w/c 15/12 Flashcards
1
Q
stable angina mx
A
beta blocker first line
if not tolerated rate limiting CCB eg verapamil or diltiazem
second line add the other one (non di hydropyrimadine CCB eg amlodipine, nifedipine)
if not tolerated add long acting nitrate/ ivabradine/ nicorandil
dont add a third drug unless waiting for PCI/CABG
2
Q
hypertension 1/2/3/4 line drugs
A
Acei/ARB
CCB
thiazide diuretic
spironolactone/doxazosin or beta blocker
3
Q
posterior MI ECG changes
A
ST depression
r waves
t waves normal
ST elevation in V7-9
4
Q
amiodarone dosing VF
A
300mg after 3 shocks
150mg after 5 shocks
5
Q
antithrombotic therapy for valve replacement
A
metallic= warfarin and aspirin
bioprosthetic= aspirin
6
Q
what test is used to diagnose hereditary spherocytosis
A
EMA binding test
7
Q
first line ocular myasthenia gravis
A
pyridostigmine
8
Q
most common cancer causing brain mets
A
lung
9
Q
radial nerve injury causes
A
inability to extend arm, forearm and fingers
lateral 3.5 digits sensory loss
10
Q
triceps reflex nerve root
A
c7-c8
11
Q
memantine moa
A
NMDA antagonism
12
Q
donepezil moa
A
acetylcholinesterase inhibitor
13
Q
where in the lung are adenocarcinomas found
A
peripherally
14
Q
where in the lung are SCCs found
A
centrally
15
Q
how to convert oral codeine to morphine
A
divide by 10
16
Q
switch from oral to subcut morphine
A
divide by 1/2
divide by 1/3 for diapmorphine
17
Q
what is used for palliative pain relief when there is renal impairment
A
buprenorphine or fentanyl
oxycodone over morphine if impairment is mild
18
Q
what is used for nausea and vomiting in palliative when a gastric cause is suspected
A
metaclopramide
19
Q
first line in palliative care for respiratory secretions
A
hyoscine hydrobromide
20
Q
what type of visual loss does macular degeneration cause
A
central
21
Q
what type of visual loss does primary open angle glaucoma cause
A
peripheral
22
Q
if magnesium and potassium are low how is this managed
A
correct the magnesium then reassess both by doing bloods in 2 weeks
low mg causes low k
23
Q
hyperkalemia QRS complex change
A
widened
24
Q
how does respiratory alkalosis affect calcium, phosphate and ALP levels
A
low calcium
normal phosphate
25
how to differentiate 3rd nerve palsy from horners syndrome
3rd nerve palsy= dilated pupil
horners= constricted pupil
26
proliferative retinopathy mx
anti VEGF
pan retinal photocoagulation
27
how are drusen seen on fundoscopy
amber retinal deposits
28
when is propylthiouracil used over carbimazole
in child bearing age
29
what ix is done in subclinical hypothyroidism to see if they will progress to overt hypothyroidism
thyroid peroxidase antibodies
30
subclinical hypothyroidism TFTs
TSH high
T4 normal
31
subclinical hyperthyroidism TFTs
TSH low
T4 normal
32
over replacement of thyroxine causes what
osteoporosis
33
1st line for acromegaly from pituitary tumor
trans shpenoidal resection
34
what causes a false low HbA1c
decreased red cell survival
35
maximum metformin dose
1g BD
36
how many units of insulin in 1ml
100
37
T1DM minimum glucose monitoring
before each meal and before bed (4x day)
38
how often should diabetics on insulin check their blood glucose while driving
before they start then every 2 hrs
39
thyrotoxic storm medications
propylthiouracil
hydrocortisone
beta blockers
40
what steroid is given in thyrotoxic storm
hydrocortisone
41
what thyroid lowering drug is given in thyrotoxicosis
propylthiouracil
42
addisons sick day steroid rules
double glucocorticoids
keep mineralocorticoid the same
43
what test is used to diagnose cushings
low dose dexamthasone supression test
44
myxoedema coma mx and explain
IV thyroid replacement
IV hydrocortisone
if they have addisions, the thyroid replacement can precipitate a crisis so give hydrocortisone to avoid this
45
what is target blood pressure for a 56-year-old man with type 2 diabetes mellitus who has no end-organ damage, if using a clinic blood pressure reading?
<140/90
46
what is target blood pressure for a 56-year-old man with type 2 diabetes mellitus who has no end-organ damage, if using ABPM?
< 135/85
47
most likely adverse effect of radioiodine therapy
hypothyroidism
48
clinic reading BP target for hypertension in <80yrs
< 140/90
49
what medication causes proximal myopathy
steroids
50
acid base imbalance seen in cushings
hypokalemic metabolic alkalosis
51
TFTs in sick euthyroid
low t3/t4 but normal TSH (in acute illness)
52
most common thyroid cancer
papillary
53
most common complication of papillary thyroid cancer
spread to cervical lymph nodes
54
what blood test is most important in assessing response to levothyroxine in hashimotos
TSH
55
if someone is hypocalcaemic and not responding to replacement, what could be going on
magnesium deficiency
56
mutation for MODY
HNF-1 alpha
57
best medication for MODY
sulfonylurea
58
if there is renal impairment after starting an ACEi, what is the cause
underlying bilateral renal artery stenosis
59
when is unsynchronised vs synchronised cardioversion used
unsynchronised only in emergency situations where it cant be synchronised eg pulseless VT or fibrillation
otherwise synchronise it
60
most common cause of mitral stenosis
rheumatic fever
61
what valve problem causes AF
mitral stenosis
62
what test can indicate pre renal AKI
low urinary sodium
in hypovolemia the body will reabsorb sodium to encourage water to follow with it so urinary sodium will be low
63
water requirement for adults in IV fluids
25-30ml/kg/day
64
potassium sodium and chloride requirement for adults on IV fluids
1mmol/kg/day
65
glucose requirement for adults on IV fluids
50-100g/day
66
platelet levels in HSP
normal
purpura is non thrombocytopenic
67
what valve abnormality is a complication of adult PCKD
mitral valve prolapse
68
when is treatment for hyperkalemia commenced
everyone with potassium over 6.5
those with ECG chnages
69
what body type may have a low gfr
those with a high muscle mass
70
how does nephrotic syndrome affect thyroid levels
causes low thyroid hormones
71
what needs to be monitored in HSP
blood presssure and urinalysis
72
main side effect of bisphosphonates
oesophageal problems eg heartburn
73
what TB drug causes lupus
isoniazid
74
what ix should be done before starting anti TNF and why
chest x ray to look for TB as it can be reactivated
75
how is a diagnosis of ank spond best supported
pelvic x ray
sacroilitis is seen early
76
granulomatosis with polyangitis antibody
c ANCA
77
phosphate levels in tertiary hyperparathyroidism
high as kidneys cant excrete it
78
1st line mx for reactive arthritis
nsaids
79
when are bisphosphonates started immediately in a fragility fracture
>75 yrs
80
what condition increases risk of pseudogout
haemochromotosis
81
ACA stroke sx
contralateral hemiparesis and sensory loss
lower limbs>upper
82
MCA stroke sx
contralateral hemiparesis and sensory loss
upper limbs>lower
83
PCA stroke sx
contralateral homonymous hemianopia with macular sparing
visual agnosia
84
PICA stroke
ipsilateral face pain and temp loss
contralateral pain and temp loss
ataxia, nystagmus
85
AICA stroke
ipsilateral face pain and temp loss
contralateral pain and temp loss
reduced hearing and facial paralysis
86
webers syndrome stroke
ipsilateral cn III palsy
contralateral limb weakness
87
webers syndrome stroke is what vessel occulsion
branches of the PCA that supply the midbrain
88
what is lateral medullary syndrome
aka wallenberg syndrome
PICA stroke
89
what is wallenberg syndrome
aka lateral medullary syndrome
PICA stroke
90
what is lateral pontine syndrome
AICA stroke
91
PICA stroke is also known as
lateral medullary syndrome
wallenberg syndrome
92
AICA stroke is also known as
lateral pontine syndrome
93
basilar artery stroke sx
locked in syndrome
94
retinal/ opthalmic artery stroke
amaurosis fugax
95
what is tinels test for
carpal tunnel
96
in a mid shaft humeral fracture what nerve may be at risk
radial
97
what does radial nerve palsy cause
wrist drop
98
isolated vertical diplopia is due to what cranial nerve palsy
trochlear
99
how does the uvula deviate in vagus nerve palsy
away from the side with the lesion
100
onsansetron moa
5 ht3 antagonist
101
degenerative cervial spondyloparthropathy imaging
MRI
102
ondansetron side effects
prolonged QT
VT
constipation
103
how to differentiate PSP from multisystem atrophy
in PSP there is impairment of vertical gaze
104
sx of a TIA resolve in
24 hrs
105
jacksonian movements indicate the seizure originated in what lobe
frontal
106
MS bladder dysfunction next step
US KUB to assess post void residual volume/ bladder emptying
107
in a bitemporal hemianopia what does the lower quadrants being affected more suggest
superior chaismal compression
more likely a craniopharyngioma
108
in a bitemporal hemianopia what does the upper quadrants being affected more suggest
inferior chiasmal compression
more likely a pituitary adenoma
109
what cranial nerves are effected in a vestibular schwannoma
V, VII and VIII
110
out of propanolol and topiramate for migraine prophylaxis what is preferred
propanolol in women of child bearing age
111
when is prothrombin complex concentrate given alongside vitamin K in reversal of warfarin
if there is a major bleed
minor bleed= give just vit K
112
where is pulmonary stenosis heard loudest
2nd ICS left sternal edge
113
for how long post MI can you not drive
4 weeks
114
when are rate limiting CCBs used instead of non rate limiting
when the patient has angine or heart block
115
rate limiting CCB examples
verapamil
diltiazem
116
when are adrenaline and amiodarone given in ALS
adrenaline every 3-5 mins, give asap in non shickable rhythms
amiodarone after 3 shocks in shockable rhythms and again after 5 shocks
117
post MI VSD sx
acute heart failure develops 5 days after MI with a pan systolic murmur
118
mx for regular VT
amiodarone
119
when does coarctation of the aorta present
at 2 days when the duct supplying the inferior aorta is cut off
120
nstemi mx
give aspirin 300mg
if grace >3% do PCI
if not give fondaparinux and ticagrelor
121
rheumatic fever mx
IM benpen
122
borad qrs complex
>0.12 secs
123
statin plus what abx is bad and what happens
macrolide
causes rhabdo and hepatotoxicity
124
bisfriens pulse
2 systolic beats
seen in HOCM
125
if someone has an acute stroke and AF when should anticoagulation be started
after 7 days
126
most specific ECG finding in acute pericarditis
PR depression
127
time window for cardioverting new onset AF
48 hrs
128
primary hyperaldosteronism mx
spironolactone
129
what mx for graves disease worsens eye disease
radioiodine
130
which steroid is given acutely in an addisonian crisis
hydrocortisone
131
in hypercalcaemia due to malignancy what happens to PTH
PTH levels are low
PTHrP is high
132
what complication occurs in HHS if insulin is given rapidly
central pontine myelinolysis
133
