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Top 100 Passmedicine Concepts pt 1 Flashcards

1
Q

When should adrenaline be given in non-shockable rhythm?

A

ASAP

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2
Q

What artery blockage can lead to complete heart block post MI?

A

Right coronary artery

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3
Q

What are the most common causes of infective endocarditis? For native and prosthetic valves

A

Staph aureus

Staph epidermidis if valve replacement <2months ago

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4
Q

What channel problem causes long QT syndrome?

A

Loss of function/blockage of K+ channels

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5
Q

Which electrolyte abnormality can lead to long QT syndrome?

A

Hypokalaemia

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6
Q

What drug is a common cause of QT prolongation?

A

Methadone

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7
Q

Describe the murmur heard in atrial septal defects.

A

Ejection systolic murmur louder on inspitation

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8
Q

How is symptomatic bradycardia treated?

A

Atropine

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9
Q

What are the antithrombotic therapies used for bioprosthetic and mechanical prosthetic valves?

A

Biosynthetic - aspirin

Mechanical - warfarin + aspirin

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10
Q

What is pulsus alternans seen in?

A

Left ventricular failure

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11
Q

What lung disease should pregnancy be avoided with?

A

Pulmonary hypertension as very high mortality levels

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12
Q

What are the rules for discharge post anaphylaxis?

A

Fast track 2hours after symptom resolution if good response to one dose of adrenaline, complete resolution, know how to use epipen
6+ hours post symptom resolution if 2 doses IM adrenaline needed or previous biphasic reaction
12+ hours if requiring more than 2 doses adrenaline, severe asthma, ongoing reaction, late night presentation, difficulty in reaching ED

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13
Q

How is CLL investigated for diagnosis?

A

Immunophenotyping

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14
Q

What is CLL caused by?

A

Monoclonal proliferation of B-cell lymphocytes

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15
Q

How is hereditary spherocytosis managed in acute haemolytic crisis and longer term?

A

Acute - supportive, transfusion if needed

Longer term - folate replacement, splenectomy

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16
Q

What is the pathogenesis of thrombotic thrombocytopenic purpura?

A

Abnormally large and sticky multimers of von Willebrand’s factor -> platelet clumps within vessels. Deficiency of ADAMTS13 which breaks down these large multimers.

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17
Q

What can help distinguish TTP from HUS?

A

Neuro signs seen in TTP

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18
Q

What happens to the oxygen dissociative curve in carbon monoxide poisoning?

A

Oxygen saturation of Hb decreases so early plateau in curve

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19
Q

Patient with cocaine use presenting with abdo pain or rectal bleeding =?

A

Ischaemic colitis

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20
Q

How does hypokalaemia cause digoxin toxicity?

A

Digoxin normally binds to ATPase pump at same site as potassium, if hypokalaemia then digoxin can bind more easily and has more inhibitory effects

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21
Q

What is the tried of symptoms in DRESS syndrome?

A

Drug rash with eosinophilia and systemic symptoms = skin rash + high fever + organ involvement

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22
Q

What are some common drug causes of urticardia?

A

Aspirin, penicillins, NSAIDs, opiates

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23
Q

Which drugs exhibit zero-order kinetics?

A

Phenytoin, salicylates, heparin, ethanol

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24
Q

What’s the general rule for autosomal recessive and dominant conditions?

A

Recessive are metabolic e.g. CF, sickle cell anaemia

Dominant are structural e.g. achondroplasia, APCKD, EDS

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25
Give an example of an autosomal recessive and dominant condition
AR - CF, sickle cell anaemia, cystinuria, familial mediterranean fever, Fanconi anaemia, Friedreich's ataxia, haemochromatosis, homocystinuria, thalassaemia AD - achondroplasia, APCKD, EDS, hereditary spherocytosis, Huntington's disease, Marfan's syndrome, Noonan syndrome, Peutz-Jeghers syndrome
26
What cell surface protein is found on Reed-Sternberg cells?
CD15
27
What receptor does insulin bind to?
Tyrosine kinase
28
What is a p53 mutation associated with?
Li-Fraumeni syndrome - early-onset breast cancer, sarcoma, leukaemia
29
How do you calculate relative risk reduction?
(experimental event rate - control event rate)/control event rate
30
What is the response of pulmonary arteries to hypoxia?
Vasoconstriction
31
What does riboflavin/vitamin B2 deficiency cause?
Angular cheilitis
32
What is eczema herpeticum caused by?
Herpes simplex virus 1 or 2
33
Describe the rash associated with eczema herpeticum
Monomorphic punched-out erosion, circular, depressed, ulcerated lesions 1-3mm diameter
34
How can fungal nail infections be treated?
Oral terbinafine
35
Which patient population do Keloid scars most commonly occur in?
Young, black, male adults
36
Describe the usual presentation of lentigo maligna melanoma
Suspicious freckle on face or scalp of chronically sun-exposed patients
37
Describe the nature of nodular melanomas
Invade aggressively and metastasise early
38
What can deficiency of niacin /vitamin B3 cause?
Pellagra - dermatitis, diarrhoea, dementia
39
How does pemphigus vulgaris present?
Mucosal blistering, painful but non itchy blisters
40
What type of cancer can arise from chronic scars?
SCC - more aggressive and increased metastatic risk
41
What is Stevens-Johnson syndrome?
Severe systemic reaction affecting skin and mucosa
42
How is Cushing's syndrome investigated?
Low-dose overnight dex suppression test
43
What HbA1c level is diagnostic of DM?
48mmol/mol (6.5%) or greater
44
When should metformin be considered in T1DM patients?
If BMI >25
45
What is the initial management of DKA?
Isotonic saline, then start IV insulin 0.1 units/kg/hour
46
What are the typical features of MEN type 1?
Peptic ulceration, galactorrhoea, hypercalcaemia | Parathyroid cancer, pituitary cancer, pancreatic cancer, adrenal and thyroid cancers
47
What's the first line investigation in suspected primary hyperaldosteronism?
Plasma aldosterone/renin ratio - shows high aldosterone levels with low renin levels
48
What's the best way to test exocrine function in chronic pancreatitis?
Faecal elastase
49
What is the pattern of inheritance for haemochromatosis?
Autosomal recessive
50
What are the reversible and irreversible complications of haemoachromatosis?
Reversible - cardiomyopathy, skin pigmentation | Irreversible - liver cirrhosis, DM, hypogonadotrophic hypogonadism, arthropathy
51
How should non-alcoholic fatty liver disease be investigated?
Enhanced liver fibrosis blood test
52
What complication could PPIs cause that results in chronic diarrhoea?
Microscopic colitis - needs colonoscopy + biopsy
53
How should small bowel bacterial overgrowth syndrome by investigated?
Hydrogen breath test
54
How should spontaneous bacterial peritonitis be treated?
IV cefotaxime
55
What is BCG vaccine unreliable in protecting against?
Pulmonary TB
56
When should someone receive VZIG post exposure to chickenpox?
If they are immunosuppressed secondary to long-term steroids or methotrexate and have no antibodies, pregnant women without antibodies
57
How should recurrent genital herpes be treated in pregnancy?
With suppressive therapy, low risk of transmission is low, aciclovir is safe in pregnancy
58
How should genital warts be treated if multiple and non-keratinised vs solitary keratinised?
Multiple non-keratinised - topical podophyllum | Solitary keratinised - cryotherapy
59
How is gonorrhoea treated?
IM ceftriaxone
60
How is HIV investigated 4 weeks post exposure?
p24 (with HIV antibody)
61
When should exchange transfusion be considered in malaria falciparum?
If parasite count >10%
62
What is the typical CSF picture with mumps meningitis?
Viral but low bacteria, clear/cloudy appearance, normal/raised protein, 15-1000 cells lymphocytes
63
How is mycoplasma pneumonia treated?
Doxycyline or macrolide
64
How is latent syphilis treated?
Benpen IM single dose
65
What can give a false positive to syphilis testing?
SomeTimes Mistakes Happen - SLE, TB, malaria, HIV
66
What would the urine tests show in acute interstital nephritis?
Sterile pyruia, white cell casts
67
What can help differentiate acute tubular necrosis from prerenal uraemia?
Prerenal uraemia holds onto sodium to preserve volume - low urine sodium, high urine osmolality, good response to fluid challenge, raised urea:creatinine ratio ATN is the opposite
68
How long does it take for an AV fistula to develop?
6-8 weeks
69
What would recent URTI + haematuria make you think about?
Rapidly progressive GN - granulomatosis with polyangiitis
70
How does thiazide diuretics impact renal stone risk?
Calcium excretion and stone formation decreased by their use
71
What are some of the adverse effects of tacrolimus?
Impaired glucose tolerance, diabetes, tremor
72
What is the most common form of renal disease in SLE?
Diffuse proliferative glomerulonephritis
73
How does Klumpke's palsy present?
T1 nerve root damage -> loss of intrinisc hand muslces
74
What can trigger cluster headaches?
Alcohol
75
What anti-epileptic is linked with Stevens-Johnson syndrome?
Lamotrigine
76
How should bladder dysfunction be managed in MS?
Ultrasound to assess bladder emptying. If significant residual volume -> intermittent self-catheterisation If not -> anticholinergic to improve frequency
77
What is the presentation of progressive supranuclear palsy?
Postural instability and falls, impairment of vertical gaze (down gaze worse than up), parkinsonism, cognitive impairment
78
How can raised ICP cause 3rd nerve palsy?
Through uncal herniation through tentorium
79
What are the antiplatelets used in TIA/stroke?
Clopidogrel | Aspirin + dipyridamole if can't tolerate clopi
80
How do you differentiate between upper and lower quadrant bitemporal hemianopias?
Upper - inferior chiasmal compression due to pituitary tumour Lower - superior chiasmal compression due to craniopharyngioma
81
What's the classic presentation of central retinal vein occlusion + fundoscopy findings?
Sudden painless loss of vision | Several retinal haemorrhages on fundoscopy
82
How should morphine dose be adjusted in palliative care if still in pain?
Increase by 30-50%
83
How do benzodiazepines work?
Enhance effect of GABA - inhibitor neurotransmitter
84
What's first line treatment in GAD/panic disorder?
SSRIs
85
What drugs should be avoided when a patient is on an SSRI?
NSAIDs - give with PPI Warfarin/heparin - consider mirtazapine Aspirin - consider mirtazapine Triptans - increased risk of serotonin syndrome MAOIs - increased risk of serotonin syndrome
86
Which TCA is most dangerous in overdose?
Dosulepin
87
How should a patient with suspected asthma be investigated?
With FeNO test + spirometry with reversibility
88
What bacteria causes aspiration pneumonia?
Klebsiella
89
What is the prognosis of sarcoidosis?
Remits in 2/3 without treatment
90
What are the vasculites associated with the two ANCA types?
``` c = granulomatosis with polyangiitis p = eosinophilic granulomatosis with polyangiitis ```
91
What are the causes of avascular necrosis of the hip?
Long-term steroid use, chemotherapy, alcohol excess, trauma
92
What advice should be given to a pregnant patient taking azathioprine?
Safe to use
93
What is the typical presentation of Behcet's syndrome?
Oral ulcers + genital ulcers + anterior uveitis
94
What can cause drug-induced lupus?
Proceinamide, hydralazine, isoniazid, minocycline, phenytoin
95
What is the pathophysiology of gout?
Microcrystal synovitis caused by deposition of monosodium urate monohydrate in the synovium due to chronic hyperuricaemia
96
What are the cardiac associations with Marfan's disease?
Dilation of aortic sinuses -> aortic aneurysm, aortic dissection, aortic regurgitation, mitral valve prolapse
97
What disease can cause positive anti-U1 ribonucleoprotein? (anti-RNP)
Mixed connective tissue disease, SSc, SLE
98
What are the characteristic pattern of joint involvement in osteoarthritis of the hand?
Carpometacarpal joints, distal interphalangeal joints affected more than proximal interphalangeal joints
99
What are the early XR features of RA?
Juxta-articular osteoporosis/osteopenia
100
What antibodies are associated with SLE in pregnancy causing congenital heart block?
Anti-Ro

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