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Finals question bank > w/c 15/12 > Flashcards

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

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2
Q

hypertension 1/2/3/4 line drugs

A

Acei/ARB
CCB
thiazide diuretic
spironolactone/doxazosin or beta blocker

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3
Q

posterior MI ECG changes

A

ST depression
r waves
t waves normal
ST elevation in V7-9

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4
Q

amiodarone dosing VF

A

300mg after 3 shocks
150mg after 5 shocks

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5
Q

antithrombotic therapy for valve replacement

A

metallic= warfarin and aspirin
bioprosthetic= aspirin

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6
Q

what test is used to diagnose hereditary spherocytosis

A

EMA binding test

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7
Q

first line ocular myasthenia gravis

A

pyridostigmine

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8
Q

most common cancer causing brain mets

A

lung

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9
Q

radial nerve injury causes

A

inability to extend arm, forearm and fingers
lateral 3.5 digits sensory loss

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10
Q

triceps reflex nerve root

A

c7-c8

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11
Q

memantine moa

A

NMDA antagonism

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12
Q

donepezil moa

A

acetylcholinesterase inhibitor

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13
Q

where in the lung are adenocarcinomas found

A

peripherally

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14
Q

where in the lung are SCCs found

A

centrally

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15
Q

how to convert oral codeine to morphine

A

divide by 10

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16
Q

switch from oral to subcut morphine

A

divide by 1/2
divide by 1/3 for diapmorphine

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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

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18
Q

what is used for nausea and vomiting in palliative when a gastric cause is suspected

A

metaclopramide

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19
Q

first line in palliative care for respiratory secretions

A

hyoscine hydrobromide

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20
Q

what type of visual loss does macular degeneration cause

A

central

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21
Q

what type of visual loss does primary open angle glaucoma cause

A

peripheral

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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

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23
Q

hyperkalemia QRS complex change

A

widened

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24
Q

how does respiratory alkalosis affect calcium, phosphate and ALP levels

A

low calcium
normal phosphate

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25
Q

how to differentiate 3rd nerve palsy from horners syndrome

A

3rd nerve palsy= dilated pupil
horners= constricted pupil

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26
Q

proliferative retinopathy mx

A

anti VEGF
pan retinal photocoagulation

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27
Q

how are drusen seen on fundoscopy

A

amber retinal deposits

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28
Q

when is propylthiouracil used over carbimazole

A

in child bearing age

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29
Q

what ix is done in subclinical hypothyroidism to see if they will progress to overt hypothyroidism

A

thyroid peroxidase antibodies

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30
Q

subclinical hypothyroidism TFTs

A

TSH high
T4 normal

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31
Q

subclinical hyperthyroidism TFTs

A

TSH low
T4 normal

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32
Q

over replacement of thyroxine causes what

A

osteoporosis

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33
Q

1st line for acromegaly from pituitary tumor

A

trans shpenoidal resection

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34
Q

what causes a false low HbA1c

A

decreased red cell survival

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35
Q

maximum metformin dose

A

1g BD

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36
Q

how many units of insulin in 1ml

A

100

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37
Q

T1DM minimum glucose monitoring

A

before each meal and before bed (4x day)

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38
Q

how often should diabetics on insulin check their blood glucose while driving

A

before they start then every 2 hrs

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39
Q

thyrotoxic storm medications

A

propylthiouracil
hydrocortisone
beta blockers

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40
Q

what steroid is given in thyrotoxic storm

A

hydrocortisone

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41
Q

what thyroid lowering drug is given in thyrotoxicosis

A

propylthiouracil

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42
Q

addisons sick day steroid rules

A

double glucocorticoids
keep mineralocorticoid the same

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43
Q

what test is used to diagnose cushings

A

low dose dexamthasone supression test

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44
Q

myxoedema coma mx and explain

A

IV thyroid replacement
IV hydrocortisone

if they have addisions, the thyroid replacement can precipitate a crisis so give hydrocortisone to avoid this

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45
Q

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?

A

<140/90

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46
Q

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?

A

< 135/85

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47
Q

most likely adverse effect of radioiodine therapy

A

hypothyroidism

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48
Q

clinic reading BP target for hypertension in <80yrs

A

< 140/90

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49
Q

what medication causes proximal myopathy

A

steroids

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50
Q

acid base imbalance seen in cushings

A

hypokalemic metabolic alkalosis

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51
Q

TFTs in sick euthyroid

A

low t3/t4 but normal TSH (in acute illness)

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52
Q

most common thyroid cancer

A

papillary

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53
Q

most common complication of papillary thyroid cancer

A

spread to cervical lymph nodes

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54
Q

what blood test is most important in assessing response to levothyroxine in hashimotos

A

TSH

55
Q

if someone is hypocalcaemic and not responding to replacement, what could be going on

A

magnesium deficiency

56
Q

mutation for MODY

A

HNF-1 alpha

57
Q

best medication for MODY

A

sulfonylurea

58
Q

if there is renal impairment after starting an ACEi, what is the cause

A

underlying bilateral renal artery stenosis

59
Q

when is unsynchronised vs synchronised cardioversion used

A

unsynchronised only in emergency situations where it cant be synchronised eg pulseless VT or fibrillation

otherwise synchronise it

60
Q

most common cause of mitral stenosis

A

rheumatic fever

61
Q

what valve problem causes AF

A

mitral stenosis

62
Q

what test can indicate pre renal AKI

A

low urinary sodium

in hypovolemia the body will reabsorb sodium to encourage water to follow with it so urinary sodium will be low

63
Q

water requirement for adults in IV fluids

A

25-30ml/kg/day

64
Q

potassium sodium and chloride requirement for adults on IV fluids

A

1mmol/kg/day

65
Q

glucose requirement for adults on IV fluids

A

50-100g/day

66
Q

platelet levels in HSP

A

normal

purpura is non thrombocytopenic

67
Q

what valve abnormality is a complication of adult PCKD

A

mitral valve prolapse

68
Q

when is treatment for hyperkalemia commenced

A

everyone with potassium over 6.5

those with ECG chnages

69
Q

what body type may have a low gfr

A

those with a high muscle mass

70
Q

how does nephrotic syndrome affect thyroid levels

A

causes low thyroid hormones

71
Q

what needs to be monitored in HSP

A

blood presssure and urinalysis

72
Q

main side effect of bisphosphonates

A

oesophageal problems eg heartburn

73
Q

what TB drug causes lupus

A

isoniazid

74
Q

what ix should be done before starting anti TNF and why

A

chest x ray to look for TB as it can be reactivated

75
Q

how is a diagnosis of ank spond best supported

A

pelvic x ray
sacroilitis is seen early

76
Q

granulomatosis with polyangitis antibody

A

c ANCA

77
Q

phosphate levels in tertiary hyperparathyroidism

A

high as kidneys cant excrete it

78
Q

1st line mx for reactive arthritis

A

nsaids

79
Q

when are bisphosphonates started immediately in a fragility fracture

A

> 75 yrs

80
Q

what condition increases risk of pseudogout

A

haemochromotosis

81
Q

ACA stroke sx

A

contralateral hemiparesis and sensory loss

lower limbs>upper

82
Q

MCA stroke sx

A

contralateral hemiparesis and sensory loss

upper limbs>lower

83
Q

PCA stroke sx

A

contralateral homonymous hemianopia with macular sparing

visual agnosia

84
Q

PICA stroke

A

ipsilateral face pain and temp loss

contralateral pain and temp loss

ataxia, nystagmus

85
Q

AICA stroke

A

ipsilateral face pain and temp loss

contralateral pain and temp loss

reduced hearing and facial paralysis

86
Q

webers syndrome stroke

A

ipsilateral cn III palsy
contralateral limb weakness

87
Q

webers syndrome stroke is what vessel occulsion

A

branches of the PCA that supply the midbrain

88
Q

what is lateral medullary syndrome

A

aka wallenberg syndrome
PICA stroke

89
Q

what is wallenberg syndrome

A

aka lateral medullary syndrome
PICA stroke

90
Q

what is lateral pontine syndrome

A

AICA stroke

91
Q

PICA stroke is also known as

A

lateral medullary syndrome
wallenberg syndrome

92
Q

AICA stroke is also known as

A

lateral pontine syndrome

93
Q

basilar artery stroke sx

A

locked in syndrome

94
Q

retinal/ opthalmic artery stroke

A

amaurosis fugax

95
Q

what is tinels test for

A

carpal tunnel

96
Q

in a mid shaft humeral fracture what nerve may be at risk

A

radial

97
Q

what does radial nerve palsy cause

A

wrist drop

98
Q

isolated vertical diplopia is due to what cranial nerve palsy

A

trochlear

99
Q

how does the uvula deviate in vagus nerve palsy

A

away from the side with the lesion

100
Q

onsansetron moa

A

5 ht3 antagonist

101
Q

degenerative cervial spondyloparthropathy imaging

A

MRI

102
Q

ondansetron side effects

A

prolonged QT
VT
constipation

103
Q

how to differentiate PSP from multisystem atrophy

A

in PSP there is impairment of vertical gaze

104
Q

sx of a TIA resolve in

A

24 hrs

105
Q

jacksonian movements indicate the seizure originated in what lobe

A

frontal

106
Q

MS bladder dysfunction next step

A

US KUB to assess post void residual volume/ bladder emptying

107
Q

in a bitemporal hemianopia what does the lower quadrants being affected more suggest

A

superior chaismal compression
more likely a craniopharyngioma

108
Q

in a bitemporal hemianopia what does the upper quadrants being affected more suggest

A

inferior chiasmal compression
more likely a pituitary adenoma

109
Q

what cranial nerves are effected in a vestibular schwannoma

A

V, VII and VIII

110
Q

out of propanolol and topiramate for migraine prophylaxis what is preferred

A

propanolol in women of child bearing age

111
Q

when is prothrombin complex concentrate given alongside vitamin K in reversal of warfarin

A

if there is a major bleed
minor bleed= give just vit K

112
Q

where is pulmonary stenosis heard loudest

A

2nd ICS left sternal edge

113
Q

for how long post MI can you not drive

A

4 weeks

114
Q

when are rate limiting CCBs used instead of non rate limiting

A

when the patient has angine or heart block

115
Q

rate limiting CCB examples

A

verapamil
diltiazem

116
Q

when are adrenaline and amiodarone given in ALS

A

adrenaline every 3-5 mins, give asap in non shickable rhythms
amiodarone after 3 shocks in shockable rhythms and again after 5 shocks

117
Q

post MI VSD sx

A

acute heart failure develops 5 days after MI with a pan systolic murmur

118
Q

mx for regular VT

A

amiodarone

119
Q

when does coarctation of the aorta present

A

at 2 days when the duct supplying the inferior aorta is cut off

120
Q

nstemi mx

A

give aspirin 300mg
if grace >3% do PCI
if not give fondaparinux and ticagrelor

121
Q

rheumatic fever mx

A

IM benpen

122
Q

borad qrs complex

A

> 0.12 secs

123
Q

statin plus what abx is bad and what happens

A

macrolide

causes rhabdo and hepatotoxicity

124
Q

bisfriens pulse

A

2 systolic beats

seen in HOCM

125
Q

if someone has an acute stroke and AF when should anticoagulation be started

A

after 7 days

126
Q

most specific ECG finding in acute pericarditis

A

PR depression

127
Q

time window for cardioverting new onset AF

A

48 hrs

128
Q

primary hyperaldosteronism mx

A

spironolactone

129
Q

what mx for graves disease worsens eye disease

A

radioiodine

130
Q

which steroid is given acutely in an addisonian crisis

A

hydrocortisone

131
Q

in hypercalcaemia due to malignancy what happens to PTH

A

PTH levels are low

PTHrP is high

132
Q

what complication occurs in HHS if insulin is given rapidly

A

central pontine myelinolysis

133
Q
A

Finals question bank (6 decks)

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