TB?

A

Sputum culture

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56
Q

How is pseudogout also known?

A

Calcium pyrophosphate deposition disease

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57
Q

Pseudogout presentation?

A

Knee, wrist and shoulders most commonly affected

Joint aspiration- weakly-positive birefringent rhomboid-shaped crystals

X-ray- chondrocalcinosis

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58
Q

Gonorrhoea cause?

A

Neisseria gonorrhoeae

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59
Q

Gonorrhoea treatment?

A

First line- single dose of IM ceftriaxone 1g
If sensitivities known and organism sensitive to cirpofoxacin that should be given 500mg orally

If ceftriaxone refused then oral cefixime and oral azithromycin should be used

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60
Q

Disseminated gonococcal infection classic triad?

A

Tenosynovitis, migratory polyarthritis and dermatitis

Later complications- septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)

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61
Q

Subacute unilateral visual loss, eye pain worse on movements?

A

?Optic neuritis

Features:
Unilateral decrease in visual acuity over hours or days
Poor discrimination of colours, ‘red desaturation’
Pain worse on eye movement
Relative afferent pupillary defect
Central scotoma

Investigation- MRI of the brain and orbits with gadolinium contrast

Management- high-dose steroids

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62
Q

Abdo diseases children?

A

Pyloric stenosis - Projectile, non-bilious vomiting at 4-6 wks old

Malrotation - Bilious vomiting, abdominal pain, acutely unwell

Intestinal atresia - Bilious vomiting if distal to ampulla of Vater, usually hours-days old

Hirschsprung’s disease - Failure to pass meconium >48 hours, abdominal distension, failure to thrive, sometimes bilious vomiting

GORD - Milky vomiting after feeds, crying, arching of back, drawing up of knees into chest, failure to thrive, <8 weeks old

GOR - Physiological, regurgitation but no symptoms or complications (‘happy spitter’)

Intussusception - Colicky abdominal pain, drawing up of knees into chest, pale, RUQ sausage-mass, refusing feeds, red-currant stools late sign, non-bilious vomiting that may become bilious if obstruction, at 6-18 months old

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63
Q

Can the temporal artery biopsy be false negative?

A

Yes as there can be skip lesions in temporal arteritis- continue the treatment

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64
Q

Vision complication in temporal arteritis?

A

Anterior ischemic optic neuropathy

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65
Q

Reduced fetal movement investigations?

A

Initially, handheld doppler to confirm fetal heartbeat- if no heartbeat detectable immediate ultrasound should be offered
If fetal heartbeat present on doppler- CTG should be used to monitor for at least 20 mins

Referral if fetal movements not felt by 24 weeks

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66
Q

RA and eye problems?

A

?Scleritis

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67
Q

Scleritis?

A

RA, SLE, Sarcoidosis associations

Features:
Red eye
Classically painful (in comparison to epscleritis)
Watering/photophobia
Gradual decrease in vision

Management- same day assessment by an opthalmologist

Oral NSAIDs first line

Oral glucocoriticoids in severe presentations

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68
Q

Gliptins side effects?

A

Pancreatitis

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69
Q

Pioglitazone contraindication?

A

Heart failure

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70
Q

Symptoms/signs of hypocalcaemia memory aid?

A

CATs go numb- Convulsions, Arrythmias, Tetany, Numbness also Trouseau’s sign and Chvostek’s sign

QT prolongation on ECG

Blood transfusions can cause hypocalaemia and hyperkalaemia

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71
Q

Signs/symptoms of hyperkalaemia?

A

Metabolic acidosis, arrythmias, muscle weakness, reduced reflexes, diarrhoea

ECG features- Absent P waves, prolonged QRS, peaked or tall tented T waves, sine wave pattern

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72
Q

Aortic stenosis symptoms?

A

SAD- syncope, angina, dyspnoea

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73
Q

Which UTI medication is contraindicated in pregnancy?

A

Trimethoprim

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74
Q

Initial emergency treatment for acute angle-closure glaucoma?

A

IV acetazolamide + timolol, pilocarpine and apraclonidine eyedrops

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75
Q

Definitive management for acute angle-closure glaucoma?

A

Laser peripheral iridotomy

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76
Q

Typical presentation of coarctation of the aorta?

A

Acute circulatory collapse at 2 days of age, mid systolic murmur maximal over the back

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77
Q

Management of croup?

A

Single dose of dexamethasone to all children regardless of severity

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78
Q

Hand-foot syndrome in sickle cell anameia?

A

Red blood cells interfere with circuation to hands and feet- causes pain, swelling and erythema

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79
Q

Colorectal screening age?

A

Every 2 years to all men and women aged 60-74 in England

Patients over 74 may request screening

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80
Q

Tests done in all patients with colorectal cancer for staging?

A

Carcinoembryonic antigen (CEA)

CT of the chest, abdomen and pelvis

Entire colon should have been evaluated with a colonoscopy or CT colonography

Patients whose tumours lie below the peritoneal reflection should have their mesorectum evaluated with MRI

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81
Q

Management of colon cancer?

A

Nearly always treated with surgery

Resectional surgery is the only option for cure in patients with colon cancer

Site of cancer Type of resection Anastomosis
Caecal, ascending or proximal transverse colon Right hemicolectomy Ileo-colic
Distal transverse, descending colon Left hemicolectomy Colo-colon
Sigmoid colon High anterior resection Colo-rectal
Upper rectum Anterior resection (TME) Colo-rectal
Low rectum Anterior resection (Low TME) Colo-rectal
(+/- Defunctioning stoma)
Anal verge Abdomino-perineal excision of rectum None

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82
Q

Panproctocolectomy?

A

Removes the colon, rectum and anus- often in HNPCC carriers

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83
Q

Caecal, ascending or proximal transverse colon colorectal cancer treatment?

A

Right hemicolectomy- ileo-colic anastomosis

84
Q

Distal transverse, descending colon?

A

Left hemicolectomy- colo-colon

85
Q

Sigmoid colon?

A

High anterior resection- colo-rectal

86
Q

Upper rectum?

A

Anterior resection (TME)- colo-rectal

87
Q

Low rectum?

A

Anterior resection (Low TME)- colo-rectal (+/- defunctioning stoma)

88
Q

Anal verge

A

Abdomino-perineal excision of rectum- none

89
Q

What is the resection of the sigmoid colon and an end colostomy fashioned in the operation called?

A

Hartmann’s procedure

90
Q

Hypocalcaemia?

A

CATS go numb:

Hypocalcaemia:

Convulsions
Arrhythmia (and long QT)
Tetany
Spasm - Chvostek and Trousseau signs
(go)
Numb - paraesthesia

91
Q

Imaging for multiple myeloma?

A

Whole-body MRI

92
Q

Premenstrual syndrome (PMS)?

A

Emotional and physical symptoms in the luteal phase of the normal menstrual cycle- anxiety, stress, fatigue, mood swings- bloating, breast pain

Mild symptoms- lifestyle advice- low alcohol, regular meals, sleep, exercise, no smoking

Moderate- may benefit from a new-generation COCP (example is Yasminu- drospirenone 3mg and ethinylestradiol)

Severe symptoms may benefit from an SSRI

93
Q

How to tell heart rate/BP in a traumatic injury?

A

Fast and weak- there’s a leak

Slow and strong- something in the head wrong

94
Q

Cushing’s triad from raised ICP?

A

Hypertension, bradycardia and irregular breathing

Aimed at maintaining cerebral perfusion

95
Q

Which stomas need to be spouted vs not spouted?

A

Small bowel spouted- so that irritant contents do not come into contact with the skin

Colonic stomas do not need to be spouted as their contents are less irritant

96
Q

If having a total colectomy which sort of stoma would be formed?

A

Ileostomy

97
Q

Location of stomas?

A

Ileostomy- right iliac fossa, spouted, output- liquid

Colostomy- varies, more likely on the left side, flushed, output- solid

98
Q

EBV rash with what?

A

Amoxicillin

99
Q

EBV triad?

A

Sore throat, pyrexia, lymphadenopathy

Other features:
Malaise, anorexia, headache
Palatal petechiae
Splenomegaly
Haemolytic anaemia secondary to cold agglutins (IgM)
Maculopapular, pruritic rash with amoxicillin

100
Q

Infectious mononucleosis investigation?

A

Heterophil antibody test (Monospot tet)

101
Q

When is ECV offered?

A

36 weeks for nulliparous

37 weeks for multiparous

If no contraindications:

where caesarean delivery is required

antepartum haemorrhage within the last 7 days

abnormal cardiotocography

major uterine anomaly

ruptured membranes

multiple pregnancy

102
Q

Hartmann’s procedure?

A

Sigmoid colectomy and formation of end stoma

Is the emergency operation for things like acute siverticulitis with perforation

103
Q

Which type of analgesia is best after surgery to reduce the chance of postoperative ileus and promote gastrointestinal motility?

A

Epidural analgesia- opioid/local anaesthetic

104
Q

Lynch syndrome surgery?

A

Panproctocolectomy- takes the colon sigmoid and rectum- reduce risk of further malignancies

105
Q

SLE management?

A

Basics- NSAIDs, sun-block

Treatment of choice- hydroxychloroquine

If internal organ involvement- renal, neuro, eye, consider prednisolone or cyclophosphamide

106
Q

Temporal arteritis eye problem summary?

A

Anterior ischaemic optic neuropathy whereby inflammation of the posterior ciliary arteries causes optic nerve infarction and subsequent vision loss

107
Q

Surgeries for the different aortic dissections?

A

Type A- Aortic route replacement surgery

Type B- bed rest and beta blockers

108
Q

C-peptide levels in diabetes?

A

Type 1 diabetes- c-peptide levels are low

Type 2 diabetes- c-peptide levels are high

Diabetes specific antibodies point towards type 1

109
Q

Anticoagulation and head injury?

A

CT head within 8 hours

110
Q

Exam question fungal nail?

A

If more than 2 nails affected- oral terbinafine

If less than that amorolfine nail lacquer

Trichophyton rubrum is one of the most common dermatophyte nail infections

111
Q

Which echocardiogram investigation for dissection if too unstable for a CT?

A

Transoesophageal

112
Q

Causes of Horner’s syndrome?

A

Symptoms- miosis, ptosis, usually anhidrosis

Look on passmed for causes

Some can cause no anhidrosis

113
Q

Mononeuritis multiplex?

A

RFs for it- diabetes, RA, amyloidosis, sarcoidosis

Distribution of weakness/sensory loss that doesnt make sense

> =2 single nerve lesion

114
Q

Intrahepatic cholestasis of pregnancy?

A

Pruritis
Clinically detectable jaundice
Raised bilirubin seen in >90% of cases

Management
Induction of labour at 37-38 weeks
Ursodeoxycholic acid
Vitamin K supplementation

115
Q

Gingival hyperplasia?

A

CCBs, Phenytoin, Tacrolimus/cyclosporin

116
Q

Thiazide diuretics electrolytes?

A

Hypokalaemia

Hyponatremia

Hypercalcaemia

117
Q

Recurrent episodes of otitis externa despite antibiotic treatment?

A

?Candida infection- especially if severe itching/ white, curd-like discharge

Bacterial causes are staphylococcus aureus, pseuomonas aeruginosa

Seborrhoeic dermatitis or recent swimming

118
Q

Tachycardia peri arrest?

A

Shock/hypotension/instability- Synchronised DC cardioversion

Broad complex- amiodarone infusion

Narrow complex- vagal manouvres then adenosine

If narrow an irregular- follow A-Fib protocol
If broad and irregular- specialist help

119
Q

Subclinical hypothyroidism?

A

TSH raised- T3, T4 normal

TSH >10 and free thyroxine in normal range- consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart

TSH between 5.5-10 and free thyroxine in normal range-
if <65 considering offering 6 months levothyrooxine trial if the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and
there are symptoms of hypothyroidism
In older people watch and wait is often use
If asymptomatic observe and repeat thyroid function in 6 months

120
Q

First line anticoagulant in reducing stroke risk?

A

DOACs

121
Q

Should tricyclic antidespressants be stopped in dementia?

A

Yes

122
Q

When would you start antihypertensives straight away if BP 180/120 or higher?

A

If evidence of target organ damage is identified- do not wait for ABPM or HBPM

Such as blood in urine, vision changes

123
Q

First line drugs for spasticity in MS?

A

Baclofen

Gabapentin

124
Q

Reducing the risk of relapses in MS?

A

Natalizumab

125
Q

Birth defects drug timing?

A

Lungs mature last, heart matures first

For fluoxetine-
First trimester- congenital heart defects
Last trimester- persistent pulmonary HTN

126
Q

Broad vs narrow tachycardia?

A

Generally speaking-

Broad is ventricular- treat with amiodarone

Narrow is SVT- adenosine

127
Q

Conservative care for pneumothorax?

A

Primary spontaneous PTX- review every 2-4 days as an outpatient

Secondary spontaneous PTX- monitor as inpatient

128
Q

MI secondary prevention drugs?

A

DABS

Dual antiplatelet therapy
ACEi
Beta blocker
Statin

Ticagrelor and prausgrel more widely used-

Post ACS medically managed- ticagrelor to aspirin- stop ticagrelor after 12 months

Post PCI- add prausgrel or ticagrelor to aspirin- stop second antiplatelet after 12 months

12 month period can be altered for people at high risk of bleeding or those at high risk of further ischaemic events

129
Q

Stages of labour?

A

1st stage- onset of labour to full dilation
Latent phase 0-3cm dilation
Active phase 3-7cm dilation
Transition 7-10cm dilation

2nd stage- from full dilation to delivery

3rd stage- from delivery to when the placenta and membranes have been completely delivered

130
Q

Post menopausal bleeding?

A

Endometrial cancer until proven otherwise

All women over 55 who present with PMB should be referred using the suspected cancer pathway

First investigation is a transvaginal ultrasound

Hysteroscopy with endometrial biopsy

Treated with surgery

131
Q

Punched out lesions?

A

Eczema herpeticum- severe primary infection of the skin by HSV 1 or 2

Most commonly seen in children with atopic eczema and presents with a rapidly progressing painful rash

Potentially life-threatening- admit for IV aciclovir

132
Q

Gastric cancer investigations?

A

Diagnosis- oesophago-gastro-dudenoscopy with biopsy
Signet ring cells may be seen in gastric cancer

Staging- CT scan of chest, abdomen and pelvis

Management-
Surgical- gastrectomy

Chemotherapy

133
Q

DMD

Kawasaki

heart problems?

A

Duchenne- dilated cardiomyopathy

Kawasaki- coronary artery spasm

134
Q

DMD?

A

Progressive muscle weakness from 5, calf pseudohypertrophy, Gower’s sign- child uses arms to stand from squatted position

Investigation- raised CK and genetic testing

Management- supportive

135
Q

Management of essential tremor?

A

Propanolol

136
Q

What are the heart sounds made by?

A

The valves closing

S1- Mitral and tricuspid closing

S2- aortic and pulmonary closing

(S3 is sometimes normal in athletes, sometimes pathological)- rapid filling of ventricles during diastole

(S4 always pathological- atrial contraction against stiff/non-compliant ventricle)

137
Q

Which drug is contraindicated in VT?

A

Verapamil- important

138
Q

Score for prediciting the severity of pancreatitis?

A

Modified Glasgow score

PANCREAS

Pa02 <8kPa
Age >55 years
Neutrophilia WBC >15x10^9
Calcium <2mmol/L
Renal function Urea >16mmol/L
Enzymes LDH >600 ; AST >200
Albumin <32g/L
Sugar Blood glucose >10mmol/L

139
Q

GET SMASHED?

A

Passmed

140
Q

Asthma new guidelines

A

Diagnosis and treatment

141
Q

Which antibiotics can cause torsades de pointes?

A

Macrolides (azithromycin)

142
Q

Sexual history and knee pain?

A

Septic arthritis from Neisseria gonorrhoeae

Gram negative diplococci

143
Q

Refractory anaphylaxis?

A

Ongoing anaphylactic reaction that persists despite being given 2 doses of IM adrenaline

144
Q

How to remember homonymous quadrantanopias?

A

PITS (Parietal-Inferior, Temporal-Superior)

145
Q

Craniopharyngioma vs pituitary tumour visual field defect?

A

Bitemporal hemianopia

lesion of optic chiasm

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

146
Q

Surgery prep if a long fasting period of more than one missed meal or whose diabetes is poorly controlled?

A

Variable rate intravenous insulin infusion- (sliding scale)

147
Q

Difference between posterior MI and NSTEMI?

A

Tall R waves

Posterior MIs cause:
reciprocal changes in V1-3
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2

148
Q

Acanthosis nigricans is associated with which type of cancer?

A

Gastrointestinal cancer

149
Q

What causes acanthosis nigricans?

A

T2DM
GI cancer
Obesity
PCOS
Acromegaly
Cushing’s disease
Hypothyroidism

150
Q

Management of tension PTX?

A

Decompression of the pleural space

Needle thoracostomy (decompression) second intercostal space mid clavicular line on affected side first as quicker in emergency

Place a chest drain in the triangle of safety

Tension PTX should be diagnosed clinically

151
Q

Head CT within 1 hour?

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

152
Q

CT head within 8 hours?

A

CT head scan within 8 hours of the head injury - for adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury:
age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

153
Q

Bloody diarrhoea, abdominal pain and fever after dodgy food?

A

Campylobacter

Crampylobacter

Usually self limiting

First line antibiotic would be clarithromycin

154
Q

Most common cause IE?

A

S.aureus- especially in IVDUs

Staph epidermis is common after surgery due to indwelling lines

155
Q

In which MI complication is ESR elevated?

A

Dressler’s syndrome

156
Q

RIPE ONGO?

A

RIPE ONGO
Rifampicin: Orange secretions
Isoniazid: Neuropathy- prevent with pyridoxine (Vit B6)
Pyrazinamide: Gout
Ethambutol: Optic Neuritis

157
Q

Gonorrhoea management?

A

Gram negative diplococcus

1st- Ceftriaxone
If sensitive to ciprofloxacin- give that instead

If refuse needle- cefixime oral and azithromycin oral

158
Q

What causes Lyme disease?

A

Borrelia burgdorferi

Early features-
Erythema migrans- bullseye rash- develops on 1-4 weeks
Systemic- headache, lethargy, fever, arthralgia

Later features-
Cardio- heart block, myocarditis
Neuro- meningitis, facial nerve palsy

159
Q

Lyme disease investigation?

A

If erythema migrans is present- start antibiotics

Enzyme-linked immunosorbent assay (ELISA) antibodies to Borrelia burgdorferi is first line

If negative but still suspected or positive and immunoblot test should be done

It is a spirochaete (like syphilis)

160
Q

Management of lyme disease?

A

Doxycycline

Ceftriaxone if disseminated disease

Jarisch-Herxheimer may be seen (also seen in syphilis)- fever, rash, tachycardia after first dose of antibiotic

161
Q

Only two BBs with evidence in heart failure?

A

Bisoprolol, carvedilol, nebivolol

162
Q

Rare but important side effect of DPP4-inhibitors such as sitagliptin?

A

Pancreatitis

163
Q

What should patients with MI secondary to cocaine be given?

A

Benzodiazepine first line

If chest pain- benzo + glyceryl trinitrate

BB poor evidence but arguements for/against

164
Q

Adverse effects of cocaine?

A

Cardiovascular- coronary artery spasm, hypertension

Neurological- seizures

165
Q

Impetigo return to school?

A

48 hours after treatment

166
Q

Impetigo treatment?

A

Hydrogen peroxide 1% cream if systemically well

Topical fusidic acid

Extensive disease- oral flucloxacillin

167
Q

Legionella treatment?

A

Macrolides such as clarithromycin

168
Q

Diagnostic investigation for Legionella?

A

Urinary antigen

169
Q

Legionella symptoms?

A

Flu-like symptoms including fever
Dry cough
Relative bradycardia
Confusion

Mid-lower zone patchy consolidation

169
Q

Epilepsy treatment?

A

Generalised- M- Sod Val F- Lam/leve

Focal- Both- Lam/leve 2nd- Carbamazepine

Absence-Both- Ethosuximide 2nd- F- Lam/leve M- Sod Val

Atonic- F- Lam M- Sod Val

Myclonic- F- Leve M- Sod Val

169
Q

In acute mitral regurgitation (rupture of the papillary muscle) what else can occur?

A

Acute hypotension and pulmonary oedema

169
Q

Status epilepticus definition?

A

Single seizure lasting >5 mins or

> =2 seizures within a 5-minute period without the person returning to normal between them

169
Q

Which drug reduces the risk of calcium oxalate stones recurring?

A

Bendroflumethiazide

169
Q

Status epilepticus treatment pathway?

A

ABC- airway adjunct, oxygen, check blood glucose

First-line- benzodiazepines
Pre-hospital- PR diazepam or buccal midazolam
In hospital- IV lorazepam, repeated once after 5-10 mins

If ongoing status epilepticus appropriate to start a second-line agent such as levetiracetam, phenytoin or sodium valproate

If no response within 45 minutes- refractory status- best way to achieve rapid control of seizure activity is induction of general anaesthesia or phenobarbital

170
Q

COCP cancer risks?

A

Increased risk of breast and cervical

Protective against ovarian and endometrial

171
Q

What can cause ascites?

A

History of alcohol excess, cardiac failure can

172
Q

Women with breast cancer and no palpable lymphadenopathy, if pre-operative axillary ultrasound negative, management?

A

Sentinel node biopsy to assess nodal burden

173
Q

Which infection can cause lactose intolerance and foul smelling floating stool?

A

Giardia lamblia- giardiasis

RFs- foreign travel

Features:
often asymptomatic
non-bloody diarrhoea with steatorrhoea
Bloating, abdo pain
Lethargy
Malabsorption and lactose intolerance

Stool microscopy for trophozoite and cysts

Treatment is with metronidazole

174
Q

Can myocarditis have ST elevation?

A

Yes, myocarditis can have ST elevation and it can be in a specific area of the heart- in contrast to pericarditis where the ST elevation is usually more widespread (affects the pericardial sack which is around the whole heart)

Myocarditis can also caused raised troponin/cardiac enzymes

Suspect it as more likely than MI in younger patients

Preceding flulike illness is characteristic and most common cause is viral

175
Q

Myocarditis?

A

Inflammation of the myocardium- paticularly consider it in younger patients with chest pain

Causes- viral- cocksakie
(bacterial, spirochaetes (lyme disease)

Presentation- young patient with chest pain, SOB, arrythmias

Raised inflammatory markers, raised cardiac enzymes, ST elevation on ECG

Tx cause- supportive or antibiotics if bacterial

176
Q

Rough/sandpaper/course rash?

A

Scarlet fever

Caused by streptococcus pyogenes

ORal penicllin V for 10 days

177
Q

MDMA (ecstasy) poisoning?

A

Hyponatremia

Neuro- agitation, anxiety, confusion, ataxia
Cardio- tachycardia, hypertension
Hyperthermia
Rhabdomyolysis

Supportive
Dantrolene for hyperthermia if simple measures fail

178
Q

PSC positive finding?

A

p-ANCA (also found in UC and autoimmune hepatitis)

Some others
Anti-dsDNA- SLE
Anti-CCP- RA

179
Q

What do all cases of pneumonia get?

A

Repeat chest x-ray at 6 weeks after clinical resolution- ensure consolidation resolved and no underlying pathologies (such as a lung tumour)

180
Q

Breast cancer screening age?

A

50-70 years (mammogram every 3 years)

181
Q

What should be co prescribed when starting allopurinol for gout prevention?

A

Colchicine

182
Q

Aplastic crisis in sickle cell?

A

Pancytopenia- severe drop in haemoglobin

Decreased reticulocyte count

183
Q

Haemolytic crisis in sickle cell?

A

Rare- severe anaemia and jaundice

184
Q

Acute chest syndrome in sickle cell?

A

Chest pain, cough, wheeze, SOB, tachypnoea

Pulmonary infiltrates

Vaso-occlusive crisis of the lungs

185
Q

Sequestration crisis?

A

This would present with abdominal pain, signs of haemodynamic compromise and hepatomegaly/splenomegaly. Pooling of blood in the spleen occurs, leading to severe anaemia and haemodynamic collapse

Increased reticulocyte count

186
Q

Vaso-occlusive crisis?

A

These could affect different organs, but would typically present with the development of acute pain due to microvascular occlusion. Other presentations include dactylitis, cerebral infarction, mesenteric ischaemia, avascular necrosis of the femoral head or priapism

187
Q

Is doxycycline contraindicated in pregnancy?

A

Yes

188
Q

What is considered early menarche?

A

Before age 12

189
Q

Does HRT increase cancer risk?

A

If progestogen is added- it increases the risk of breast cancer

Increased risk of endometrial cancer if oestrogen given without progestogen- adding progestogen lowers the risk but not completely

Increased risk of VTE

Transdermal HRT does not increase the risk of VTE

Increased risk of stroke

Increased risk of ischaemic heart disease

190
Q

Polycythemia vera associated with which mutation?

A

JAK2

191
Q

Anticoaglation to prevent stroke in AF?

A

DOACs

Warfarin 2nd line

192
Q

Actinic keratoses management?

A

Avoid sun

Fluorouracil cream

Topical diclofenac

193
Q

Autoimmune haemolytic anaemia?

A

Anaemia
Reticulocytosis
Raised LDH
Low haptoglobin
Blood film- spherocytes and reticulocytes

Specific to autoimmune haemolytic anaemia- positive direct antiglobulin test (Coomb’s test)

Most common type of AIHA- warm AIHA- idiopathic, SLE, neoplasia

Management
Treat underlying disorder
Steroids (+/- rituximab) used 1st line

In cold AIHA usually IgM

194
Q

PULSELESS ELECTRICAL ACTIVITY?

A

NOT A SHOCKABLE RHYTHM

195
Q

Investigations for pericarditis?

A

ECG- Saddle shaped ST elevation, PR depression- most specific ECG marker for pericarditis

All patients with suspected acute pericarditis should have TRANSTHORACIC ECHOCARDIOGRAPHY

Elevated inflammatory markets and possibly troponin

196
Q

Treatment of pericarditis?

A

Combination of NSAIDs and colchicine

197
Q

Sites for venous and arterial ulcer?

A

Venous- above medial malleolus- painless
Compression bandaging

Arterial- occurs on the toes and heel
Punched out appearance
Painful

198
Q

Difference between somatisation disorder and illness anxiety disorder (hypochondriasis)?

A

Somatisation- worrying about symptoms present for at least 2 year

Illness anxiety disorder- persistent belief in the presence of an underlying serious disease

199
Q

SSRI and NSAID?

A

GI bleeding risk give a PPI

200
Q
A

Phase 4 Question Knowledge (31 decks)

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