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year 3 revision > things i have learnt > Flashcards

things i have learnt Flashcards

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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
what organism often infect bartholian glands
ecoli
26
results from screening for down syndrome
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
27
preferred test for Chlamydia in an asymptomatic female is
high vag swab NAAT
28
antibiotics for chlamydia
Doxycycline 100mg bd (7 days). If contra-indication: azithromycin 1g od day 1 then 500mg od for 2 days
29
when is the nuchal translucency screen for down syndrome done?
11-14 weeks
30
what do you give for vWF deficiency
desmopressin, stimulates endothelial cells to make it and release stores
31
what is used to reverse the effect of heparin
Protamine sulfate
32
how to remember where things are absorbed
Iron (I) = Duodenum (DO) Folate (FUCK)= Jejunum (JOIN) B12 (BEARS) = Ileum (IN)
33
what do you give in long qt
beta blockers
34
what drugs should be avoided in long qt
amiodarone class 1 antiarrythmic drugs tricyclides, SSRI particularly citalopram methadone chloroquine terfenadine** erythromycin haloperidol ondanestron
35
what triggers long qt
hypokalemia drugs that prolong qt usually due to blockage of potassium channels exercise loud noise/ emotional stress
36
what is brugada syndrome ecg apperance? (AD, males more effected)
ecg appearance shows ST elevation and RBBB in V1-V3 (can be intermittent)
37
wolf parkinson white ecg changes? (basically like af electric loop but in af it stays in the atrium but this spreads to the ventricles)
short PR interval, delta wave, AF, ventricular preexcitation.
38
heridatery spherocytosis= G6DP= haemphillias= fanconi = sickle cell= huntingtons= fredricks ataxia= duchens muscular dystophy= brac= myotonic dystrophy=
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
39
the abdominal aorta begins and ends at
T4/5
40
what are the accessory muscles of respiration?
the scalene, the sternocleidomastoid, the pectoralis major
41
names some gram positive rods
Bacillus, Clostridium, Corynebacterium, Listeria, and Gardnerella
42
most common cause of necrotizing fascitis
group a strep
43
what to give in necrotizing fascitis
give it all you got fluclox for gram pos, clindamycin for antitoxin effect, gent for neg
44
how to diagnose c diff
stool toxin test
45
a patient with HIV presents confused, they have multiple ring-enhancing lesions in the basal ganglia what is diagnosis and treatment?
cerebral toxoplasmosis pyrimethamine and sulphadiazine
46
what is another name for a plasma cell?
Post-germinal B cell
47
is splenomegaly more common in CML or CLL or ALL
CML
48
what is conversion disorder?
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
what is a deterent medication in alcohol dependence that causes n and v with alcohol
Disulfiram (Antabuse)
50
trisomy screened for? how? when?
- 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
in neutropenic sepsis what are the antibiotics given?
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
in autoimmune haemolysis what is the difference between warm and cold autoantibodies
warm= IgG cold= IgM
53
management for lambert-eaton myasthenic syndrone?
3,4-diaminopyridine
54
what characterises schizoid personality disorder vs schizotypal personality disorder?
schizotypal- eccentric, magical thinking, lack of close relations, paranoid schizoid- volunteer social isolation, not eccentric
55
what is the first line medication for medical assisted detoxification?
Chlordiazepoxide
56
what antibiotic should be given in preterm ROM
oral erythromycin for 10 dys
57
what nerve supplies serratus anterior which causes scapula winging?
the long thoracic nerve
58
what is the difference in presentation between an anterior inferior cerebellar artery infarct and a PICA
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
what is webers syndrome?
branch of PCA infact that causes ipsilateral CNIII palsy and contralateral weakness of upper and lower extremitys
60
what are some scoring systems for depression?
- 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
what do you give in wilsons disease?
D-penicillamine= acts as a copper chelator, binding copper, and thus allowing it to be eliminated in the urine
62
what drug would you give that lower the EPSE of antipsychotics?
procyclidine which is anti-cholnergic so balances these things
63
what prophylactic treatment do you give in Polycythemia Vera?
aspirin
64
what antibiotic do you give in PROM?
Erythromycin
65
over what blood sugars is gestational diabetes?
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
what drugs do you give for group b strep
benzylpenicillin as intrapartum antibiotic prophylaxis (give if fever, preterm, gbs with previous baby)
67
features of Intrahepatic cholestasis of pregnancy? management?
intense itch, jaundice, raised bilirubin induction of labour at 37-38 weeks medical is ursodeoxycholic acid vit k supplements
68
PPH medical management?
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
PPH surgical management
intrauterine balloon first line others include B-lynch suture, ligation of uterine arteries or internal iliac last resort is hysterectomy
70
acute fatty liver in preg vs intrahepatic cholestasis of pregnancy
acute fatty liver= Abdopain and vom intrahepatic cholestasis= Itch
71
what do you give in suspected endometritis?
intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)
72
what prophyactic treatment for VTE is given in pregnancy?
Low molecular weight heparin
73
alzheimers pathophysiology?
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
vascular dementia pathophysiology
lots of little infacts, stepwise progression same risk factors as a normal ischemic stroke
75
lewy body dementia pathophysiology?
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
Frontal temporal dementia pathopysiology
abnormal amounts of protiens TDP43 (DNA binding protien) and TAU protien form pick bodys are the name for TAU fibrils in cytoplasm
77
some genetics to get early onset alzeimers
amyloid precursor protien on CH21 presenlin 1 presenilin 2 later onset apolipoprotein E
78
cardiovascular changes in preganacy?
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
what are the respiratory changes seen in pregnancy
40% increase in tidal volume decrease in functional residual capacity mild respiratory alkalosis with metabolic compensation
80
renal changes in a pregnant patient
increased GFR due to dilation of AA, hence increased urine production increase in bacteria infection
81
what is used to stain the cervix during colposcopy
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
learn antibiotic moa
83
what drugs trigger haemolysis in G6PD deficiency
sulph drugs- sulphonamides, sulphasalazine and sulfonylureas also antimalarials ciprofloxasin nitroferitoin
84
what is used to reverse rivaroxaban and apixaban?
andexanet alfa (recombinant factor Xa protien)
85
where is the CAG repeat in huntingtones
on chromosome 4p leads to neuronal death in the putamen and caudate nucleus
86
what eye palsy based on what cranial nerve issues?
CN3= posterior com artery/ SAH CN4= trauma/ congenital, in brain for longest CN6= raised ICP
87
where would a bleed in the bridging viens cause blood to pool
between dura and arachnoid
88
where is the primary auditory cortex?
superior temporal gyrus
89
what drugs to you give acutely in an acute dystonic reaction?
procyclidine (can try benzatropine0
90
breast cancer chemo drugs?
HER2+ patients= trastuzumab premenopausal= tamozifen post menopausal= anastrozole
91
how to calculate TNM staging for breast cancer?
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
when should you not give anti-cholinesterase inhibitors eg in dementia
long QT as it prolongs it further
93
when do you use tyrosine kinase inhibitors?
CML
94
what shows basophillic stipping of red blood cells?
sideroblastic anemia
95
why should topiramate be avoided in women of child bearing age to prevent migranes
teratenogenic, reduce effectivness of hormonal contraceptives
96
management of ITP? LOOK AT DIC AND TTP TOO
Emergency treatment: life-threatening or organ threatening bleeding= Platelet transfusion, IV methylprednisolone and intravenous immunoglobulin Platelet count >30*109/L= Observation Platelet count <30*109/L= Oral prednisolone
97
mesolimbic vs mesocortical; which is responsible for positive and negative symptoms of schizophrenia?
mesolimbic= overactivity causes positive symptoms mesocortical= underactivity causes negative symptoms
98
give some examples of MAO-B inhibitors used in parkinsons (often alongside levodopa later in disease)
Selegiline, Rasagiline
99
what is the most likely antipsychotic to cause neuroleptic malignant syndrome (high temp, increased tone and autonomic instability)?
haloperidol
100
most likely antipsychotic to cause metabolic syndrome?
olanzapine
101
what drugs do you give for focal seizures?
lamotrigine or carbamazepine
102
1st and second line disease modifying drugs in MS?
1st= tecfedaira, interferon beta 2nd= MAB or fingolimod
103
alternative tayside formulary for overactive bladder
tolteridone (antimuscrinic)
104
liscenced drug in huntingtons?
tetrabenazine
105

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