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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
epididymo
MSSU urine dip doxycycline
26
breast cancer
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
27
varicose
3mm or more atrophie blanche varicose eczema 2 sounds on doppler = incompetent graduated compression stockings phlebectomy
28
osa
can cause HT urgent referral to sleep clinic
29
retinal detachment
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
30
tumour lysis syndrome
hypocalcaemia oliguira/ dysuria allopurinol
31
urticaria
remove trigger
32
orbitl/periorbital
behind orbital septum anterior -peri CT orbit proptosis mdt - opthalm, ent
33
delirium
reversible constipation, dehydration, malnutrition ECG hallucinations glasses and hearing aids
34
apls
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
35
essential thrombocytosis
erythromelalgia headaches - viscosity low risk - aspriin, intermediate - either, high - aspriin and hydroxycarbamide (cardiac rfs, rlly high platelets, previous haemorrhage/ thrombosis) - age trephine biopsy
36
necrotising fasciitis
t1 - anaerobes polymicrobial t2 - mono, t3 - perfringens not underlying muscle fournier's gangrene - sglt2
37
tinea
terbinafine onycholysis
38
epidermoid
central punctum not sebum keratin containing
39
vaculitides
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)
40
peripehral nerve
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
41
cirrhosis
JBAE = decompensated secondary - RHF, methotrexate AFP, liver biopsy - percutaneous, transjugular (clotting probs/ ascitic), child pugh - PT. albumin, bilirubin, ascites, encephalopathy
42
bowel obs
hernias dievrticular disease proximal is dilated, distal is collapse srgical if perforated erect CXR catheter CT w/ gastograffin
43
rheumatic
CASES FRAP - marginatum aspirin, steorids, ABx benzathine penicillin prophylaxis 2-6 weeks after ifnection Jone's - 2 majors/ 2 minors + 1 major
44
tricuspid regurg
ebstein's anomoly annuloplasty carcinoid p pulmonale prominent V waves
45
pneumoconiosis
beryllium lymphocyte proliferation test - coal eggshelol calcification in hilar - silicosis cor pulmonale
46
trigeminal
compression, MS carbamezepine only
47
acromegaly
osteoarthritis carpal tunnel gynaecomastia macroglossia pituitayr profile fundoscopy
48
thyroid cancer
lymphoma - hashimoto's yearly thyroglobulin (pap, foll) tracheal deviation radioiodine to kill residual cells
49
CKD
HT statin, ACEi SGLT2 inhibitors vaccines low salt diet phosphate binders SLE
50
menieres
unilateral NV excess fluid so initiually diuretics and low salt betahistine antihistamines fullness in ear intermittent
51
thyroid eye disease
dry eyes exposure keratosis compression optic neuropathy diplopia dry eyes smoking is rf
52
haemophilia
avoid aspirin and NSAIDs
53
conjunctivitis
conjunctival papillae conjunctival follicles
54
GORD
PPI trial H.pylori Barrett's oesophagus conservative - small diet, lose weight lying flat
55
raynauds
primary is bilateral, secondary = unilateral leukaemia dilated nail folds white --> blue --> red COCP, cervical rib
56
sle
pleurisy anti-Sm vaccines belilumab, rituximab severe flares = pred + IV cyclophosphamide ACEi Lupus nephritis
57
gallstones
cocp ercp, lfts normalise then chole no need to admit phrenic nerve - scapula pain
58
hernia
superiomedial, inferolateral indirect lateral to inferior epigastric deep ring occlude - indirect patent processus vaginalis rectus abdominas, inferior epigastric, inguinal canal
59
PBC
high cholesterol granuloma ursodeoxycholic acid middle aged females other AI e.g. RA, sjogren
60
appendicitis
lanz, mcburney's excision obturator, psoas - retrocoecal, rovsing sign
61
aortic dissection
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
IE
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
tb
cervical lymph nodes sterile pyuria addisions, pott's caseating granulomas meningitis HIV test amikacin for drug resistant
64
pneumothorax
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
neurofibromatosis
AD NF1 - axillary/groin freckles, phaeochromo, lisch nodules, RAS opthalm, audiometry MRI brain and spine scoliosis BP monitoring
66
parkinsons
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
diabetic neph
ratio >2.5
68
hypopituitarism
hypphtalamic dusfucntion - anorexia insulin stress test GH lost first - dec muscle strength, inc abdo fat central DI can occur as result - desmopressin osteoporosis
69
renal cell carcinoma
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
prostate cancer
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
aaa
>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
epistaxis
anticoagulants nasal balloon catheter posterior bleed = admit
73
central retinal artery occlusion
RAPD, thromboeembolism/ GCA steroids if GCA ocular massage/ intrarterial thromblysis/ anterior chamber paracentesis/ vasodilation isosorbide dinitrate rapid unilateral vision loss
74
burns injury
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
anaphylaxis
500mcg 1:1000 remove tirgger, lie down raise legs dietitcian if food related allergy clinic
76
myelodysplasia
after chemo/ radio ringed sideroblasts, basophilic stippling hypomethylating agents erythropiein stimualtign agents, myeloid growth factors
77
epiglottitis
dex and cefuroxime rifampicin for household conatcts
78
GCA
anterior ischaemic optic neuropathy ALP raised and platelets tocilizumab 18-24 months steroids
79
hypermobility
thin stretchy skin diarrhoea/ constipatiion physio + OT strengthening exercises simple analgesia
80
acute liver failure
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
oesophageal cancer
>55 scleroderma, achalasia, plummer vinson syndrome (dysphagia, IDA, oesophageal webs, glossitis)
82
perineal abscess fistula
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
cardiac arrest
ecg hypothermia, hypoxia, hypo/hyperkalaemia, hypovolaemia, hydrogen ions thromboembolism, tamponade, toxina, trauma, tension pneumothorax
84
heart block
digoxin, electrolytes, IE, sarcoidosis stokes-adams cannon a waves ifnerior MI not indication for pacing 500mcg transvenous after transcutaenous
85
copd
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
PE
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
radiculopathy
spondylolisthesis ligamentum hypertrophy LMN and muscle wasting steroid injections, weight loss, physio
88
gbs
ascending paraesthesia IV immunoglobulin + plasmapharesis normal WCC, high protein ataxia, arreflexia - miller anti ganglioside nerve conduction studies vaccine, URTI
89
hypothyroidism
radiation sarcoid, haem, wilsons myxoedema coma - ITU, thyroxine, IV hydrocortisone, fluids, glucose, HF - confusion, hypothermia, hypoventilation recheck 3 monthlu until stable then annually
90
phaeo
neurofibromatosis 1 phenoxybenzamine
91
lymphoma
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
hyposplenism
polycythaemia, thalassaemua - splenectomy influenza antibiotic prophylaxis
93
toxic shock syndrome
erythrodermic macular rash N+V diarrhoea desquamation
94
melanoma
nodular, superficial spreading, lentigo maligna, acral lentinginous clarke's and breslow thickness lymph node biopsy CT, CXR sunscreen, vit D supplements
95
otitis externa
chrnoic is fungal necrotising - DM into bone - urgent ENT neomycina nd azetic acid discharge, tinnitus, ear fullness
96
fibromyalgia
>6 months at least 2 both below and above pelvis sleep disturbance low mood amitryptilline educaition family allodynia hyperanalgesia
97
rheumatoid arthritis
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
stable angina
aspirin 75mg HF - bisoprolol decubitus coronary syndrome x beta blockers worsen spasm
99
acs
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
comp
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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