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(91 cards)
1
Q
hypertension management under 55 or T2DM
A
- ACEI or ARB
- add Ca or both ^
- ACEI/ARB + Ca + thiazide
- if K <4.5 = aldosterone antagonist (spironolactone)
if K >4.5 add alpha/beta blocker
2
Q
treatment of uraemic pericarditis secondary to AKI
A
haemodialysis
3
Q
viral pericarditis most commonly caused by
A
coxsackie virus
4
Q
clinical presentation of acute pericarditis
A
chest pain worse lying (relieved leaning) pyrexia dry cough, SOB pericardial rub tachycardia, tachypnoea
5
Q
management of acute pericarditis
A
NSAID and colchicine (if viral, idiopathic)
6
Q
1st degree heart block
A
prolonged PR >200ms
7
Q
2nd degree heart block type 1
A
mobitz/wenckeback
progressive prolongation of PR until a QRS drops
8
Q
cause of 2nd degree heart block type 1
A
AV nodal blocking drugs (ca channels, beta blockers, digoxin)
9
Q
risk factors for infective endocarditis
A
previous IE prosthetic valves IVDU CHD rheumatic heart disease tattoos/piercing
10
Q
which valve usually affected in IVDU infective endocarditis?
A
tricuspid
11
Q
urinary hydroxyproline suggests
A
Paget’s disease of the bone
12
Q
3 causes of HF with reduced ejection fraction
A
IHD
HTN
DCM
13
Q
three causes of HF with preserved ejection fraction
A
HTN, HCM, valvular
14
Q
high output HF causes
A
anaemia AV malformations thiamine deficiency thyrotoxicosis Paget's disease of bone pregnancy
15
Q
diastolic murmur heard at 2nd intercostal space, right sternal edge
A
aortic regurgitation
16
Q
key diagnostic investigation for aortic dissection
A
CT angiography (before sugery IF stable patient)
TOE (if haemodynamically unstable)
17
Q
causes of aortic dissecition
A
hypertension trauma Marfan's pregnancy syphilis
18
Q
murmur commonly heard in aortic dissection
A
aortic regurgitation
19
Q
management of aortic dissection
A
Stanford A - emergency: IV beta blockers (labetolol) and surgery
Stanford B - conservative management
20
Q
murmurs heard with VSD
A
pansystolic murmurs cannot be extenuated by changes in breathing or manoeuvres
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
22
Q
pansystolic murmur louder on expiration and radiates to axilla
A
mitral regurgitation
23
Q
first line COPD
A
SABA/SAMA
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
25
COPD symptoms in young person non smoker?
alpha anti-trypsin deficiency
26
three complications of COPD
secondary polycythaemia (dec O2 -> inc demand for RBC)
pulmonary hypertension (backing up pressure in systemic. -> cor pulmonale)
peripheral oedema
27
pharmacological management of PE
apixaban/riveroxaban/dabigatran
unprovoked = 6 m
provoked = 3m
cancer = 3-6m
28
what does squamous cell cancer produce (lung)
PTHrp --> acts like hypercalcaemia.
29
what imaging feature separates MS from other neurological conditions
disseminated in space and time
| presence of oligoclonal bands in CSF
30
Guillain-Barre syndrome commonly caused by what organism
campylobacter jejuni
| - antibodies produced by bacteria are similar to antigens on Schwann cells on peripheral nerves
31
clinical features of Guillain barre syndrome
```
progressive symmetrical ascending weakness
reflexes reduced or absent
flaccid paralysis
leg and back pain
after eating bad meal
```
32
investigations for Guillain Barre syndrome
LP (inc protein with normal WBC)
Nerve conduction studies = slow
FVC - weakening of muscles
33
treatment options for Guillain Barre syndrome
IV Imunoglobulins
Plasma exchange (take bad ones out)
ITU ventilation
34
clinical features of myasthenia gravis
- extraoculr muscle weakness (diplopia)
- proximal muscle weakness: face, neck, limb girdle
- ptosis
- dysphagia
35
Investigations for myasthenia gravis
CT thorax to exclude thymoma
Single fibre electromyography!!
CK must be normal
36
Management for myasthenia gravis
| - long term
- long acting acetylcholinesterase inhibitors (pyridostigmine)
- immunosuppression (prednisolone)
- thymectomy
37
treating emergency myasthenia gravis
plasmapheresis
| IV Ig
38
investigation for stroke
CT head
39
treatment for stroke
thrombolysis within 4.5hrs
thrombectomy within 6
aspirin straight away (300mg)
clopidogrel lifelong after 2 weeks
40
treatment for meningitis <3 months old
IV ceft + amoxicillin
41
treatment for meningitis: 3M-50 years
IV ceft
42
treatment for meningitis over 50 years old
IV ceft + amox
43
meningiococcal septicaemia treatment
benzylpenicillin + ceftriaxone
44
pneumococcal meningitis treatment
IV ceft
45
listeria meningitis treatment
amoxicillin + gentamycin
46
HiB meningitis treatment
IV ceft
47
pneumococcal septicaemia immediate treatment
IV dexamthasone (+ IV ceft)
48
complications of meningitis
hearing loss
49
risk factors for chronic subdural haemorrhage
```
older
chronic alcoholic
epilepsy
coagulopathy
diabetes
confusion
```
50
management of brain haemorrhages
burr holes (unilateral/bilateral)
evacuation of collection
check ICP-mass effect
decompression
51
investigations for a brain haemorrhage
CT head straight away
| LP 12 hours later if SAH
52
definitive management for a bleeding peptic ulcer
endoscopic clipping (+/- adrenaline)
53
what are variceal bleeds typically caused by
portal hypertension secondary to chronic liver disease/cirrhosis
54
key risk factors for non-variceal bleeds
usually peptic ulcers. H-pylori and NSAIDa
55
initial management for variceal bleed
give teripressin and broad spectrum antibiotics
| then do an upper gi endoscopy
56
treatment for oesophageal varices
band ligation
57
secondary prevention for variceal bleed
propanolol
58
bradycardia caused by beta blocker/ca channel blocker managed with what
glucagon IV
59
first line management of anaphylaxis
IM adrenaline
| then can give IV chlorphenamine and hydrocortisone to reduce risk of biphasic reaction
60
why is ECG important for amitriptyline overdose
can cause arrythmias
61
symptoms of amitryptiline overdose
anticholingeric toxidrome
| - mydriasis, tachycardia, blurred vision, urinary retention, drowsiness, arrythmias
62
```
organophosphate overdose (insecticides)
symptoms
```
cholinergic toxidrome
| - symptoms: salivation, lacrimation, urination, diarrhoea, constricted pupils, bradycardia
63
organophosphate overdose management
atropine
64
benzodiazepine overdose management
flumenazil
65
symptoms of digoxin overdose
anticholinergic effects
blurred vision
K abnormalities
66
managing ethylene glycol overdose (antifreeze)
ethanol/fomepizole
67
first diagnostic investigation of ectopic pregnancy
TVUSS
68
ruptured ectoptic pregnancy management
laparoscopic salpingectomy
or salpingotomy if contralateral tube damage
69
immunosuppressed patient with a new fever is what
neutropenic sepsis until proven otherwise
DO SEPSIS SIX
70
what is most common cause of neutropenic sepsis in patients with foreign device
staphylococcus epidermis
71
anterior vs posterior nosebleeds
anterior: unilateral, young patient trauma
posterior: bilateral, older due to atherosclerosis. risk of aspiration and airway compromise.
72
anterior nosebleed with visible bleeding point management
```
cauterisation.
if unsuccessful (or point not visible) - anterior nasal packing.
```
73
lifestyle measures post epistaxis
```
don't blow nose
don't pick nose
avoid hot drinks
avoid strenous activity
don't lie flat for 24 hours
```
74
stable SVT initial management
vagal maneouvres (carotid sinus massage, valsalva)
then IV adenosine (or verapamil if CI)
75
contraindication of adenosine
asthma
76
regular SVT/tachycardia with adverse feature (HF, chest pain, syncope, shock) management
synchronised DC cardioversion
77
tachycardia with torsades de pointes management
magnesium sulphate
78
tachycardia with ventricular tachycardia management
amiodarone
79
triad in diabetic ketoacidosis
symptoms
hyperglycaemia, ketonaemia, metabolic acidosis
abdo pain, vomiting, lethargy, dehydration, kussmaul breathing
80
why does kussmaul breathing happen in DKA
deep, laboured to try compensate for the acidosis
81
three parts of DKA management
Fluids (1L 0.9% NaCl over 1 hour) if BP >90. over 15 mins if below.
Insulin (short acting)
Potassium in the fluids
82
hypoglycaemia in patients with significant alcohol history treated with what
IV thiamine
83
hypoglycaemia unconcious with IV access treatment
10% dextrose IV
84
risk factors for acute angle closure glaucoma
female
east asian
long sighted (hypermetropia)
being on meds: pupil dilaters, antimuscarinics, adrenergics
85
when are acute angle closure glaucoma symptoms worse
at night as pupil dilates, reducing iridocorneal angle and reduce drainage of aqueous humour.
86
what medication can worsen acute angle closure glaucoma
amitripyline (has anticholinergic effects so can cause pupil dilation and reduce the angle)
87
management of Acute angle closure glaucoma
carbonic anhydrase inhibitor (acetazolamide)
topical beta blocker (timolol)
topical alpha 2 agonis
muscarinic agonst (topical pilocarpine)
88
definitive management of acute angle closure glaucoma
bilateral peripheral iridotomy
89
Post MI: acute pericarditis or Dressler's
acute: within 1 week
| Dressler's: over 1 week
90
most common cause of viral meningitis
enterovirus
91
definitive management for bleeding gastric varices
sclerotherapy
