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year 6 > week 1 > Flashcards

week 1 Flashcards

1
Q

xachalasia

A

cxr
pneumatic dilation

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2
Q

HT

A

180/110 = admitting
stage 2 = 160/100
clinic vs ABPM targets
acromegaly
PCKD
steroids
s4 HS
urine dip
if high offer ABPM but if signs of end organ damage - tx immediately/ 180/110 = admit
if ABPM >135/85 - treat if rfs e.g. diabetes high QRISK, if 150/95 = treat
145/85 target in elderly

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3
Q

malignant ht

A

IV esmolol
IV hydralazine nitroprusside

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4
Q

keratitis

A

slit lamp
CLARE
cycloplegic - cyclopentolate for pain relief
psuedomonas in contact lens - corneal scrap and culture of contact lens solution
viral assay, immunofluorescence - herpes

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5
Q

af

A

valvular probs, PE, HT
check for signs of HF
absence of a wave on JVP
3 weeks anticoag before also 4 weeks after
haemodynamically unstable = shock
paroxysmal - pill in pocket
digoxin in coexistant heart failure
review in 1 week
CHADVASC and ORBIT
CHF, new onset and reversible
1st line flecainide

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6
Q

stroke

A

swallow assessment
NIHSS - 42 max
haemosiderin
Rosier
clotting screen
stroke rehab
barthel index
feeding assessment - NG tube
posterior inferior = horner’s

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7
Q

leukaemia

A

AML: gum hypertrophy, immunophenotyping
PICC line
CML: imatinib, hydroxycarbamide
ALL: high LDH, high uric acid
CLL: unmutated immunoglobulin, TP53, Rcihter’s –> NHL

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8
Q

conn’s

A

most common in bilateral adrenal hyperplasia - treat w spironolactone
if adenoma = laporoscopic adrenolectomy
renin:aldosterone first line
adrenal venous sampling
polyuria and polydipsia

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9
Q

crystal arthropathies

A

gout: loop diuretics, pyrazinamide, podagra, excess etoh
if warfarin, peptic ulcer no NSAIDS
steroids in renal impairment in acute attack
febuxostat instead of allopurinol
review 4-6 weeks after attack
pseudogout: hypothyroid, OA, knees wrists, hips
rat bite = gout
admit if septic

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10
Q

pancreatic cancer

A

trousseau’s sign of malignancy
pancreatic protocol CT
pale grey stools

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11
Q

c difficile

A

PPIs
toxic megacolon, hypotension
PO vanc 1st line
severe add IV metronidazole
abdo X ray
raised WCC but little change in CRP

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12
Q

herpes

A

herpes meningitis
NAAT
target lesions
ramsay hunt: aciclovir 7 days, steroids 5 days
shignles: within 72 hours

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13
Q

cushings

A

acth dep and independ
ankle oedema
acth suppressed in high dose for both
insulin stress test pseudo
nelson
osteoporosis
hypokalaemic met alk

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14
Q

polymyalgia

A

ddx is myeloma
steroid card - ue’s

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15
Q

bell’s

A

72 hours within steroids
3 weeks no improvemnt - ENT
kerotoconjucrivitis sicca
hyperacuisis
post uricular pain
corneal ulcers
lyme ramsay

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16
Q

glomerulonephritis

A

cyclophosphamide, prophylactic trimethoprim
complement levels
plasmapharesis
bp control

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17
Q

hip fracture

A

long term steroids
stable fracture, undisplaced, displaced, boney disruption
subtroachanteric and intertrochanteric are extracapsular
dynaic hip screw in stable intertrochanteric

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18
Q

sjogrens

A

NHL
hydroxychlrooquine/ methotrex
congenital heart block

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19
Q

haemorrhoids

A

injection sclerotherapy
pruritus
proctoscopy

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20
Q

rectal prolapse

A

type 1 just mucosa
type 2 all layers of rectum
MS, cauda equina

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21
Q

myocarditis

A

rise in CK and trops without ischaemia
coxsackie , SLE< doxorubicin
HF signs and symps

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22
Q

EAA

A

aka hypersensitvitiy pneumonitis
pigeon fanciers sugar workers
wheeze
fine inspiraotry
ground glasss ct
IgG

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23
Q

meningitis

A

brudzinski - flex neck when hips flexed
bacterial - raised protein, TB - lymphocytes and low glucose
rifampicin for close contacts
IV dex
sepsis 6

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24
Q

non-functioning

A

MRI with contrast
visual field testing
bromocriptine
radiotherapy
hypophysectomy

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25
Q

epididymo

A

MSSU
urine dip
doxycycline

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26
Q

breast cancer

A

predictnhs, trastuzumab, nottingham prognostic
letrozole
cytology for cyst/solid/benign/malg
histology for grade and receptor status
liver USS, CXR
sentinal lymph node biopsy
ashkenazi jews

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27
Q

varicose

A

3mm or more
atrophie blanche
varicose eczema
2 sounds on doppler = incompetent
graduated compression stockings
phlebectomy

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28
Q

osa

A

can cause HT
urgent referral to sleep clinic

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29
Q

retinal detachment

A

previous cataract surgery
sudden onset painless vision loss
red reflex lost
if macular involvement - central acuity affected
if optic nerve incolvement - relative afferent pupillary defect
laser/ cryotherapy

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30
Q

tumour lysis syndrome

A

hypocalcaemia
oliguira/ dysuria
allopurinol

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31
Q

urticaria

A

remove trigger

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32
Q

orbitl/periorbital

A

behind orbital septum
anterior -peri
CT orbit
proptosis
mdt - opthalm, ent

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33
Q

delirium

A

reversible
constipation, dehydration, malnutrition
ECG
hallucinations
glasses and hearing aids

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34
Q

apls

A

CLOT - livedo reticularis, thrombocytopenia
low dose aspriin
warfarin target 2-3, recurrent -4
fallse long APTT add more phospholipids
12 weeks apart 2 occasions - at least 1
pregnancy - LMWH
cocp avoidance, control cardiac rf’s

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35
Q

essential thrombocytosis

A

erythromelalgia
headaches - viscosity
low risk - aspriin, intermediate - either, high - aspriin and hydroxycarbamide
(cardiac rfs, rlly high platelets, previous haemorrhage/ thrombosis) - age
trephine biopsy

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36
Q

necrotising fasciitis

A

t1 - anaerobes polymicrobial t2 - mono, t3 - perfringens
not underlying muscle
fournier’s gangrene - sglt2

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37
Q

tinea

A

terbinafine
onycholysis

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38
Q

epidermoid

A

central punctum
not sebum
keratin containing

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39
Q

vaculitides

A

mononeuritis multiplex - wrist/ foot drop
anca -ve
takayasu - weak/ unequal upper limb pulses + claudication, MR angiogram
polyarteritis nodosa - antivirals, if not hep B - cyclophsopahmide + steroids, rosary bead sign on renal angiogram, GI
kawasaki: high dose aspirin + IVIG
wegenr’s: cyclo + preg, proptosis
microscopyic: glomerulonephritis
cryoglobulinaemia: SLE (mixed), myeloma (simple)

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40
Q

peripehral nerve

A

median nerve: supracondylar, close to elbow, FOOSH, semi flexed position
ulnar: ulnar paradox, elbow, fromet’s sign (adductor pollicis), good luck sign
radial: shaft of humerus, radial head, triceps weakness
axillary: weak abduction, extension lag test
common peroneal: inverted, high stepping gate, neck of fibula, extensor hallucis longus, sensory loss of dorsum and lower later leg
lumpske’s C8-T1 - horber’s
cubital tunnel
spironolactone
lactulose and rifaximin
therapeutic paracentesis
hep A/B, fly/pneumococcal

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41
Q

cirrhosis

A

JBAE = decompensated
secondary - RHF, methotrexate
AFP, liver biopsy - percutaneous, transjugular (clotting probs/ ascitic), child pugh - PT. albumin, bilirubin, ascites, encephalopathy

42
Q

bowel obs

A

hernias
dievrticular disease
proximal is dilated, distal is collapse
srgical if perforated
erect CXR
catheter
CT w/ gastograffin

43
Q

rheumatic

A

CASES FRAP - marginatum
aspirin, steorids, ABx
benzathine penicillin prophylaxis
2-6 weeks after ifnection
Jone’s - 2 majors/ 2 minors + 1 major

44
Q

tricuspid regurg

A

ebstein’s anomoly
annuloplasty
carcinoid
p pulmonale
prominent V waves

45
Q

pneumoconiosis

A

beryllium lymphocyte proliferation test - coal
eggshelol calcification in hilar - silicosis
cor pulmonale

46
Q

trigeminal

A

compression, MS
carbamezepine only

47
Q

acromegaly

A

osteoarthritis
carpal tunnel
gynaecomastia
macroglossia
pituitayr profile
fundoscopy

48
Q

thyroid cancer

A

lymphoma - hashimoto’s
yearly thyroglobulin (pap, foll)
tracheal deviation
radioiodine to kill residual cells

49
Q

CKD

A

HT
statin, ACEi
SGLT2 inhibitors
vaccines
low salt diet
phosphate binders
SLE

50
Q

menieres

A

unilateral
NV
excess fluid so initiually diuretics and low salt
betahistine
antihistamines
fullness in ear
intermittent

51
Q

thyroid eye disease

A

dry eyes
exposure keratosis
compression optic neuropathy
diplopia
dry eyes
smoking is rf

52
Q

haemophilia

A

avoid aspirin and NSAIDs

53
Q

conjunctivitis

A

conjunctival papillae
conjunctival follicles

54
Q

GORD

A

PPI trial
H.pylori
Barrett’s oesophagus
conservative - small diet, lose weight
lying flat

55
Q

raynauds

A

primary is bilateral, secondary = unilateral
leukaemia
dilated nail folds
white –> blue –> red
COCP, cervical rib

56
Q

sle

A

pleurisy
anti-Sm
vaccines
belilumab, rituximab
severe flares = pred + IV cyclophosphamide
ACEi
Lupus nephritis

57
Q

gallstones

A

cocp
ercp, lfts normalise then chole
no need to admit
phrenic nerve - scapula pain

58
Q

hernia

A

superiomedial, inferolateral
indirect lateral to inferior epigastric
deep ring occlude - indirect
patent processus vaginalis
rectus abdominas, inferior epigastric, inguinal canal

59
Q

PBC

A

high cholesterol
granuloma
ursodeoxycholic acid
middle aged females
other AI e.g. RA, sjogren

60
Q

appendicitis

A

lanz, mcburney’s excision
obturator, psoas - retrocoecal, rovsing sign

61
Q

aortic dissection

A

bicuspid, coarctation
INFERIOR MI
anterior spinal, coronary, coeliac
blood pressure different >20mmhg
unequal pulses
cross match
CXR - wodened mediastinum
IV labetalol for both
A - TEVAR thoracoc endovascular aortic repair
cardiothoracic + vascular

62
Q

IE

A

Dukes
1 major + 3 minor
5 minor
roth spots
prolonged PR itnerval
transoesophageal
FLAWS
colorevtal cancer
MATP
amx + gent
sugery: aortic abscess (PR), severe valvular incompetence, recurrent emboli after abx, resistant to abx
if staph then fluclox

63
Q

tb

A

cervical lymph nodes
sterile pyuria
addisions, pott’s
caseating granulomas
meningitis
HIV test
amikacin for drug resistant

64
Q

pneumothorax

A

reexpansion pulmonary oedema
needle decomrpession 2nd ICS MCL
chest drain - lat dorsi, pec major, axilla, 5th ICS (4,6th ICS MAL)
air flying, follow up 2 weeks later
in tension 2 hours later
stop smoking
VATS - recurrent, bullectomy

65
Q

neurofibromatosis

A

AD
NF1 - axillary/groin freckles, phaeochromo, lisch nodules, RAS
opthalm, audiometry
MRI brain and spine
scoliosis
BP monitoring

66
Q

parkinsons

A

MSA - bladder dysfunction
lead pipe
REM sleep disorder
MRI humming bird Mickey
resting tremor
selegiline - maob inhibitor
da
drymouth, insomnia, NV
co-careldopa (dopa decarboxylase inhb)
medication by specialist

67
Q

diabetic neph

A

ratio >2.5

68
Q

hypopituitarism

A

hypphtalamic dusfucntion - anorexia
insulin stress test
GH lost first - dec muscle strength, inc abdo fat
central DI can occur as result - desmopressin
osteoporosis

69
Q

renal cell carcinoma

A

TS
clear cell
obesity, PCKD
strauffer’s syndrome - deranged LFTs
>45 haematuria persisting
paraneoplastic - fever, PTH, cushing’s
abdo mass
>7cm radical nephrectomy
<4cm partial
nephroureterectomy if transitional

70
Q

prostate cancer

A

back pain
prostate acid phosphatase
gleason score
radio - proctits, bladder cancer
transrectal USS guided biopsy
goserelin
urosepsis following biopsy - rigors, confusion
multi parametric MRI

71
Q

aaa

A

> 3cm, x1.5
smoking, atherosclerosis
check popliteal
doppler USS - 1st
CT
3-4.4 - eevry year
4.5-5.4 - 3 months
5.5> = 2 week to vascular
EVAR - stent to stop blood collecting in aneurysm
crossmatch 6 units blood, fluid resuscitate
comp: endoleak, abdominal compartment syndrome
5.5, symptomatic, rapidly enlarging, ruptured

72
Q

epistaxis

A

anticoagulants
nasal balloon catheter
posterior bleed = admit

73
Q

central retinal artery occlusion

A

RAPD, thromboeembolism/ GCA
steroids if GCA
ocular massage/ intrarterial thromblysis/ anterior chamber paracentesis/ vasodilation isosorbide dinitrate
rapid unilateral vision loss

74
Q

burns injury

A

burns calculator
ck, ecg
stridor
toxic shock syndrome
>10% burns - burns unit
escharotomy
urinary catheter
superficial epidermal, parital thickness (superficial dermal), deep dermal, full thickness

75
Q

anaphylaxis

A

500mcg 1:1000
remove tirgger, lie down raise legs
dietitcian if food related
allergy clinic

76
Q

myelodysplasia

A

after chemo/ radio
ringed sideroblasts, basophilic stippling
hypomethylating agents
erythropiein stimualtign agents, myeloid growth factors

77
Q

epiglottitis

A

dex and cefuroxime
rifampicin for household conatcts

78
Q

GCA

A

anterior ischaemic optic neuropathy
ALP raised and platelets
tocilizumab
18-24 months steroids

79
Q

hypermobility

A

thin stretchy skin
diarrhoea/ constipatiion
physio + OT
strengthening exercises
simple analgesia

80
Q

acute liver failure

A

kings college critieria -ph<7.3/ grad3/4 enceph, PT >100, creatinine >300
fluids, hypogly = bad
empirical abx
hepatorenal, infection (most common)
enceph coag, jaundice
<7, 7-28, 4-12 weeks (hyperacute, acute, subacute)

81
Q

oesophageal cancer

A

> 55
scleroderma, achalasia, plummer vinson syndrome (dysphagia, IDA, oesophageal webs, glossitis)

82
Q

perineal abscess fistula

A

fistula can be comp of abcess
diabetic unablet o defaecate w/ swinging fevers
MRI for fistulae
low = fistulotomy, high = seton as incontinence
pepper pot perineum - multiple in crohn’s

83
Q

cardiac arrest

A

ecg
hypothermia, hypoxia, hypo/hyperkalaemia, hypovolaemia, hydrogen ions
thromboembolism, tamponade, toxina, trauma, tension pneumothorax

84
Q

heart block

A

digoxin, electrolytes, IE, sarcoidosis
stokes-adams
cannon a waves
ifnerior MI not indication for pacing
500mcg
transvenous after transcutaenous

85
Q

copd

A

CAT, ADLs
30mg pred and abx 5 days
rescue pack - steroids _ abx
pulm rehab
SABA/ SAMA –> SABA + LABA + SAMA –> +ICS
peak flow, diurnal variability
IV 200mg hydrocortisone, 24% venturi 2-3l / 28% 4l
NIV
influenza and pneum vaccines
ABG two occasions 3 weeks apart - pao2<7.3 LTOT
lung volume red - paco2<7.3, upper lobe emphysema, fev1<50, TLCO >20
MDI –> DPI

86
Q

PE

A

CXR - wedge
low o2 despite max o2
IVC filters
embolectomy if alteplase CI
malignancy
resp alkalosis
ecg
d-dimer, leg scan if DVT suspected
>4

87
Q

radiculopathy

A

spondylolisthesis
ligamentum hypertrophy
LMN and muscle wasting
steroid injections, weight loss, physio

88
Q

gbs

A

ascending paraesthesia
IV immunoglobulin + plasmapharesis
normal WCC, high protein
ataxia, arreflexia - miller
anti ganglioside
nerve conduction studies
vaccine, URTI

89
Q

hypothyroidism

A

radiation
sarcoid, haem, wilsons
myxoedema coma - ITU, thyroxine, IV hydrocortisone, fluids, glucose, HF - confusion, hypothermia, hypoventilation
recheck 3 monthlu until stable then annually

90
Q

phaeo

A

neurofibromatosis 1
phenoxybenzamine

91
Q

lymphoma

A

weight loss 10% 6 months
mycosis fungoides, follicular, diffuse large b cell
ann arbor
cd30, cd15 - immunophenotyping
ABVD
mixed cellilarity, nodular sclerosing, nodular lymphocyte predom
rubbery painless

92
Q

hyposplenism

A

polycythaemia, thalassaemua - splenectomy
influenza
antibiotic prophylaxis

93
Q

toxic shock syndrome

A

erythrodermic macular rash
N+V
diarrhoea
desquamation

94
Q

melanoma

A

nodular, superficial spreading, lentigo maligna, acral lentinginous
clarke’s and breslow thickness
lymph node biopsy
CT, CXR
sunscreen, vit D supplements

95
Q

otitis externa

A

chrnoic is fungal
necrotising - DM into bone - urgent ENT
neomycina nd azetic acid
discharge, tinnitus, ear fullness

96
Q

fibromyalgia

A

> 6 months at least 2 both below and above pelvis
sleep disturbance
low mood
amitryptilline
educaition family
allodynia
hyperanalgesia

97
Q

rheumatoid arthritis

A

HLADR4
amyloidosis, pericarditis
DAS28 and ESR disease activity
sulfasalazine, hydroxy, leflunomide
2 DMARDS fail
IL6, TNFa
steroids for flare ups
trigger finger
soft tissue swelling

98
Q

stable angina

A

aspirin 75mg
HF - bisoprolol
decubitus
coronary syndrome x
beta blockers worsen spasm

99
Q

acs

A

coronary artery dissection - young women
serail trops
coronary angiogram
secondary - acei, beta blcoker statin, dual antiplatley
tricagrelor 90 x2
second stopped aftter 1 year
unstable/ nstemi - aspirin + fonda 2.5mg subcut + tricag unfrac heparin if PCI
grace score >3%
stemi - time period
fibrinolysis if no pci

100
Q

comp

A

LV free wall rupture - tamponade signs
Acute mitral regurg - inferior posterior MI
left septal defect- HF + pansystoli murmur
Left ventricular aneurysm - persistent ST elevation

year 6 (4 decks)

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