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year 3 revision > things i have learnt > Flashcards

things i have learnt Flashcards

1
Q

what are some signs of pernicious anaemia causing low B12 and what tests would you do for it?

A

carbot rings, Glossitis - inflammation of the tongue
Vitamin B12 Assays= low
Intrinsic Factor Antibodies
Parietal cell Antibodies
Bone Marrow Aspiration and Biopsy: May show megaloblastic changes in erythropoiesis.

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2
Q

ecg changes in hypokalemia (potassium of under 3.5, severe under 2.5)

A

PR prolongation, widespread ST depression / T wave flattening and prominent U waves.

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3
Q

management of hypokalemia

A

If potassium is >3mmol/L, the patient is asymptomatic, and there are no ECG changes, oral potassium replacement can be given

If potassium is <3mmol/L or ECG changes are present, intravenous potassium replacement is indicated. Consider cardiac monitoring, especially if ECG changes are present.

recheck the potassium level after 4-6 hours of iv replacement

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4
Q

drugs that cause hyperkalemia

A

spirolactone, ace inhibitor, arb

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5
Q

hyperkalemia (potassium over 5.5, severe over 6.5) ecg changes

A

peaked T waves, prolonged PR interval and widened QRS complexes, eventually sine wave pattern

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6
Q

management in severe hyperkalaemia (over 6.5)

A

Stabilise the myocardium with IV calcium chloride or calcium gluconate
Shift potassium intracellularly: insulin/dextrose infusion
then identify and treat underlying cause eg rhabdomyalisis

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7
Q

what are Nabothian cysts?

A

Nabothian cysts are on the cervix when the squamous-cell epithelium of the cervix slightly covers the columnar epithelium
The cysts contains yellow/amber mucous and located around epitheliums transition at the os. They are a normal finding, particularly in women who have had children

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8
Q

what is asherman’s syndrome?

A

intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction to the menstrual outflow

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9
Q

what is the management for Waldenstrom’s macroglobulinaemia which is a type of non hodgkins lymphoma

A

Plasmapheresis to get rid of viscous IgM

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10
Q

what electrolyte imbalance do you get in a panic attack

A

hypocalcaemia

Alkalosis promotes calcium binding to albumin, reducing the levels of free calcium and thus causing hypocalcaemia

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11
Q

what dermatology defect has small, painless, pearly lesions with an area of central umbilication

A

Molluscum contagiosum

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12
Q

how does methylphenidate work? (1st line ADHD medicine)

A

dopamine/ norepinephrine reuptake inhibitor

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13
Q

list the names of some epithelial ovarian tumours

A
  • Serous *#- lines tubes
  • Mucinous*- epithelial cells with mucin
  • Endometrioid*
  • Clear cell *
  • Brenner*- transitional, lines bladder
  • Undifferentiated carcinoma rare
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14
Q

list some ovarian germ cell tumours

A

teratoma (dermoid cyst, full of teeth and hair etc)
dysgerminoma
yolk sac

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15
Q

list some sex chord/ stromal cell ovarian tumors

A

fibroma
Sertoli-Leydig cell tumours, can produce androgens
Granulosa-theca cell tumour

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16
Q

what is a complication of a molar pregnancy

A

complete moles can go on to become choriocarcinoma (follow up involves checking HCG and not getting pregnant for a year after)

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17
Q

if someone is on drugs (such as alcohol, benzo…) that are liver enzyme inducers what emergency contraception can they have?

A

give copper coil and levogestrel

dont give u……

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18
Q

when do you use amniocentesis vs CVS?

A

from 11.5 weeks can use CVS and after 15 weeks can use amniocentesis (and unlike CVS can pick up neural tube defects)

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19
Q

what score decides if you should induce labour or not?

A

bishop score
looks at cervix consistency, position, dilation and baby station

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20
Q

what structures allow the transmission of oxygen and nutrients between maternal and fetal blood.

A

chorionic villi

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21
Q

what antiemetics should be used in pregnancy

A

Cyclizine first line

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22
Q

what UTI treatment should be given in pregnancy

A

1st and 2nd trimester= nitrofuratoin
3rd trimester= trimethoprim

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23
Q

what is the CUBS test?

A

‘Combined ultrasound and biochemical screening’ - to look for trisomies or other defects

Done at 11 - 13 weeks

Combines nuchal translucency + serum test (hCG + PAPP-A)

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24
Q

what do sertoli cells and leydig cells do?

A

The Sertoli cells are normally located in the male reproductive glands (the testes). They feed sperm cells. The Leydig cells, also located in the testes, release a male sex hormone

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25
Q

what organism often infect bartholian glands

A

ecoli

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26
Q

results from screening for down syndrome

A

results expected for trisomy 21 include low AFP, low oestriol, low PAPP-A, high human chorionic gonadotrophin beta-subunit (b-HCG), and thickened nuchal translucency

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27
Q

preferred test for Chlamydia in an asymptomatic female is

A

high vag swab NAAT

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28
Q

antibiotics for chlamydia

A

Doxycycline 100mg bd (7 days). If contra-indication: azithromycin 1g od day 1 then 500mg od for 2 days

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29
Q

when is the nuchal translucency screen for down syndrome done?

A

11-14 weeks

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30
Q

what do you give for vWF deficiency

A

desmopressin, stimulates endothelial cells to make it and release stores

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31
Q

what is used to reverse the effect of heparin

A

Protamine sulfate

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32
Q

how to remember where things are absorbed

A

Iron (I) = Duodenum (DO)
Folate (FUCK)= Jejunum (JOIN)
B12 (BEARS) = Ileum (IN)

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33
Q

what do you give in long qt

A

beta blockers

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34
Q

what drugs should be avoided in long qt

A

amiodarone
class 1 antiarrythmic drugs
tricyclides, SSRI particularly citalopram
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron

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35
Q

what triggers long qt

A

hypokalemia
drugs that prolong qt usually due to blockage of potassium channels
exercise
loud noise/ emotional stress

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36
Q

what is brugada syndrome ecg apperance? (AD, males more effected)

A

ecg appearance shows ST elevation and RBBB in V1-V3 (can be intermittent)

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37
Q

wolf parkinson white ecg changes? (basically like af electric loop but in af it stays in the atrium but this spreads to the ventricles)

A

short PR interval, delta wave, AF, ventricular preexcitation.

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38
Q

heridatery spherocytosis=
G6DP=
haemphillias=
fanconi =
sickle cell=
huntingtons=
fredricks ataxia=
duchens muscular dystophy=
brac=
myotonic dystrophy=

A

heridatery spherocytosis= dominant
G6DP= x linked recessive
haemphillias= X-linked recessive
fanconi anemia= autosomal recessive
sickle cell= autosomal recessive
huntingtons= autosomal dominant
fredricks ataxia= autosomal recessive
duchens muscular dystophy= x linked recessive
von williebrand’s disease= autosomal dominant
brac= dominant
myotonic dystrophy= autosomal dominance

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39
Q

the abdominal aorta begins and ends at

A

T4/5

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40
Q

what are the accessory muscles of respiration?

A

the scalene, the sternocleidomastoid, the pectoralis major

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41
Q

names some gram positive rods

A

Bacillus, Clostridium, Corynebacterium, Listeria, and Gardnerella

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42
Q

most common cause of necrotizing fascitis

A

group a strep

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43
Q

what to give in necrotizing fascitis

A

give it all you got
fluclox for gram pos, clindamycin for antitoxin effect, gent for neg

44
Q

how to diagnose c diff

A

stool toxin test

45
Q

a patient with HIV presents confused, they have multiple ring-enhancing lesions in the basal ganglia

what is diagnosis and treatment?

A

cerebral toxoplasmosis

pyrimethamine and sulphadiazine

46
Q

what is another name for a plasma cell?

A

Post-germinal B cell

47
Q

is splenomegaly more common in CML or CLL or ALL

A

CML

48
Q

what is conversion disorder?

A

A psychiatric condition that results in a presentation of neurological symptoms without any underlying neurological cause (e.g. paralysis, pseudoseizures, sensory changes). It is not an intentional process, and the symptoms real to the patient. It is linked to emotional stress.

49
Q

what is a deterent medication in alcohol dependence that causes n and v with alcohol

A

Disulfiram (Antabuse)

50
Q

trisomy screened for?
how?
when?

A
  • Down’s syndrome T21
  • Edward’s Syndrome T18 (heart and lung)
  • Patau’s Syndrome T13 (cleft lip)

11-13+6 weeks
nuchal translucency thickness combined with PAPPA and HCG
(less than 3.5 is normal)

51
Q

in neutropenic sepsis what are the antibiotics given?

A

news less than 7 give piperacillin/ tazobactam within an hour ( if pen allergic teicoplanin and aztreonam)

if news = to or more than 7 then give piperacillin/ tazobactam and gent

52
Q

in autoimmune haemolysis what is the difference between warm and cold autoantibodies

A

warm= IgG
cold= IgM

53
Q

management for lambert-eaton myasthenic syndrone?

A

3,4-diaminopyridine

54
Q

what characterises schizoid personality disorder vs schizotypal personality disorder?

A

schizotypal- eccentric, magical thinking, lack of close relations, paranoid

schizoid- volunteer social isolation, not eccentric

55
Q

what is the first line medication for medical assisted detoxification?

A

Chlordiazepoxide

56
Q

what antibiotic should be given in preterm ROM

A

oral erythromycin for 10 dys

57
Q

what nerve supplies serratus anterior which causes scapula winging?

A

the long thoracic nerve

58
Q

what is the difference in presentation between an anterior inferior cerebellar artery infarct and a PICA

A

PICA= ipsilateral facial pain and temp loss, contralateral limb/ torso pain and temp loss, ataxia and nystagmus
AICA= as above + facial paralysis and deafness

59
Q

what is webers syndrome?

A

branch of PCA infact that causes ipsilateral CNIII palsy and contralateral weakness of upper and lower extremitys

60
Q

what are some scoring systems for depression?

A
  • inventory of depressive symptomatology- self report 30 (IDS-30-SR)- good for getting patients to tick box of things they might not want to say outloud
  • quick inventory of depressive symtomatology self report 16- shorter, can be done more often
  • hospital anxiety and depression scale
  • Montgomert-Asberg Rating Scale (madrs)- for a patient that is too unwell to complete other scores, a close observer to patient does this
61
Q

what do you give in wilsons disease?

A

D-penicillamine= acts as a copper chelator, binding copper, and thus allowing it to be eliminated in the urine

62
Q

what drug would you give that lower the EPSE of antipsychotics?

A

procyclidine which is anti-cholnergic so balances these things

63
Q

what prophylactic treatment do you give in Polycythemia Vera?

A

aspirin

64
Q

what antibiotic do you give in PROM?

A

Erythromycin

65
Q

over what blood sugars is gestational diabetes?

A

Fasting- 5.3 mmol/l
1 hour after meals- 7.8 mmol/l, or:
2 hour after meals- 6.4 mmol/l
over 7 treat with insulin straight away
under then 2 weeks of lifestyle then add metformin

66
Q

what drugs do you give for group b strep

A

benzylpenicillin as intrapartum antibiotic prophylaxis
(give if fever, preterm, gbs with previous baby)

67
Q

features of Intrahepatic cholestasis of pregnancy?
management?

A

intense itch, jaundice, raised bilirubin

induction of labour at 37-38 weeks
medical is ursodeoxycholic acid
vit k supplements

68
Q

PPH medical management?

A

IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH

69
Q

PPH surgical management

A

intrauterine balloon first line
others include B-lynch suture, ligation of uterine arteries or internal iliac
last resort is hysterectomy

70
Q

acute fatty liver in preg vs intrahepatic cholestasis of pregnancy

A

acute fatty liver= Abdopain and vom
intrahepatic cholestasis= Itch

71
Q

what do you give in suspected endometritis?

A

intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)

72
Q

what prophyactic treatment for VTE is given in pregnancy?

A

Low molecular weight heparin

73
Q

alzheimers pathophysiology?

A

accumulation of beta amyloid plaques particularly found in hippocampus, parietal and temporal lobes, (the breakdown process is disrupted because the beta one acts first)= extracellular and hyperphosphorylated tau protien= intracellular

74
Q

vascular dementia pathophysiology

A

lots of little infacts, stepwise progression

same risk factors as a normal ischemic stroke

75
Q

lewy body dementia pathophysiology?

A

lewy bodies, little circles found in the cytoplasm of neurones (formed from synulein and ubiquitin)

also include symptoms of parkinsons, visual hallucinations and fluctuating cognition

76
Q

Frontal temporal dementia pathopysiology

A

abnormal amounts of protiens TDP43 (DNA binding protien) and TAU protien form
pick bodys are the name for TAU fibrils in cytoplasm

77
Q

some genetics to get early onset alzeimers

A

amyloid precursor protien on CH21
presenlin 1
presenilin 2

later onset
apolipoprotein E

78
Q

cardiovascular changes in preganacy?

A

30-50% increase in cardiac output
40-50% increase in plasma volume but only 20-30% increase in RBC so anemia
HR increases
initial decrease in BP due to progesterone, 20% less SVR

79
Q

what are the respiratory changes seen in pregnancy

A

40% increase in tidal volume
decrease in functional residual capacity
mild respiratory alkalosis with metabolic compensation

80
Q

renal changes in a pregnant patient

A

increased GFR due to dilation of AA, hence increased urine production

increase in bacteria infection

81
Q

what is used to stain the cervix during colposcopy

A

acetic acid is applied first and is taken up by abnormal cells and appears bright white
iodine solution is then applied which is taken up by healthy cells making abnormal cells white more clear

82
Q

learn antibiotic moa

A
83
Q

what drugs trigger haemolysis in G6PD deficiency

A

sulph drugs- sulphonamides, sulphasalazine and sulfonylureas

also antimalarials
ciprofloxasin
nitroferitoin

84
Q

what is used to reverse rivaroxaban and apixaban?

A

andexanet alfa (recombinant factor Xa protien)

85
Q

where is the CAG repeat in huntingtones

A

on chromosome 4p
leads to neuronal death in the putamen and caudate nucleus

86
Q

what eye palsy based on what cranial nerve issues?

A

CN3= posterior com artery/ SAH
CN4= trauma/ congenital, in brain for longest
CN6= raised ICP

87
Q

where would a bleed in the bridging viens cause blood to pool

A

between dura and arachnoid

88
Q

where is the primary auditory cortex?

A

superior temporal gyrus

89
Q

what drugs to you give acutely in an acute dystonic reaction?

A

procyclidine (can try benzatropine0

90
Q

breast cancer chemo drugs?

A

HER2+ patients= trastuzumab
premenopausal= tamozifen
post menopausal= anastrozole

91
Q

how to calculate TNM staging for breast cancer?

A

T1= 0-2 cm T2= 2-5 T3= more than 5cm T4= chest wall/ broke through skin

N0= no nodes
N1= less than 4
N2= 4-9
N3= spread to supra or infraclavicular lymphnodes

m0= none
m1= mets

92
Q

when should you not give anti-cholinesterase inhibitors eg in dementia

A

long QT as it prolongs it further

93
Q

when do you use tyrosine kinase inhibitors?

A

CML

94
Q

what shows basophillic stipping of red blood cells?

A

sideroblastic anemia

95
Q

why should topiramate be avoided in women of child bearing age to prevent migranes

A

teratenogenic, reduce effectivness of hormonal contraceptives

96
Q

management of ITP? LOOK AT DIC AND TTP TOO

A

Emergency treatment:
life-threatening or organ threatening bleeding= Platelet transfusion, IV methylprednisolone and intravenous immunoglobulin
Platelet count >30109/L= Observation
Platelet count <30109/L= Oral prednisolone

97
Q

mesolimbic vs mesocortical; which is responsible for positive and negative symptoms of schizophrenia?

A

mesolimbic= overactivity causes positive symptoms
mesocortical= underactivity causes negative symptoms

98
Q

give some examples of MAO-B inhibitors used in parkinsons (often alongside levodopa later in disease)

A

Selegiline, Rasagiline

99
Q

what is the most likely antipsychotic to cause neuroleptic malignant syndrome (high temp, increased tone and autonomic instability)?

A

haloperidol

100
Q

most likely antipsychotic to cause metabolic syndrome?

A

olanzapine

101
Q

what drugs do you give for focal seizures?

A

lamotrigine or carbamazepine

102
Q

1st and second line disease modifying drugs in MS?

A

1st= tecfedaira, interferon beta
2nd= MAB or fingolimod

103
Q

alternative tayside formulary for overactive bladder

A

tolteridone (antimuscrinic)

104
Q

liscenced drug in huntingtons?

A

tetrabenazine

105
Q
A

year 3 revision (4 decks)

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