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1
Q

hypertension management under 55 or T2DM

A
  1. ACEI or ARB
  2. add Ca or both ^
  3. ACEI/ARB + Ca + thiazide
  4. if K <4.5 = aldosterone antagonist (spironolactone)
    if K >4.5 add alpha/beta blocker
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2
Q

treatment of uraemic pericarditis secondary to AKI

A

haemodialysis

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3
Q

viral pericarditis most commonly caused by

A

coxsackie virus

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4
Q

clinical presentation of acute pericarditis

A 
chest pain worse lying (relieved leaning) 
pyrexia 
dry cough, SOB
pericardial rub 
tachycardia, tachypnoea
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5
Q

management of acute pericarditis

A

NSAID and colchicine (if viral, idiopathic)

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6
Q

1st degree heart block

A

prolonged PR >200ms

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7
Q

2nd degree heart block type 1

A

mobitz/wenckeback

progressive prolongation of PR until a QRS drops

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8
Q

cause of 2nd degree heart block type 1

A

AV nodal blocking drugs (ca channels, beta blockers, digoxin)

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9
Q

risk factors for infective endocarditis

A 
previous IE 
prosthetic valves 
IVDU 
CHD 
rheumatic heart disease 
tattoos/piercing
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10
Q

which valve usually affected in IVDU infective endocarditis?

A

tricuspid

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11
Q

urinary hydroxyproline suggests

A

Paget’s disease of the bone

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12
Q

3 causes of HF with reduced ejection fraction

A

IHD
HTN
DCM

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13
Q

three causes of HF with preserved ejection fraction

A

HTN, HCM, valvular

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14
Q

high output HF causes

A 
anaemia 
AV malformations 
thiamine deficiency 
thyrotoxicosis
Paget's disease of bone
pregnancy
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15
Q

diastolic murmur heard at 2nd intercostal space, right sternal edge

A

aortic regurgitation

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16
Q

key diagnostic investigation for aortic dissection

A

CT angiography (before sugery IF stable patient)

TOE (if haemodynamically unstable)

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17
Q

causes of aortic dissecition

A 
hypertension 
trauma 
Marfan's 
pregnancy 
syphilis
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18
Q

murmur commonly heard in aortic dissection

A

aortic regurgitation

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19
Q

management of aortic dissection

A

Stanford A - emergency: IV beta blockers (labetolol) and surgery

Stanford B - conservative management

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20
Q

murmurs heard with VSD

A

pansystolic murmurs cannot be extenuated by changes in breathing or manoeuvres

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21
Q

Post MI complications

A 
Dressler's 
arrest (VF)
Regurgitation mitral (due to ischaemia/papillary muscle rupture. pansystolic murmur LOUDER on expiration and radiates to axilla)
T
Heart failure (usually systolic)
VSD (rupture of IV septum, with acute HR, pansystolic murmur with no changes with breathing)
Acute pericarditis 
D
E
r
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22
Q

pansystolic murmur louder on expiration and radiates to axilla

A

mitral regurgitation

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23
Q

first line COPD

A

SABA/SAMA

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24
Q

alveolar transfer factor for COPD patient

A

decreased due to dysfunctional type 1 pneumocytes that form up alveoli and hence reduced exchange in COPD

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25
Q

COPD symptoms in young person non smoker?

A

alpha anti-trypsin deficiency

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26
Q

three complications of COPD

A

secondary polycythaemia (dec O2 -> inc demand for RBC)

pulmonary hypertension (backing up pressure in systemic. -> cor pulmonale)

peripheral oedema

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27
Q

pharmacological management of PE

A

apixaban/riveroxaban/dabigatran
unprovoked = 6 m
provoked = 3m
cancer = 3-6m

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28
Q

what does squamous cell cancer produce (lung)

A

PTHrp –> acts like hypercalcaemia.

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29
Q

what imaging feature separates MS from other neurological conditions

A

disseminated in space and time

presence of oligoclonal bands in CSF

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30
Q

Guillain-Barre syndrome commonly caused by what organism

A

campylobacter jejuni

- antibodies produced by bacteria are similar to antigens on Schwann cells on peripheral nerves

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31
Q

clinical features of Guillain barre syndrome

A 
progressive symmetrical ascending weakness
reflexes reduced or absent 
flaccid paralysis 
leg and back pain 
after eating bad meal
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32
Q

investigations for Guillain Barre syndrome

A

LP (inc protein with normal WBC)
Nerve conduction studies = slow
FVC - weakening of muscles

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33
Q

treatment options for Guillain Barre syndrome

A

IV Imunoglobulins
Plasma exchange (take bad ones out)
ITU ventilation

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34
Q

clinical features of myasthenia gravis

A
  • extraoculr muscle weakness (diplopia)
  • proximal muscle weakness: face, neck, limb girdle
  • ptosis
  • dysphagia
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35
Q

Investigations for myasthenia gravis

A

CT thorax to exclude thymoma
Single fibre electromyography!!
CK must be normal

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36
Q

Management for myasthenia gravis

- long term

A
  • long acting acetylcholinesterase inhibitors (pyridostigmine)
  • immunosuppression (prednisolone)
  • thymectomy
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37
Q

treating emergency myasthenia gravis

A

plasmapheresis

IV Ig

38
Q

investigation for stroke

A

CT head

39
Q

treatment for stroke

A

thrombolysis within 4.5hrs
thrombectomy within 6

aspirin straight away (300mg)
clopidogrel lifelong after 2 weeks

40
Q

treatment for meningitis <3 months old

A

IV ceft + amoxicillin

41
Q

treatment for meningitis: 3M-50 years

A

IV ceft

42
Q

treatment for meningitis over 50 years old

A

IV ceft + amox

43
Q

meningiococcal septicaemia treatment

A

benzylpenicillin + ceftriaxone

44
Q

pneumococcal meningitis treatment

A

IV ceft

45
Q

listeria meningitis treatment

A

amoxicillin + gentamycin

46
Q

HiB meningitis treatment

A

IV ceft

47
Q

pneumococcal septicaemia immediate treatment

A

IV dexamthasone (+ IV ceft)

48
Q

complications of meningitis

A

hearing loss

49
Q

risk factors for chronic subdural haemorrhage

A 
older 
chronic alcoholic 
epilepsy 
coagulopathy
diabetes 
confusion
50
Q

management of brain haemorrhages

A

burr holes (unilateral/bilateral)
evacuation of collection
check ICP-mass effect
decompression

51
Q

investigations for a brain haemorrhage

A

CT head straight away

LP 12 hours later if SAH

52
Q

definitive management for a bleeding peptic ulcer

A

endoscopic clipping (+/- adrenaline)

53
Q

what are variceal bleeds typically caused by

A

portal hypertension secondary to chronic liver disease/cirrhosis

54
Q

key risk factors for non-variceal bleeds

A

usually peptic ulcers. H-pylori and NSAIDa

55
Q

initial management for variceal bleed

A

give teripressin and broad spectrum antibiotics

then do an upper gi endoscopy

56
Q

treatment for oesophageal varices

A

band ligation

57
Q

secondary prevention for variceal bleed

A

propanolol

58
Q

bradycardia caused by beta blocker/ca channel blocker managed with what

A

glucagon IV

59
Q

first line management of anaphylaxis

A

IM adrenaline

then can give IV chlorphenamine and hydrocortisone to reduce risk of biphasic reaction

60
Q

why is ECG important for amitriptyline overdose

A

can cause arrythmias

61
Q

symptoms of amitryptiline overdose

A

anticholingeric toxidrome

- mydriasis, tachycardia, blurred vision, urinary retention, drowsiness, arrythmias

62
Q 
organophosphate overdose (insecticides)
symptoms
A

cholinergic toxidrome

- symptoms: salivation, lacrimation, urination, diarrhoea, constricted pupils, bradycardia

63
Q

organophosphate overdose management

A

atropine

64
Q

benzodiazepine overdose management

A

flumenazil

65
Q

symptoms of digoxin overdose

A

anticholinergic effects
blurred vision
K abnormalities

66
Q

managing ethylene glycol overdose (antifreeze)

A

ethanol/fomepizole

67
Q

first diagnostic investigation of ectopic pregnancy

A

TVUSS

68
Q

ruptured ectoptic pregnancy management

A

laparoscopic salpingectomy

or salpingotomy if contralateral tube damage

69
Q

immunosuppressed patient with a new fever is what

A

neutropenic sepsis until proven otherwise

DO SEPSIS SIX

70
Q

what is most common cause of neutropenic sepsis in patients with foreign device

A

staphylococcus epidermis

71
Q

anterior vs posterior nosebleeds

A

anterior: unilateral, young patient trauma
posterior: bilateral, older due to atherosclerosis. risk of aspiration and airway compromise.

72
Q

anterior nosebleed with visible bleeding point management

A 
cauterisation. 
if unsuccessful (or point not visible) - anterior nasal packing.
73
Q

lifestyle measures post epistaxis

A 
don't blow nose
don't pick nose 
avoid hot drinks 
avoid strenous activity 
don't lie flat for 24 hours
74
Q

stable SVT initial management

A

vagal maneouvres (carotid sinus massage, valsalva)

then IV adenosine (or verapamil if CI)

75
Q

contraindication of adenosine

A

asthma

76
Q

regular SVT/tachycardia with adverse feature (HF, chest pain, syncope, shock) management

A

synchronised DC cardioversion

77
Q

tachycardia with torsades de pointes management

A

magnesium sulphate

78
Q

tachycardia with ventricular tachycardia management

A

amiodarone

79
Q

triad in diabetic ketoacidosis

symptoms

A

hyperglycaemia, ketonaemia, metabolic acidosis

abdo pain, vomiting, lethargy, dehydration, kussmaul breathing

80
Q

why does kussmaul breathing happen in DKA

A

deep, laboured to try compensate for the acidosis

81
Q

three parts of DKA management

A

Fluids (1L 0.9% NaCl over 1 hour) if BP >90. over 15 mins if below.

Insulin (short acting)

Potassium in the fluids

82
Q

hypoglycaemia in patients with significant alcohol history treated with what

A

IV thiamine

83
Q

hypoglycaemia unconcious with IV access treatment

A

10% dextrose IV

84
Q

risk factors for acute angle closure glaucoma

A

female
east asian
long sighted (hypermetropia)
being on meds: pupil dilaters, antimuscarinics, adrenergics

85
Q

when are acute angle closure glaucoma symptoms worse

A

at night as pupil dilates, reducing iridocorneal angle and reduce drainage of aqueous humour.

86
Q

what medication can worsen acute angle closure glaucoma

A

amitripyline (has anticholinergic effects so can cause pupil dilation and reduce the angle)

87
Q

management of Acute angle closure glaucoma

A

carbonic anhydrase inhibitor (acetazolamide)
topical beta blocker (timolol)
topical alpha 2 agonis
muscarinic agonst (topical pilocarpine)

88
Q

definitive management of acute angle closure glaucoma

A

bilateral peripheral iridotomy

89
Q

Post MI: acute pericarditis or Dressler’s

A

acute: within 1 week

Dressler’s: over 1 week

90
Q

most common cause of viral meningitis

A

enterovirus

91
Q

definitive management for bleeding gastric varices

A

sclerotherapy

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