To sort Flashcards by Nikita Verma

How does amiodarone affect the QT interval and which condition is it contraindicated in?

Prolongs QT interval and CI in long QT syndrome

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What is the most common cause of an extradural haematoma?

Trauma - skull fracture in teporal/parietal region leading to a bleed in the middle meningeal artery

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What type of haematoma is known to lead to a traumatic brain injury with a lucid interval?

extradural haematoma

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What prophylactic drugs are given to longterm steroid users?

PPI (lansoprazole) for gastroprotection and bisphosphonates and calcium for osteoporosis prevention

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How do tendon reflexes change above, at and below the level of spinal cord compression?

normal above
absent at
increased below

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Which condition is internuclear ophthalmoplegia associated with and which cranial nerves are affected?

Multiple sclerosis

CN ipsi 3rd and contra 6th leading to diplopia

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What is the classic triad of Horner’s syndrome and what causes it?

Ptosis, miosis and anhydrosis

lesion of the sympathetic trunk

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What is the histological hallmark of pilocytic astrocytomas?

Rosenthal fibres

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What type of drug is sildenafil and what is it used to treat? What is its street name?

phosphodieserase inhibitor
Tx for erectile dysfunction as it inhibits PDE which is used by the sympathetic nervous system to cause smooth muscle contraction that leads to flaccidity
AKA viagra

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How can lifting the testis above the symphysis help you differentiate between 2 causes of tesituclar pain?

Pain increases if due to testicular torsion

Pain decreases if due to epididymitis

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What is the ddx for a rash that involves the palms and soles?

Measles, syphilis and coxsackie virus

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What is the Jarisch-Herxheimer reaction?

Fever, headache, rigors and myalgia in reaction to syhphis treatment that resolves w/in 24 hrs - mgmt: antipyretics and reassurance

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What is the ddx for hyponatraemia?

Hypo or hypervolaemia 
Diuretic use
N&V, diarrhoea
liver cirrhosis 
cardiac failure
SIADH
adrenal insufficiency
renal failure
burns
sweating

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Which test would help you investigate Cushing’s disease?

Overnight dexamethasone suppression test

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Which test would help you investigate adrenal insufficiency?

Synacthen test

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Which test would help you investigate adrenal insufficiency and GH deficiency?

Insulin tolerance test

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Which test would help you investigate GH deficiency?

glucagon test

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Which condition is thumb squaring a feature of?

Osteoarthritis

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How do platelet levels change in rheumatoid arthritis vs lupus?

Rheumatoid –> thrombocytosis

Lupus –> thrombocytopenia

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What is the difference between thrombocytosis and thrombocythaemia?

They are both terms for high platelet levels
Thrombocytosis - cause is known
Thrombocythaemia - cause is unknown

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What is the classic triad of Wernicke’s encephalopathy?

Ataxia, nystagmus, confusion

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How do you treat Wernicke’s encephalopathy?

IV thiamine (B1)

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How does Korsakoff syndrome differ from Wernicke’s encephalopathy?

Korsakoff = Wernicke’s + memory impairment (dementia) and is irreversible

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What are the extra-articular manifestations of rheumatoid arthritis?

Episcleritis, subcutaneous nodules, peripheral sensory neuropathy and pericardial effusion

(SEEN - subcut nods, epis, effusion, neuropathy)

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What is the treatment for paracetamol overdose?

Depending on paracetamol levels (plot of graph) | N-acetyl cysteine

What is the treatment for subarachnoid haemorrhage?

Extra-ventricular device to drain CSF and reduce ICP

What are the four main complications of a subarachnoid haemorrhage?

Hydrocephalus, rebleeding, vasospasm, seizures

What is the ophthalmologic complication of anticholinergic drugs?

Glaucoma causing blurred vision

How does Epstein-Barr virus present and what would you expect to see on a blood film?

Sore throat, myalgia, fever, tiredness, splenomegaly | Blood film = atypical lymphocytes

What would you expect to see on a lumbar puncture in someone with MS?

Oligoclonal bands

What effect does MS have on visually evoked potentials?

reduced

What is the initial tx/tx for acute flare-ups of MS?

Methyprednisolone

What is the longterm disease modifying treatment for MS?

Natalizumab or beta-interferon

What does neutrophilia indicate?

Bacterial infection, corticosteroid use

What does neutrophilia in the context of MSK indicate?

Septic arthritis

What does neutropenia and thrombocytopenia in the context of MSK indicate?

drug-induced bone marrow suppression

What does lymphopenia indicate?

SLE

What does eosinophilia in the context of MSK indicate?

eosinophilic granulomatosus with polyangiitis

What can a red, shiny, swollen joint be a sign of?

Septic arthritis or gout

What type of drug is Allopurinol and what is it used to treat?

xanthine oxidase inhibitor tx for gout xanthine oxidase is responsible for purine metabolism which increases the production of uric acid which can form crystals and result in gout

How does acute gout affect serum uric acid levels?

Can reduce it

What crystals are found in gout?

Monosodium urate - long, needle-shaped, negatively birefringent

What crystals are found in pseudogout?

calcium pyrophosphate - small, brick-shaped, weak positive birefringent

How does SLE present?

arthralgia (non-erosive, non-inflam), malar rash, photosensitivity, secondary fibromyalgia, mouth ulcers, Raynaud's, lymphadenopathy

What immunological markers are positive in SLE?

anti-dsDNA, ANA, low complement (C3 and C4), anti-phospholipid antibodies

How does systemtic sclerosis present?

Raynaud's, pulmonary artery hypertension, renal disease

How does Sjogren's syndrome present?

xerophthalmia xerostomia, parotitis

Which osteophytic bone deformities would you find on the hands of someone with osteoarthritis?

Heberden's nodes (DIPJ) and Bouchard's nodes (PIPJ)

What radiological features of osteoarthritis would you find on an x-ray?

``` joint space narrowing osteophyte formation subchondral sclerosis subchondral cysts abnormalities of bone contour ```

What MRI findings would you expect to find in mechanical lower back pain?

disc degenration and bulging discs

What is Felty's syndrome?

rheumtoid arthritis + splenomegaly + neutropenia

What radiological findings would you expect to see in rheumatoid arthritis?

``` soft tissue swelling loss of joint space periarticular osteopenia erosions deformities ```

Name 2 DMARDs.

Methotrexate | Sulfsalazine

What is the triad of reactive arthritis?

arthritis + conjunctivitis / anterior uveitis + sterile urethritis

Which immunological marker would help you differentiate between GCA and Wegner's granulomatosis?

both are types of vasculitis ANCA test + ve = WG - ve = GCA

What is the pathophysiology of pernicious anaemia?

autoimmune condition atrophic gastritis + loss of ucosal parietal cells = reduced intrinsic factor production causing vit B12 malabsorption in the terminal ileum.

What is the gold standard investigation for DVT?

contrast venography

Presence of Auer rods are a sign of which condition?

Acute Myeloid Leukaemia

Which condition is defined by the presence of the Philadelphia chromosome?

Chronic Myeloid Leukaemia

Which drug is used to treat chronic myeloid leukaemia?

imatinib - tyrosine kinase inhibitor

Which drug is used to treat chronic lymphocytic leukaemia?

rituximab - anti-CD20 on B cells as it targets the clonal expansion of mature B lymphocytes

Which virus is associated with Hodgkin's lymphoma?

Epstein Barr Virus

Which bacterium is associated with non-Hodgkin's lymphoma?

H pylori

What would you expect to see on the lyph node biopsy of someone with Hodgkin's lymphoma?

Reed-Sternberg cells w/ benign lymphocytes and histiocytes

What would you expect to see on the blood film of someone with myeloma?

rouleaux formation (RBCs stick together)

What might you see on a skull x-ray of someone with myeloma?

Pepper pot skull

Which drugs should be avoided in patients wit G6PD deficiency due to risk of haemolysis?

primaquine ciprofloxacin nitrofurantoin co-trimoxazole

Which clotting factors are dependent on vitamin K?

``` 1972 prothrombin (II) VII IX X ```

What is the gold standard investigation for malaria?

thick and thin blood smears with Giemsa stain

What would you expect to see on a malarial blood film?

trophozoite

What is Samter's triad?

asthma + resp symptoms worsened by NSAID/aspirin + nasal polyps

If a patient has a reduced FEV1, what can the FEV1:FVC ratio tell you?

reduced FEV1/:FVC = obstructive picture | normal FEV1:FVC = restrictive picture

How does the appearance of a primary lung tumour differ from lung metastases on CXR?

primary tumour = stellate appearance | mets = canonball, round

What are the side effects of inhaled corticosteroids?

loss of bone density adrenal suppression glaucoma (worsened by anticholinergics if taking it for asthma) cataracts

Which immunological marker would you check for in Graves disease?

IgG-type thyroid stimulating immunoglobulin

Which immunological markers would you check for in Hashimoto's thyroiditis?

anti-TPO anti-thyroglobulin anti-TSH-R

What would you expect to see on an ECF in atrial fibrillation?

irregularly irregular, absent P waves

What would you expect to see on an ECG in atrial flutter?

saw-tooth appearance | regular and identical flutter F waves

What would you expect to see on an ECG in STEMI?

ST elevation hyperacute T waves pathological Q waves (days later)

What would you expect to see on an ECG in NSTEMI and unstable angina?

ST depression | T wave inversion

What would you expect to see on an ECG in hypercalcaemia?

shortened QT interval | broad QRS complex

What would you expect to see on an ECG in hypocalcaemia?

prolonged QT interval | narrow QRS complex

What would you expect to see on an ECG in hyperkalaemia?

tall, tented T waves

What would you expect to see on an ECG in hypokalaemia?

flattened T waves | U waves

What is an accurate marker for cardic failure?

brain natriuretic peptide

What are the 6 Ps of acute limb ischaemia?

``` pain pallor pulselessness paraesthesia perishingly cold paralysis ```

What signs would you expect to find on a CXR in someone with cardiac failure?

``` Alveolar oedema Kerley B lines Cardiomegaly Dilated prominent upper lobe Effusion (pleural) ```

What signs would you expect to see in infective endocarditis?

splinter haemorrhage Janeway lesions Osler nodes Roth spots on retina

Which 4 defects make up the tetralogy of Fallot?

ventricular septal defect right ventricular hypertrophy pulmonary artery stenosis overriding aorta

Name 2 signs of pericardial effusion.

pulsus parodoxus - an exaggerated fall in a patient's blood pressure during inspiration by greater than 10 mm Hg. Kussmaul sign - paradoxical increase in JVP that occurs during inspiration. this is because in pericardial effusion, fluid collects outside th eheart in the pericardial sac which does not allow the right ventricle to fill and contract properly

What would you expect to see on an ECG in someone with pericarditis?

diffuse ST elevation concave ST segment PR depression saddle shaped

What shape does an extradural haemorrhage have on a CT scan?

convex shape

What shape does a subdural haemorrhage have on a CT scan?

Concave shape

What shape does a subarachnoid haemorrhage have on a CT scan?

5-star or stellate appearance

What causes jaundice + unconjugated hyperbilirubinaemia?

haemolysis

What causes hepatocellular jaundice +/- cholestasis?

viruses | paracetamol overdose

What causes jaundice + conjugated hyperbilirubinaemia?

CBD gall stones | pancreatic cancer

How does conjugated hyperbilirubinaemia present?

pale faeces dark urine pruritus

What would histology of acute hepatic failure reveal?

multiacinar necrosis

How would you treat raised intracranial pressure?

IV infusion of mannitol

Which liver conditions would have Mallory bodies on histology?

alcoholic hepatitis Wilson's disease primary biliary cholangitis

Where does copper deposit in Wilson's disease?

liver basal ganglia cornea

How does acute cholangitis present?

Charcot's triad | fever + jaundice + RUQ pain

What is the tx for acute cholangitis?

ERCP

What is the triad of clinical features in hereditary haemochromatosis?

bronze skin pigmentation + hepatomegaly + diabetes mellitus

How do you tx hereditary haemochromatosis?

venesection + screen relatives (transferrin saturation + serum ferritin)

What is haemosiderosis?

secondary iron deposition in reticuloendothelial cells with pancreatic-sparing

Which antibiotics are commonly used to treat UTIs?

nitrofurantoin, trimethoprim, amoxicillin