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year 6 > week 3 > Flashcards

week 3 Flashcards

1
Q

acute bronchitis

A

viral pneumonia, copd pic
wheeze fever
crp normal
comsrbative mangement
if crp high - doxy
coryzal symps

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2
Q

ards

A

pao2<300, bilateral opacities, acute pnset
non cardio PO
prone psoitoning, A toE
ABG - refractory to oxygen
pul cap pressure <18mmhg

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3
Q

hydrocephalus

A

sah and meningitis
medical can be furosemide

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4
Q

motor neurone

A

ALS = mixed
PLS = UMN, Betz
PBP = both, absent jaw jerk, flaccid fasciculation of tongue, Donald duck speech
Pseudobulbar: UMN, increased jaw ja=erk, hot potato
PMA = LMN
riluzole -prolong 3 monthd
percutaneous gastrostomy tube
NIV
vit D if bed boung
eye spared, autonomic fx spared

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5
Q

myasthenia gravis

A

criss: lithium, BB - need for NIV, FVC low
diplopia. ptosis
hypernasal speech
plasmapharesis + IVIG in crisis
SCLC, brrast, ovarian cancer = Lambert
pyridostigmine

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6
Q

hypogonadism

A

eunucoid
chemo radio dmaage to gonads
menopause symps
buccal, oral, IM
gynaecomastia, erectile dsfucntion
DEXA
polycythaemia due to testosterone
haemochromatosis
pelvic imaging - amenorrhoea - structural defects

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6
Q

carcinoid

A

appendix, small inetstine
5-HIAA
right sided murmurs, bronchospasm,, wheeze, pulm stenosis
octreotide

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7
Q

prolactinoma

A

cabergoline/ bromocriptine
hypothyroid
amenorrhoea (secondary)
men1

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8
Q

thyroditis

A

riedel’s: woody painless, psc assoc
rapid thryoid enlargement: dyspnoea, dysphagia

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9
Q

nephrotic

A

Membranous nephropathy = SLE, hep B
Focal segmental glomerulosclerosis = HIV
4-6 weeks steroids
biopsy if haematuria, steroid unrepsonsive
3.5g/24 hours protein
anti PL2R = membranous glomerulonephritis

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10
Q

hydrocoele

A

straining, raising arms, coughing
tetsicular tumour
patent processus vainalis
torsion, tumour, epididymo orchitis
USS

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11
Q

fibroadenoma

A

> 3cm = surgical excision

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12
Q

aterial and venous

A

venous oozes and bleeds
sloping shallow
atrophie blanche

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13
Q

bppv

A

brandt daroff exercises
if no improvement by 4 weeks - follow
admit if unable to keep down fluids
saccade

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14
Q

viral labyrinthtisi

A

horizontal nystagmus towards unaffected side
prochlorperazine/ antihistamines

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15
Q

scleirtis

A

RA, SLE, sarcoid, granulomatosis w polyangitis
red eye, painful
same day assessment
NSAIDs
episcleritis, blanching vessels, not painful

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16
Q

reactive arthritis

A

sterile pyuria
circinate balanitis
NSAIDs may need PO steroids
dysentery

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17
Q

alcoholic hepatitis

A

Maddrey’s discriminant function to determine if need steroids for severe
3 months abstinence and best mx and sutiable candidate –> liver transplant

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18
Q

AI hepatitis

A

type 1: ANA, ASMA
type 2: ALKM
cushingoig features
steroids then axatjioprine (LFT and FBC)
6-12 monthly USS and AFP
liver biopsy
hypergammaglobulinaemia

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19
Q

diverticular disease

A

colovesical fistula -faecaluria, pneumaturia, brown urine
IV fluids, abx .etc. in itis
hartmann’s if peritonitis
brown coloured urine
CT
barium and colonoscpy can be done but perf in acute

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20
Q

aspergillus lung disease

A

abpa - cf, asthmatics, eosinophilia, IGE, proximal bronchiectasis
aspergilloma - tb, sarcoid
invasive - septic
steroids and antifungals for abpa
can cause tracheal deviation and haemoptysis if massive aspergilloma

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21
Q

obstructive sleep apnoea

A

4 week referral in comorbidities, affecting work - sleep clinic
epworth sleepiness scale

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22
Q

hypoglycaemia

A

sepsis, adrenal insufficiency, alcohol
short synacthen, cortisol
ffa’s
two hypoglycaemia requqiring help - no licence
avoid choc

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23
Q

bph

A

obesity, afrocaribbean
5a redcutase - finasteride (test to dihydrotest inhi)
phosphodiesterase-5
anticholinergic - tolterodine, oxybutinin
acute retention - cathter
TURP, TUIP
REZUM - use vapour,
HoLEP - laser - bigger prostate
glycine –> ammonia toxicitiy

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24
mastittis/ breast abscess
12-24 no improvment I&D - diagnostic and therapeutic
25
infectious mono
palatal petachiae posterior cervical lymph burkitt's, gbs monospot in rapid point of care LFTs - affects liver atypical lymphocytes of blood film
26
rhinosinusitis
12 weeks back up abx smelly discharge
27
cataracts
hypocalcaemia dex and chlormaphenicol, reading glasses retinal detach, posterior capsule opacification endolphthalmitis
28
optic neuritis
sarcoid, lupus red desat, central scotoma, like looking through clouds, RAPD
29
vWD
type 3 is AR epistatxis, menorrhagia APTT and bleeding time prolonged desmopressin tranexamic acid for minor bleeding
30
neutropenic sepsis
<0.5 x10^9 prophyalxis - fluoroquinolone tx: tazocin, if no imp meropenem. venc if no ikmrpovement after few days - fungal cause ix
31
pressure sores
type 1: non blanching erythema 2: blister - dermins/ epdiemris 3: subcut 4: necrosis of msucle, bone .etc. Waterlow score - nutrition, bmi - screen likelihood of presure sores nutrition, fluids, analgesia, debridement
32
psoriasis
subungal hyperkeratosis guttate - strep, tear drop eyrhtrodermic pustular - also emegency topical steroids + vit d alcohol, beta blockers, trauam worsens 4 week break between steroids
33
syphilis
jarish heixhmer - steroid 24 hours before to prevent - fever, chills, headache uveitis in secondary lighning pains argyll robertson pupil -- small irregular pupils contrists on convergence not direct light
34
carpal tunnel
wasting of thenar amyloid, sarcoid, ra normal reflexes
35
septic arthritis
2 weeks IV then oral 4 weeks e coli in elderly prostehtic orhto in theatre gonorrhoea in young men aspirate ebfore abx
36
barrett's
metapalsia: 3-5 years surveillnce and PPI high grade: radioalblation + mucosal resection + PPI low grade: mucosal resection + PPI
37
pulm ht
loud s2 hs grham steel murmur - pulm regurg tricuspid regurg right heart catheterisation
38
hungitnton's
lability atrophy of striatum and butterfly dilatation of ventricles
39
spinal cord compression
LMN at level cauda is LMN, can be asymmetrical sciatica urinary retention 16mg dex mets to bone - thyroid, breats, lungs, prostate
40
diabetes insipidus
hypernatraemia sarcoid for cranial nephro - hypercalcawmiea, ckd rule out hypercalcameia, glycemia, hypo potassium <300 urine osmallaity nsaids and thiazides for nephjrogenic monitor hyponatraemia with vasopressin body weights during water deprivation
41
hyperparathyrodiism
primary - give vit d after secondary - phosphate binders (sevelamar) before then calcium and vit d tertiary - cinacalcat familial hypocalciuric hypercalcaemia - low urine (24 hr urine colelction)
42
hypoparathyrodiism
thyroid surgery calcirtirol pseudohypo - resistant to pth, high pth, low calcium, high phosphate psuedopseudo is normal biochem
43
siadh
demeclocycline + tolvapton if seizure s- coma hypertonic 3% saline hyponat signs - N+V, seizures, confusion SAH, TB, trauma, antipsychotics .etc. glucose, lipids, proteins rule out pseudonyponatrameia tfts , cortisol central pontine myelinolysis
44
renal artery stenosis
fibromuscular dysplasia renin high transluminal angioplasty choelstrrol cvd rf's control acute flashpulm oedema refractory hypertension
45
urinary incontiencne
pessaires, fascial sling, colposuspension overflow - constipation
46
varicocoele
enlargement of testicular veins embolisation, surgery valsalva manouvres
47
pad
<0.9, <0.5, <0.3 angioplasty in critical limb short lesions >10cm = open surgery bypass embolectomy after opioids and unfractionated heparin in acute limb <20 beurgers calf - fermoral buttocks - ilial * Leriche Syndrome (aortoiliac occlusive disease) ○ Buttock claudication ○ Impotence, erectile dysfunction Absent/weak distal pulses
48
hus ttp
aki, maha, thrombocvytopaenia bloody diarhooea haemodialysis nromal clotting
49
polycythaemia
aspirin hepatosplenomegaly, ht smoking aml
50
aspirin
hypokalaemia ecg 1 hr - activated charcoal clotting - pt prolonged slaocylate levels IV potassium chloride, sodium bicarb and fluids monitor for renal failure -pulm oedema
51
opiate
400mg naloxone resp acidosis
52
paracetmaol
hypoglycaemia if malnourished, signs of ruq even if <4hours IV nacetyl otherwsie wait as peak at 4 hours <1 - activated chasrcoal King's college: pH<7.3, PT >100, enceohalopathy, creatinine mx 2x500, 4 in 24 hrs
53
sepsis
qsofa score 2 or more - high rsik RR > 22, altered mental state, hypotension - sbp <100
54
cutaenous warts
keratanised: imiqumod non: podophyllin 6, 11 gardasil HBV, syphillis, HIV
55
hyeprcalcaemia of malig
addisons, sarcoid, paget's rule out thiazides, milk alklai also rule out
56
ibs
isphagula hsuk - fybogel >6months blaoting ssri's - cosmntipation dom, amitryptilline for diarrhoea dom cbt passage of mucus antispasmodics - peppermnt oil
57
hepatocellular carcinoma
jaundice aflatoxins - aspergillus flavus ruq mass biopsy between ribs
58
pilonidal sinus
forced hair isnertion into natal cleft karydaki's if recurrent abscess - icision and drainage same day
59
dvt
>3cm if scan -ve, d-dimer +ve, stop anticoag and repeat scan in 1 week heparin if renal failure/ risk of bleeding extend below knee/ cancer = 6 months thrombophlebitis is comp proximal leg USS within 4 hours nephrotic syndrome Homan's sign
60
dyslipidaemia
fasdting triglycerides secondary to cushings, hypothyroid check tfts steroids fundoscopy lft 3 months then 12 months ck >5 times upper limit asthenia, myositis, gi distubance qrisk - 10% not type 1, renal fialure, familial 20mg
61
asbestos
clubbing in both lymph, abdo pain thoracoscopy - bloody pleural fluid pulm rehab + oxygen therapy maybe lung transplant in asbeetsos shipyard workers bilateral insp crackles
62
idopathic lung fibrosis
pirfenidone - anti fibrotic pulm rehab, stob smoking, physio rhf - cor pulmonale
63
lung abscess
pseudomonas, kleb, staph foul smelling sputum
64
cns tumours
dex for cerebral oedema meningioma, craniopharyngioma, oligodendroma, meningioma, glioblastoma, check cheat sheet werncike's - temporal tuberous sclerosis, neurofibromatosis
65
encephalitis
CMV, cryptococcus cerebral fluid viral PCR CMV - add ganciclovir and foscarnet subacute scleroising panencephalitis monitoring for 1 year MRI: oedema, BBB breakdown, hyperdense lesions
66
horners
neck pain - carotid CT angiography for dissection STC (central, pre, post) stroke, syringo, ms trauma, thyrodectomy, pancoast tumour carotid atyery diss, cavernous sinus, cluster, carotid aneursym
67
bladder cancer
aromatic amines, smoking Baso low risk and non-invasive = TURBT (transurethral resection of bladder tumour) If low risk and invading muscle = radical cystectomy If muscle invasive and high risk and unfit for cystectomy = radiotherapy Palliative if msucle invasive and widespread metastases If hgih risk of recurrence = intravesical bacillus camette-guerin (BCG) recurrent uti's, fund symps htn + polycythaemia cystoscopy + biopsy
68
eczema
patch test tzanck test - herpes refer if contact dermatitis topical calcineurin inhibitors = tacrolimus
69
erythema multiforme
CAPINTS sarcoid malignancy mucosal - major
70
scc
marjolins arising for ulcer bowen's is SCC in situ
71
malaria
primaquine for vivax and ovale chloroquine for others parasitameia >2%, severe anaemia, hypoglycaemia, acidosis = severe rapid diagnostic tests 3 consecutive days of blood films thrombocytopaenia
72
amyloidosis
national amyloid centre dexomethoasone and bortezomib abdo fat biopsy/ rectum periorbital purpura macroglossia waldenstrom macroglobulinaemia
73
microcytic
low transferrin or normal in acd angular stomatitis peripehral neuropathy in lead piisoning pencnil cells koilonycia pyridoxine for sideroblastic dimercaprol for lead posioning
74
macrocytic
phenytoin for folate myelodysplasia, alcohols may have liver disease hypersegmented cells taregt - likver disease IM hydroxocobalamin 3x a week for 2 weeks then 3 monthly lifelong
75
mallory weiss
hyperemesis gravidarum retching tarry stools CXR - rule out boerhaave's pneumomediastinum, emphysema, crepitus, pleural effusion in boerhaave's
76
mitral regurg
bromocriptine mitral valve prolapse - mid systolic click atrial myxoma laterally displaced apex beat thrusting parasternal heave
77
wernicke's
ammonia bariatric, severe vomiting glucose after thiamine acomprosate
78
men
AD Men1 and 2 is RET gene remember prolactinoma under pituiatyr gastrinomas --> peptic ulcer
79
pcos
eflornithine worsens acne clomiphene bp, lipid profile, weight
80
testicular cancer
mumps orcvhitis afp non seminomas teratoma, choriocarcinoma ldh hydrocoele para aortic ln's
81
end of life symps
chlorpromazine for hiccups ondansetron chemo metoclopromide gi but not bowel obstruction ocycodone from morphone /2 to subcut dimorphine /3
82
metastatic disease
dex for cerebral oedema, seizures spine most common path fractures, hyperclacaemia, alp raised
83
candidiasis
nystatin, micoconazole spacer glycaemic control
84
q fever
transaminitis pneumonia doxycycline
85
acud base
stroke, sah, anxiety = resp alk met acid = diarrhiea met alk = vomiting
86
head injury
<13 <15 2 hours after new focal neurology al within 1 hr 8 hours - bleeding, <15, dangerous mech
87
hypothermia
osborne waves, j waves prolonged qt avoid iv drugs ecg, abg, glucose, haematocrit
88
malignant hyperthermia
dantrolene ca2+ release suxamethonium
89
lyme disease
meningitis, facial palsy, heart block, ericarditis ELISA, repeat 4-6 weeks later if -ve if symptoms persist at 12 weeks do immunoblot 28 days doxy IV ceftriaxone 2-4 weeks if does not resolve
90
osteomalacia
looser's zones and pseudofractures
91
psoriatic
psarc score arthritis mutilans, spondylitis, dip preodminant
92
path fractures
pagets, osteo, parathyroid, mets and primary bone tumours
93
spinal fractures
wedging of vertebra on x-ray
94
breast cancer referrals
Breast cancer in a first-degree male relative of any age Breast cancer in a first-degree relative under the age of 40 Bilateral breast cancer in a first-degree relative under the age of 50 Breast cancer in two first-degree relatives
95
ra das score
DAS scores of >5.1 indicate high disease activity and the recommendation is to escalate therapy and to consider biologic therapy if eligible

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