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week 2 Flashcards

1
Q

asthma

A

50-75 = moderate
silent chest
aspergillus serology
IV hydrocortisone
PO 5-7 days
48 hours follow up
stable 12-24 hours
>20% diurnal variability 3 x a week
>12% improvement with bronchodilator
FeNO

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2
Q

heart failure

A

low utput vs high
EF<40
dobutamine - hypotension, ITU
CPAP
hydralazine
no bb if brady
IHD, HT, valvular
BNP, CXR, ECG, transthoracic echo
drugs decrease BNP
annual pneumococcal, influenza
NYHA - no limitation, slight, marked but comfort at rest, always discomfort and nitrate
acei for cardiac remodelling

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3
Q

svt

A

ablation chronic
verapamil asthma
IV digoxin, beta b locker, amiodarone
digoxin toxicity\caffeine, alcohol

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4
Q

pericarditis

A

malignancy, sarcoid, SLE
ECG = pr depression
perciardial tamponande
pulsus paradoxus -drop in SBP by 20 on insp

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5
Q

alcohol withdrawal

A

acomprosate
CIWA
glucose not before thiamine
48-72 hours
anterograde

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6
Q

gi perforation

A

psoas sign = intraperitoneal fluid
riglers sign - intrabdominal air
pleural lavage in boerhaves
peritoneal lavage
amylase

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7
Q

peritonitis

A

rebound tenderness
urinary catheter
central venous line
SBP
rigid abdomen
reduced bowel sounds

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8
Q

portal HT

A

caput medusa
portosystemic shunt
hepatic venous pressure gradient
pre-hepatic - portal vein thrmbosis, congenital stenosis
post - constrictive pericarditis, budd chiari, RHF
hepatorenal syndrome

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9
Q

viral hep

A

IVDU = C, transfusions, HCC
direct acting antivirals
nucleoside analogues/ peginterferon alpha in B and D

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10
Q

cardiomyopathy

A

ejection systolic, apical thrill, double apex beat
displaced
scleroderma, amyloidosis
doxorubicin - dilated
arrhythmias cause of death
kussmaul’s - rise jvp on inspo in restrictive
deep s v1/v2, tall r v5/v6
amiodarone, beta, cardiac defib, dyal chamber pacemaker, endo prophylaxis

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11
Q

tia

A

amourosis fugax
diffusion weighted MRI
CHADVASc
asprin 300mg for 2 weeks
no driving 1 month, no need to inform
75mg clopi, statin
>50% stensosi
if bleeding disorder, on DOAC/ warfarin, severe carotid stensois - admit and CT head

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12
Q

type 2

A

suphony - weight gain
pancreatitis - dpp4, glp1
gi distaurbance, lactic acidosis - metformin
background, pre-prof, prolif
58 change
53 target if hypo durgs
urine albumin creatinine
cushings, pancreatitis, steroids

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13
Q

type 1

A

psychosocial support
BP control
hypoglycaemia awareness
3rd party assistance
increased monitoring when sick
ACEi, diuretics, NSAIDs stop if unable to keep fluids - AKI
above 40 on statin
metformin if BMI>25

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14
Q

dka

A

<1 ketones = subcut stop after 1 hr
resolution <0.6
§0% dextrose if <14
potassium therapy
septic screen
thromboprophylaxis
euglycaemic - glifozins

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15
Q

pckd

A

mitral valve prolapse and aortic regurg
CKD mx
tolvaptan
flank pain
diverticular disease

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16
Q

benign breast

A

both menopasual
microdochectomy in papilloma
duct ecstatsia - smokers
warm compresses

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17
Q

breast cysts

A

aspirated if probleatic
if blood stained, pus - biopsy and excision

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18
Q

gangrene

A

wet, dry, gas
surgical debridement
steroids
x-ray of joint
LDH

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19
Q

uveitis

A

hlab27
tb, behcet’s, sle, ms
posterior: yellow/ white retina, blurred vision and progressive visual loss
ciliary flush, hypopyon
cycloplegic mydriatic drops - atropine
hourly steroid regime
may need methotrexate .etc.

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20
Q

brain mets

A

lung, breast, renal, melanoma
cerebral oedema, seizures
give dex

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21
Q

cellultiis

A

erypsipelas only skin
sub cut and dermis = cellultiis
strep pyogenes = eryp
orbital decomrpession, ct/mri orbital sinuses
IV if systemic signs
swelling of lymph nodes

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22
Q

bcc

A

morphoeic, nodular ulcertaive (central ulcer), pigmented, superficial
imiquimod

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23
Q

hhs

A

glucose >30, hypotension , 320
0.9% saline if not <5osm drop then 0.45%
0.05U if fail to drop glucose or ketones >1

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24
Q

dic

A

maha
trauma/ burns
APML
raised d dimer

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25
aplastic
dyskeratosis congenita: leukoplakia schwanman diamond autoimmune -most common immunological assays immunosuppressants chloramphenicol
26
sickle cell
penicillin V o2, abx,blood transfusions, pain relief new pulm infiltrates silent strokes, visual floaters salmonella osteomyelitis hb electrophoresis, sickle solubility test, hip x ray howell jolly
27
colorectal
smokig, alcohol liver lungs bone brain mets ascites lfts normal in mets 60-74 every 2 years
28
crohns
IV hydrocortisone if severe induce--> infliximab if not 5 days flare up: above - fluids, immunosuppressants, parenteral nutrition dmards - axathioprine, mercaptopurine for maintenance fistula, abscess string of kantor = barium swallow no live vaccines OGD and colonoscopy terminal ileitis - gallstones
29
AR
valve: IE, rheumatic, bicuspid aoritic root - aorittis, syphilis low DBP thrusting displaced apex beat MDT reduce afterload corrigan's - neck
30
dermato, poly
breast cancer, lung, pancreas, bowel CXR, mammo USS myeloma nail abnorm - capillary dilatation immunosuppressants symmetrical proximal, distal spared intersitial lung spirometry
31
constricitve
echo kussmaul advanced - cachexia, jaundice, muscle wasting
32
anal fissure
break in squamous lining anal sphincter spasm conservative if reisstant 6-8 weeks of GTN then sphincterotomy opioids
33
VT
long Qt --> torsades erythromycin, ondansetron, TCAs, citalopram, haloperidol, hypokal, mag, cal, roman ward, methadone, amiodarone stable - IV amiodarone and correct e- unsatble - shock then cpr, then adrenaline ICD if syncope, MI, <35% EF, previous cardiac arrest
34
cholecystitis
NBM, fluids, analgesia, anti-emetics
35
epilepsy
24 hrs apart 10 years seizures, 5 years med lam - steven johnson phenytoin - liver, lymphadenopathy, bleeding gums, peripheral neuro SUDEP levitiractiam for women in myoclonic as lamotrigine CI
36
osteoporosis
RA, coeliac reduced bone density -1--2.5 bulky physeal plates coeliac screen >75 may not need if prev fragility fractures no need empty stomach teriperamide - anabolic, romosozumab (sclerostin inh), HRT strontium inc risk of MI osteonecrosis of jaw and atypical stress fractures
37
graves
acropachy - clubbing beta receptors - fine tremor pretibial myoedema - orange peel MI, surgery, trauma, infection, DKA - crisis 12-18 months tx block and replace regime - euthyroid give thyroxine radioiodine if reisstant - CI, eye and preg smoking increases eye IV propanolol --> IV PTU + IV lugol's idione --> IV hydroxortisone
38
polymyalgia
15mg daily >45 mins stiffness, >2 weeks myeloma differential if no improvement w/ steroids vit D and calcium DEXA, steroid card
39
otitis media
delayed if not improved in 3 days perforation - 5 day then review in 6 weeks mastoidits, facial enrve palsy, labyrinthitis passive smoking unilateral glue ear - 2ww chole - ENT hearing test 3 months apart, if no imporvement 6-12 weeks --> surgical/ non surg
40
uc
biopsy - crypt abscesses, loss of goblet cells rectal - mild ,4 moderatie + oral - 4-6 severe = steroid + ciclosporin .6 maintenance - rectal (+ oral if no impr after 4 weeks), if extensive both if >2 exacerbations - oral azathioprine/ mercapto Hb, temp, bowel movements, esr barium - loss of haustra emerg - hartman's proctosigmoidectomy and end ileo
41
coeliac
dapsone gluten for 6 weeks before endo EATL villous arrophy, crypt hyprrplasia, inc lymph
42
gastroenteritis
giardia like coeliac - swimming poos yersinia and TB - RIF mimic crohn's 48 hours home HUS, GBS botulinism - decsenidn gparalysis, canned food listeria - cheese, unpasteruisied milk
43
haemochromatosis
erectole dysfunction inc iron absorption trasnferrin sat and ferritin to monitor weekly vene to induce then 2-4 x a year perl's stain
44
mesenteric ischaema
chronic is psot prandial pain, weight loss and abdo bruit acute: clinical findsings disppropirtion to shock ischaemic coltiis - bloody diarrhoe,a colonosocpy ABG, cross match, ECG, ACR - thumbprinting, gasless abdomen CT first inv superior mesenteric anticoag
45
acute pancreatitis
A{CHE II, GLASGOW - o2, calcium, ldh/ast, albumin, glucose, age, neutrophils, rneal function - 3or more amylase cullen's, grey turner's, fox's sodium valproate removw gallstones correct electorlytes/ underlying cause, parenteral nturition, glucose control USS before ERCP
46
chronic pancreaittis
faecal elastase bloating pancreatin + omeprazole surgical
47
peptic ulcer
early satiety ssris dudodenol no need biopsy abx and ppi free for 2 weeks triple 1-2 weeks if nsaids concurrent 3 months ppi then triple if no improvmeent 6 months - endosocpyically sugery - sclero, laser serum gastrin urease in h pylori break down urea
48
psc
ercp - beading cirrhosis, ascending cholangitis cholestyramine and vitamin ADEK inc lymphocyte infiltration
49
volvulus
caecum - SBO (clockwise) - adhesions, sigmoid - LBO (Chagas, neuro - aprkinsons, cosnti, schizo) drip and suck in sigmoid - rigid sigmoidoscopy and rectal tube caecum - righ hemiolectoy
50
lung cancer
tsh - hyperthyroid - squamous hypertrophic pulmonary osteoarthropathy haemoptysius clubbing laryngeal nerve lobar collapse, pleural effusion lobectomy, wedge resection, pneumonectomy ci for surgery - svc obstruction, malignant pleural effusion, vocal cord paralysis pre-op - abg and pfts adeno - gynaecomastia
51
multiple sclerosis
central scotoma internuclear ophthalmoplegia - medial longitudinal fasciculus - 3-6 natalizumab baclofen cerebellar signs Marburg's - death within weeks
52
raised icp
redcued gcs cheynes stokes breathing papilloedema IV mannitol, raise head, repeated LP controlled hyperventilation idiopathic intracran ial ht = obese females
53
subdural
burr hole craniotomy acute <72 hours chronic > 3 weeks - progtressive memory loss correct coaguloapthy - FFP, vit K
54
adrenal insufficiency
5% dextrose, hydrocortisone bolus then 6 hourly until bp stable emergency needles and hydrocoritosne, treat rpecipitating cause majority of hydrocortiosne in morning doubling sick day rukes waterhouse friderichse n - haemorrhage
55
thyroid nodules
cervical lymphadenopathy, increasing in size emergency if stridor, signs of upper airway obstruction thyroid cysts
56
aki
1.5-1.9, 2-2.9 creatinine over 350, <0.3 for 12 hours sepsis, anaphlyaxis renal bruits rhabdomyoslysis drug chart ckd signs and ix nephrology referral if renal stop nephrotoxic drugs cystatin c vasopressor e.g. adrenaline if severe hypotension
57
uti
preganncy, haematuria, elderly, sepsis, male - urine MCS IV for pyelo confusion and falls KEEPS
58
kidney stones
uretetic - tamsulosin ad lithotripsy <5, 5-10 - litho, 10-20: litho/ ureteroscopy, >20 - percutanatenous lihtotomy haematuria loop diuretics renal tubu;lar acidosis type 1 thiaxide and low salt diet in young -potassium citrate allopurinal in urate high fluid itnake cholestyramine for oxalate within 48 ours surgery if really bad
59
acoustic neuroma
loss of corneal reflex - V cerebellopontine angle MRI and audiometry vertigo
60
vestibular neuronitis
naudea and vomitting horizontal nystagmus prochlorperazine - IM if severe, otherwise oral vestibular rehbailitation exercises
61
beningn eyelid
squamous papilloma - hpv, molluscum, xantholelasma stye is painful pointing otuwards - hair follicles , staoh chaklazion - non tender swelling pointing inwards, meibomian gland
62
diabetic eye
retinal detachment and vitreous haemorrhage anti-vegf for macular odema blot haemorrhages and microaneuryms sin background vitrectomy if vitreous haemorrhage oct for mac oedema
63
macular degen
early age and late age (dry and wet) drusen spots amsler grid distorted day to day variation subacute in wet fluorescein angiography in wet OCT vitamin ACE and zinc bevacizumab
64
typhoid
cipro or cef osteomyelitis
65
chlamydia
gram -ve parasite azithromycin in pregnant fitz hugh curtiz
66
hiv
gp120 hiv antigen and antibody first line elisa for screening - p24 antigen viral load for mx response cd4 for aids conversion rategravir - integrase, lamivudine - nrti 2nrti + ii, pi .etc. colonoscopy for cmv colitis, baso all ix cmv reitiniis - pizza pie like
67
pjp
bilateral interstial pulm infiltrates dry cough co-trimoxazole penumothorax most common comp <200 cd4 need prophylaxis
68
cd4 stuff
500 --> 50 <500 = thrush, shingles, hairy, kaposi (virus stuff) <200 = pcp, toxo, cryptosporidiosis, PML - neuro and resp, gi <100 = oesophageal, cryp menin <50 - TB - myco avium and cmv retinitis
69
cryptosporiasis
modified ziel neison - red cysts watery diarrhoea nitozoxanide
70
neuro comp
toxo - ring enhaving and thalium -ve CNS lymphoma PML TB
71
thalassaemia
hba2 >3.5 desferrioxamine w/ blood transfusions howell jolly osteopaenia
72
ITP
DAT = evan's with AIHA <30 = steroids emergency bleeding = IV methypred _ IVIG + platelet transfusion >30 = observation
73
MM
M protein in blood/ urine as criteria hyp[erviscosity, infections, Al amyloidosis rouleux on blood film randrop skull daratumumuba induction adn autologous stem cell transplant if not transplant - MPT (mephalan, pref and thalikdomide) also treat symps rpognosis - LDH, b2 microglobulin, CRP alp high in mets
74
ank spond
sydesmophytes, sacroillitis, squaring of vertebra, loss of joint space reduced chets expansion, lateral lfexion and forward flexion schober - <5cm AV node block etanercept --> sekukinumab
75
osteoarthritis
nsaids + PPI diclofenac topical varus, squaring of thumb, heberdons (DIP), bouchard's subchondral sclerosis and cysts
76
paget's
area sof sclerosis and lysis isotoep bone scan bidphosphonates sensorineural heating loss - VIII axial skeelton - head and neck
77
compartment syndrome
paralysis, paraesthetis, pulseness - not necessaringly >20 mmhg abnormall, >40 is diagnositic myoglobuniria can cause AKi - fluids
78
ascending cholangitis
sepsis, confusion
79
gastric cancer
mary joseph node early satiety, haemetemesis high salt krukenberg FBC for anaemia - ACD/ haemetemesis
80
NASH
FIB4 and ELF - refer if >F3 fatty liver index = BMi, waist circum, GGT, TGs >5% fat
81
aortic stensosi
bicuspid in young, williams <50% EF, symptomatic surgery if bicuspid non dispalced heaving apec beat s2 softened if more severe p mitrale
82
vf
implantable cardiovertor defribillator in most survivors (ICD)
83
bronchiectasis
alpha 1, abpa, ra tram track cxr signet rings ct po cipro, iv tazocin - pseudo haemoptysis, clubbing, high pitched insp crackles
84
pneumonia
cxr after 6 weeks bronchial breathing coarse crackles + clarithromycin ABG empyema copd give steroids staph after influenza
85
sah
nimodipine + coil aneurysm diagital subtraction cathter angiography xanthochromia 12 hours LP meningism ECG - torsades de pointes photophobia
86
cluster headaches
verapamil is preventative nasal symps
87
tonsilitis
centor - cent so age <3 day symps - fevrpian trismus if persistent change in voice for 2 weeks --> laryngoscopy lemierre's - jugular vein - benzylpen
88
glaucoma
acute, chronic, primary steroids rubeosis iridis ahloes, headache, N+V, fixed dilated pupil hazy cornea cupping of disc gonioscopy and tonometer prostaglandin - lantoprost - long eyelashes beta blcokers, carbonix anhydrase, miotics - pilocarpine, symptomimetics >34 = selective laser trabeculoplasty laser peripheral iridotomy
89
blepharitis
seborrhoeic dermatitis grittiness and discomfort
90
central vein occlusion
HT, cardiovascular, glaucoma sudden painless loss of visiob, retinal vitrieous haemorrhages hyperaemia stormy sunset branch -blockage of retina at arteriovenous crossings anti VEGF, laser photocoagulation
91
enteropathic
sekukinumab may exacerbate etanercept may not work
92
sarcoidosis
extrapul features, black, no erythema nodosum = poor prognosis keratoconjunctiviis sicca, uvieits lofgren's - acute arhtitis and bihilar lymphadneoapthyr- self limtiing , can give NSAIDs
93
systemic sclerosis
pulm HTN - right heart catheterisation, annual PFTs, sldienafil renal crisis - ACEi cyclophosphamide for lung fibrosis HTCT sclerodactyly
94
osteomyelitis
MRI 6 weeks oral surgical debridement pott's disease - TB
95
cholangiocarcinoma
ca19-9 ercp
96
liver abscess + cyst
parasitic south/ central america travel tender hepatomegaly stool culture for entamoeba nitroimidazole for amoeba may get chest signs refer to ID and GUM
97
wilson's
kaysher fleischer rings sunflower cataract blue nails haemolytic anaemia king wilson score - acute, lvie rtranpslant (>=11) penicillamine + zinc avoid soya, dark choc, nuts norm sensation, reflexes, strength
98
mitral stenosis
non dispalced tapping apex beat thready pulse PHT, RHF valvulopalasty treat AF atrial myoxma RA parasternal heave <1.5cm = intervention pen V for RHf prophylaxis
99
vasovagal syncope
fatigue after episode
100
WPW
ebstein anomoly, HOCM VF broad QRS red end diastolic filling svt mx, ablation

year 6 (4 decks)

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