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Top 100 Passmedicine Concepts pt 2 Flashcards

1
Q

What is Wellen’s syndrome?

A

ECG pattern caused by high-grade stenosis in the left anterior descending coronary artery that suggests high risk of critical LAD stenosis.

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2
Q

What are the features of Wellen’s syndrome on ECG?

A

Biphasic or deep T wave inversion in V2-V3, minimal ST elevation, no Q waves.

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3
Q

What is De Musset’s a sign of?

A

Aortic regurgitation, head bobbing.

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4
Q

What should be given if bleeding on dabigatran?

A

Idarucizumab, the reversal agent.

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5
Q

What might a sustained apical impulse on cardiology examination suggest?

A

Left ventricular hypertrophy.

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6
Q

What are the signs of left ventricular hypertrophy on ECG?

A

Deep S waves in V1 and V2, tall R waves in V5 and V6.

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7
Q

How does a posterior MI present on ECG?

A

Reciprocal changes of STEMI - horizontal ST depression, tall broad R waves in V1 and V2, upright T waves, dominant R wave in V2; ST elevation and Q waves in posterior leads V7-V9.

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8
Q

What is a likely causative agent of infective endocarditis in someone with very poor dental hygiene?

A

Viridans streptococci e.g. streptococcus sanguinis.

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9
Q

What is the empirical treatment of choice for prosthetic valve endocarditis?

A

IV vancomycin + rifampicin + low-dose gentamicin.

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10
Q

Which of bullous pemphigoid or pemphigus vulgaris have mucosal involvement stereotypically?

A

Pemphigus vulgaris.

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11
Q

What is an alternative to topical steroids for eczema management?

A

Calcineurin inhibitors.

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12
Q

What is a pro and a con of adding urea to emollients in eczema?

A

Pro - increases moisturising effect.
Con - can be inflammatory.

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13
Q

What should the timings for use of prednisolone treatment be for eczema to prevent rebound?

A

Use for several weeks then taper off.

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14
Q

Rank the following topical steroids from most to least potent: hydrocortisone, fluticasone, clobetasol, clobestasone, betamethasone 0.025%, betamethasone 0.1%.

A

Clobetasol 0.05% (dermovate) > fluticasone 0.05% (cutivate), betamethasone 0.1% (betnovate) > betamethasone 0.025%, clobetasone 0.05% (eumovate) > hydrocortisone 0.5-2.5%.

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15
Q

Which dermatological conditions demonstrate Koebner phenomenon?

A

Psoriasis, vitiligo, warts, lichen planus, lichen sclerosus, molluscum contagiosum.

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16
Q

What two features can help distinguish seborrhoeic lesions from malignant melanomas?

A

Pseudo-comedones and pale spots - both seen in seborrhoeic lesions.

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17
Q

Which drugs can trigger an exacerbation of psoriasis?

A

Beta blockers, lithium, antimalarial, NSAIDs, ACEi, infliximab, withdrawal of systemic steroids.

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18
Q

How is scalp psoriasis managed first line?

A

Topical potent corticosteroids once daily for 4 weeks.

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19
Q

What is the first line management of chronic plaque psoriasis?

A

Potent corticosteroid OD + vitamin D analogue OD.

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20
Q

What is the first line and second line treatment for scabies?

A

First line - permethrin 5%.
Second line - malathion 0.5%.

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21
Q

What would be the cause of an itchy rash affecting the face and scalp?

A

Seborrhoeic dermatitis.

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22
Q

What is the Leser-Trelat sign in seborrhoeic keratoses?

A

The abrupt appearance of multiple seborrhoeic keratoses suggesting underlying cancer.

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23
Q

What are the three steps of analgesia for shingles?

A

Paracetamol and NSAIDs first-line.
Neuropathic agents considered next e.g. amitriptyline.
Oral corticosteroids can be considered in the first 2 weeks if immunocompetent and severe pain.

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24
Q

When should antivirals for shingles be given?

A

Within 72 hours for patients and before lesions have crusted over.

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25
What is the colonoscopy screening programme for acromegaly?
Regular screening from the age of 40 years, frequency after that depends on colonoscopy findings and acromegaly activity.
26
What are the causes of Addison's disease?
Autoimmune destruction of the adrenal glands. Primary: tuberculosis, metastases, meningococcal septicaemia, HIV, antiphospholipid syndrome. Secondary: pituitary disorders - tumour, irradation, infiltration. Exogenous glucocorticoid therapy.
27
What are the steps of managing hypercalcaemia?
Initially - rehydration with normal saline, 3-4L/day. Bisphosphonates after rehydration, take 2-3 days to start to work. Calcitonin - acts quicker than bisphosphonates. Steroids if sarcoidosis. Loop diuretics if not tolerating aggressive fluid rehydration.
28
What investigation result confirms insulinoma?
Elevated C-peptide level after IV insulin.
29
How are prolactinomas managed? (First and second line)
First-line - dopamine agonists (bromocriptine, cabergoline) to inhibit release of prolactin from the pituitary gland. Second-line - trans-sphenoidal surgery.
30
What are the clinical features of pseudohypoparathyroidism?
Short fourth and fifth metacarpals, short stature, learning difficulties, obesity, round face, high PTH, low calcium, high phosphate.
31
How is thyroid storm managed?
Beta blockers, propylthiouracil, hydrocortisone.
32
How is acute mesenteric ischaemia managed?
Immediate laparotomy, particularly if signs of advanced ischaemia.
33
What are the clinical features of autoimmune hepatitis?
Signs of chronic liver disease, fever, jaundice, amenorrhoea.
34
What are the blood results seen in autoimmune hepatitis?
ANA/SMA/LKM1 antibodies positive, IgG levels raised, LFTs deranged.
35
How is haemochromatosis screened for in the general population and for family members?
General population - transferrin saturation, then ferritin. Family members - HFE genetic testing.
36
Which cancer are patients with haemochromatosis at an increased risk of developing?
Hepatocellular carcinoma.
37
What can cause ischaemic hepatitis?
Diffuse hepatic injury from acute hypoperfusion, e.g. low BP secondary to blood loss.
38
How is ischaemic hepatitis diagnosed?
Presence of an inciting event e.g. cardiac arrest, marked increases in aminotransferase levels >1000, usually with AKI or other end-organ dysfunction.
39
What diagnosis would low vitamin B12 and high folate levels point towards?
Small bowel bacterial overgrowth syndrome.
40
How should patients with severe systemic symptoms of an ulcerative colitis flare be investigated?
CT abdomen.
41
How is Wilson's disease managed?
Penicillamine (chelates copper).
42
What scoring tool can help distinguish between delirium and dementia?
The confusion assessment method (CAM).
43
How are flares of acute intermittent porphyria treated?
With IV haem arginate.
44
How should acute promyelocytic leukaemia be managed?
All-trans retinoic acid to force immature granulocytes into maturation to resolve a blast crisis before definitive chemotherapy.
45
What is the adult dose of adrenaline for anaphylaxis?
0.5ml of 1 in 1000 = 500 micrograms.
46
When is fresh frozen plasma offered to bleeding patients according to clotting studies?
If the prothrombin time or activated partial thromboplastin time is greater than 1.5 times normal.
47
What is the key investigation for chronic lymphocytic leukaemia?
Immunophenotyping.
48
What are the indications for initiating treatment in chronic lymphocytic leukaemia?
Progressive marrow failure (new or worsening anaemia or thrombocytopenia), massive (>10cm) or progressive lymphadenopathy, massive (>6cm) or progressive splenomegaly, progressive lymphocytosis (>50% increase in 2 months or less than 6 month doubling time), systemic symptoms (weight loss >10% in 6 months, fever >38C for >2 weeks, extreme fatigue, night sweats), autoimmune cytopaenias.
49
How does chronic myeloid leukaemia clinically present?
Anaemia and lethargy, weight loss and sweating, marked splenomegaly +- abdominal discomfort.
50
Which drugs can cause eosinophilia?
Sulfasalazine, nitrofurantoin.
51
How is acute hereditary angioedema managed?
IV C1-inhibitor concentrate or fresh frozen plasma if that's not available.
52
How is methaemoglobinaemia treated for congenital and acquired cases?
Congenital - ascorbic acid. Acquired - methylene blue (IV methylthioninium chloride).
53
How do exchange transfusions help manage sickle-cell crises?
Reduce the number of sickle red cells and increase the number of normal red cells to improve oxygenation.
54
What investigations would you expect to see in Waldenstrom's macroglobulinaemia?
Monoclonal IgM paraproteinaemia, infiltration of bone marrow wiht lymphoplasmacytoid lymphoma cells on bone marrow biopsy.
55
How does Brucellosis present?
Farmer/vet unwell with fever, malaise, hepatosplenomegaly, sacroiliitis => lower back pain.
56
What is a common complication of pneumocystis jiroveci pneumonia?
Pneumothorax.
57
What diagnosis would confusion with Parkinsonian feature or acute flaccid paralysis in a returned traveller from Asia make you think of?
Japanese encephalitis.
58
Who should prophylaxis (oral ciprofloxacin or rifampicin) be offered to in terms of meningococcal meningitis contacts?
Households and close contacts of patients. Those exposed to respiratory secretions, regardless of closeness of contact.
59
How does Mycoplasma pneumoniae usually present?
Prolonged and gradual onset, flu-like symptoms precede a dry cough.
60
How does acute Schistosomiasis usually present?
Marked eosinophilia, cough, bloody diarrhoea, splenomegaly.
61
What is the Jarisch-Herxheimer reaction in regards to syphilis?
Phenomenon after treatment with fever/rash/tachycardia after the first dose of antibiotic, it doesn't need any treatment other than antipyretics.
62
How is acute angle closure glaucoma managed?
Referral to an ophthalmologist. Eye drops: direct parasympathomimetic e.g. pilocarpine to contract ciliary muscle for increased outflow of aqueous humour; beta-blocker e.g. timolol to reduce aqueous humour production; alpha-2 agonist e.g. apraclonidine to decrease production and increase uveoscleral outflow. IV acetazolamide to reduce aqueous secretions.
63
What drugs are known to be a risk for causing acute dystonia?
Antipyschotics.
64
When might autonomic dysreflexia occur?
Patients with a spinal cord injury at or above T6. Afferent signal triggered by faecal impaction or urinary retention cause sympathetic spinal reflex via thoracolumbar outflow. This causes extreme hypertension, flushing, and sweating, agitation.
65
How is autonomic dysreflexia managed?
Removal/control of stimulus and treat life-threatening hypertension and/or bradycardia.
66
How do meningiomas present on CT?
Contrast enhancement.
67
What diagnosis would cause an older male to present with quadriceps and finger/wrist flexor weakness and raised CK?
Inclusion body myositis.
68
What would raised intracranial pressure and fever point towards?
A cerebral abscess.
69
What would the likely causative agent be in a case of meningitis caused by an ear infection?
Streptococcus pneumoniae.
70
What is a key side effect to be aware of with metoclopramide in younger patients?
Extrapyramidal effects - acute dystonia, oculogyric crisis.
71
What are some of the chronic side effects of phenytoin?
Gingival hyperplasia, hirsutism, coarsening facial features, lymphadenopathy, peripheral neuropathy, dyskinesia, megalobalstic anaemia.
72
What drug can cause hyperammonemic encephalopathy?
Sodium valproate, treated with L-carnitine.
73
How does an anterior spinal artery occlusion present?
Bilateral spastic paresis, bilateral loss of pain and temperature sensation.
74
Hoe does a pontine haemorrhage present?
Reduced GCS, paralysis, and bilateral pin point pupils.
75
What are some features that can differentiate a TIA from a mimic?
TIAs don't cause loss of consciousness. Recurrence of the same signs/symptoms is unlikely to be a TIA.
76
How should a patient with a suspected TIA be investigated?
MRI brain with diffusion-weighted imaging.
77
What disease presents with a recent history of upper respiratory tract infection, now with recurrent attacks of vertigo with nausea and vomiting and normal hearing?
Vestibular neuritis.
78
In a patient with Alport's syndrome, what is the ikely cause of a failing renal transplant?
Anti-GBM antibodies leading to a Goodpasture's syndrome like picture.
79
What are the five key features of HIV-associated nephropathy?
Massive proteinuria resulting in nephrotic syndrome, normal or large kidneys, focal segmented glomerulosclerosis with focal or global capillary collapsy on renal biopsy, elevated urea and creatinine, normotension.
80
What would normocytic anaemia, thrombocytopaenia and AKI post diarrhoeal illness make you consider?
Haemolytic uraemic syndrome.
81
What renal complication can occur due to a HIV drug?
Protease inhibitors like indinavir can precipitate intratubular crystal obstruction and renal stones.
82
What nephropathy is more common in coeliac disease?
IgA nephropathy.
83
What is an alternative to spironolactone which has caused troublesome gynaecomastia?
Eplerenone, another aldosterone antagonist.
84
What diet and insulin should patients with cystic fibrosis and diabetes be on?
High calorie intake, including high fat intake with extra insulin to control blood sugar.
85
How might severe eosinophilic asthma be managed?
Mepolizumab, a selective inhibitor of IL-5.
86
How does Klebsiella pneumoniae usually present?
In alcoholics and diabetics, sometimes following aspiration, red-current jelly sputum, cavitation in upper lobes.
87
What is a risk of high pressure non-invasive ventilation?
Pneumothorax.
88
What disease does silicosis predispose to?
Tuberculosis.
89
How should a solitary, solid, non-calcified lung nodule of less than 5mm size be managed?
No further investigation or monitoring. If 5-6mm or 8mm+ and low risk --> CT surveillance (1 year if 5-6mm, 3 months if 6mm+). If 8mm+ or high risk --> CT-PET --> biopsy if high uptake.
90
What are the As of ankylosing spondylitis?
Apical fibrosis, anterior uveitis, aortic regurgitation, achilles tendonitis, AV node block, amyloidosis.
91
What are the risks of concurrent methotrexate and trimethoprim use?
Bone marrow suppression and severe or fatal pancytopaenia.
92
What would cause low calcium, low phosphate, high alkaline phosphatase, and high PTH?
Osteomalacia. Osteoporosis and osteopetrosis have normal values for all four. Primary hyperparathyroidism causes increased calcium, ALP, and PTH but decreased phosphate. Chronic kidney disease causes secondary hyperparathyroidism and therefore decreased calcium but increased phosphate, ALP, and PTH. Paget's causes normal values apart from a raised ALP.
93
What are the next steps for a women aged over 75 years who has a fragility fracture but no DEXA scan yet?
Manage with alendronate, no need to wait for DEXA.
94
What antibodies are associated with polymyositis?
Anti-synthetase antibodies, anti-Jo-1 antibodies are seen if there is lung involvement/Raynaud's/fever.
95
How is Raynaud's phenomenon treated medically?
Calcium channel blockers first-line (e.g. nifedipine), or IV prostacyclin infusion (e.g. epoprostenol) with effect lasting weeks-months.
96
How does Still's disease present in adults?
Arthralgia, elevated serum ferritin, salmon-pink and maculopapular rash, pyrexia in the late afternoon/early evening daily with worsening joint symptoms and rash, lymphadenopathy, rheumatoid factor and ANA negative.
97
What is the most common cause of death in systemic sclerosis?
Respiratory involvement - interstitial lung disease and pulmonary arterial hypertension.
98
How are the two types of amiodarone induced thyrotoxicosis managed?
Type 1 (excess iodine-induced, goitre) --> carbimazole or potassium perchlorate. Type 2 (amiodarone-related destructive, no goitre) --> corticosteroids.
99
What should happen to amiodarone if someone develops amiodarone-induced hypothyroidism?
Continue it with levothyroxine.
100
What should happen to amiodarone if someone develops amiodarone-induced hypothyroidism?
Continue it with levothyroxine.

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