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6th year Writtens > Writtens > Flashcards

Writtens Flashcards

1
Q

What is co-trimaxazole

A

Trimethoprim and sulfamethoxazole

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2
Q

What is co-trimaxazole used for?

A
  • Pneumocystis jiroveci (PJP)
  • Toxoplasmosis
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3
Q

How do you treat MS neuropathic bladder

A

Intermittent self catheterisation

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4
Q

1st line management of SCC

A

Primary excision

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5
Q

What is mohs micrographic surgery

A

excised samples are examined under the microscope and further samples are taken until the margins are clear on all of them. Used for high-risk recurrent lesions

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6
Q

Desribe typical apperance of scc

A

Ill-defined keratotic ulcerating (upward) lesions

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7
Q

Rifampicin side effects

A

Red/Orange secretions
Liver inducer (interactions esp with the COCP)
Hepatitis

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8
Q

Isoniazid side effects

A

Iron accumulation in mitochondria (sideroblastic anaemia)
Neuropathy (B6 deficiency)
Hepatitis

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9
Q

Pyrazinamide side effects

A

Hyperuricaemia, hepatitis, photosensitivity

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10
Q

Ethambutol side effects

A

optic neuritis (decreased acuity and colour blindness) - initially affects the myeinated cones more than the un-myelinated rods
ototoxicity

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11
Q

Drug co-prescribed with TB medication?

A

Pyridoxine (B6)

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12
Q

What medication contributes to hypothyroidism?

A

Amiodarone
The chemical structure is analogous to thyroxine and it contains large amounts of iodine
Therefore has a cytotoxic effect on thyroid follicular cells and inhibits the conversion of T4 to T3
Consequently hypothyroidism (Wolff-chaikoff effect) or hyperthyroidism (jod-basedow effects) can occur
TFTs should be checked before and every 6 months of therapy

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13
Q

What are the symptoms or limited cutaneous scleroderma?

A

Thickening and fibrosis of the skin in the distal limbs (elbows and knees) Beaked nose
small furrowed mouth (microstoma)
CREST syndrome
* Calcinosis
* Raynauds
* Esophageal dysmotility
* Sclerodactyly
* Telangietcasia

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14
Q

What is a common complication of limited cutaneous scleroderma?

A

Pulmonary hypertension

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15
Q

What Ix for scleroderma?

A

Anti centromere antibodies

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16
Q

What Ix for diffuse sytseic sclerosis?

A

Anti-SCL-70 antibodies aka anti-topoisomerase II

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17
Q

Goodpastures treatment

A

Plasma electrophoresis
Steroids
Immunosupression

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18
Q

Causes of atrial fibrillation

A

DEHYDRATED PIRATES
Dehydration
Pulmonary disease e.g. pulmonary embolism
Ischemia (hypertension, ischemic heart disease, heart failure)
Rheumatic heart disease
Anaemia, atrial myxoma
Thyrotoxicosis
Ethanol Abuse
Sepsis

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19
Q

Ix for GBS

A

Nerve condustion studies = decreased motor conduction speed with/without complete block
CSF shows raised protein but no cells and no oligoclonal bands

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20
Q

CSF picture of viral meningitis

A

Glucose normal
Protein normal/raised
Lymphocytes

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21
Q

What is becks triad? What is it seen in?

A

Muffled heart sounds, engorged neck veins, hypotension
Indicitive of cardiac tamponade

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22
Q

What is cushings triad? What is it seen in?

A

Bradycardia, hypertension, widening pulse pressure
Seen in riased ICP

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23
Q

What is Kussmauls sign? What is it seen in?

A

Paradoxical raised JVP with inspiration

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24
Q

What is a sign of acth-dependent cushings syndrome?

A

Tanned skin

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25
Q

What are the common signs/symptoms of cushings?

A

Weight gain (94%)
Fatiguability and (proximal) weakness (87%)
HTN >150/90 (82%)
Hirsutism (80%)
Amenorrhoea (77%)
Cutaneous striae (67%)
Personality changes (66%)
Ecchymoses (65%)
Oedema (62%)

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26
Q

What is mobitz type 1 heart block

A

P-R delay increase with time until a beat is miseed

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27
Q

What is mobitz type 2 heart block

A

P-R delay NOT increasing, where beats are missed in a ratio e.g. every 3rd beat is missed

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28
Q

What is a stokes adam attack?

A

syncope secondary to complete heart block due to reduced CO

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29
Q

What are the lung manifestations of SLE?

A
  • Pleurisy
  • Pleural effusion
  • Pneumonitis
  • Interstital lung disease
  • Pulmonary hypertension
  • Alveolar haemorrhage
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30
Q

DIagnostic criteria of HHS

A

Serum glucose >35mmol/L
Leads to osmolarities >320mOsm/Kg

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31
Q

Fluid correction in HHS

A

Defecit = 100-220 mL/kg
Aim to replace 50% of this deficit within the first 12 hours.

32
Q

Targets for treatment in HHS

A

Reduce glucose concentration of 4-6 mmol/L/hr
Fall in sodium concentration of less than 10 mmol/L/day.

33
Q

Management of HHS

A

Fluids (0.9% sodium chloride)
1 litre over 1 hour, 1 litre over 2 hours, 1 litre over 6 hours
Aim for fall in sodium of no more than 10mmol/l in 24 hours
Will also need potassium replacement (as per DKA guidelines)

Insulin 0.05units/kg/hour
Aim for fall in glucose of 4-6mmol/hour

34
Q

Serum findigns in wilsons

A

Low serum caeruloplasmin
High urinary copper
Low serum copper (paradoxical)

35
Q

Treatment for wilsons diseae

A

Penicillamine

36
Q

X ray findings in rheumatoid

A

LESS
Loss of joint space
Periarticular erosions
Soft tissue swelling
Subluxation

Juxta-articular osteoporosis

37
Q

X ray findgins in osteoarthritis

A

LOSS
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts

38
Q

Causes of prolonger diarrhoea

A

Giardia

39
Q

Omeprazole side effects

A

Osteoporosis

40
Q

Fracture type in bisphosphonates

A

Atypical e.g. subtrochanteric femur fracture

41
Q

Cause of tinea infections

A

Trichophyton rubreum

42
Q

Anaemia in CKD management

A

Normal ferritin = EPO
Low ferritin = IV iron

43
Q

TCA overdose symtpoms

A

Dilated pupils
Wide QRS
Sinus tachycardia
Urine retnetion
Constipation and nausea
Confusion

44
Q

Statin targets

A

> 40% reduction in non-HDL cholesterol

45
Q

Insulin adjustment in hsopital if still eating

A

Continue regular outpatient regime (consider 25% reductions)

46
Q

Insluin adjustment if NBM

A

Continue basal insulin
Stop rapid/short acting if missing just 1 meal
If missing >1 meal or very ill and require tight control start sliding scale

47
Q

Ischemic Stroke management

A

Must CT to rule out haemorrhagic
Formal swallowing assessment is essential

If <4.5 hrs:
300mg aspirin
Assess for Thrombolysis (IV Alteplase)
Thrombolectomy

If >4.5 hrs:
300mg aspirin
Thrombolectomy

48
Q

Secondary prevention of stroke

A

With AF:
Warfarin/DOAC
Without AF:
Continue aspirin for 2 weeks
Life-long clopidogrel

49
Q

Haemorrhagic stroke management

A

Haemorrhagic stroke
* Control BP, balance & review anticoagulation medication
Stop smoking
Control hypertension and hyperlipidaemia

50
Q

Carotid endarterectomy thresholds

A

Symptomatic stenosis of 70-99% (ECST criteria)
Symptomatic stenosis of 50-99% (NASCET criteria)

51
Q

Scoring systems in TIA

A

ABCD2 score to assess likelihood of stroke after TIA
* Age ≥ 60 years = 1
* Initial BP. Either SBP ≥ 140 or DBP ≥ 90 = 1
* Clinical features of the TIA (Unilateral weakness = 2
Speech imparment without weakness =1)
* Duration of symptoms (10-59mins = 1, >60 = 2)
* Diabetes = 1

52
Q

Complications of stroke

A

Aspiration pneumonia
Cerebral oedema (↑ ICP)
Immobility
Depression
DVT
Seizures
Death

53
Q

Features of secondary hyperparathyroidism

A

Low calcium

54
Q

Normal kidney size

A

10-12cm

55
Q

Renal artery stenosis findings

A

Displarity in kidney size >1.5cm
Hypertension
AKI
Other signs of vascular disease

56
Q

Management of displaced intracapsular hip fracture

A

Total hip replacement: if can walk independently, no cognitive imparement, medically fit for anaesthesia)
Hemiarthroplasty: If not suitable for total e.g. old and frail

57
Q

Most common parotid tumour

A

Pleomorphic adenoma

58
Q

Management if not tolerating metformin side effects?

A

Modified release metformin

59
Q

Causes of ‘end of stream’ haemturia?

A

Bladder cancer
Prostate cancer

60
Q

Psoriasis management

A

Stress and alcohol avoidance
Emollients - soften the plaques
Topical drugs:
Vit D based creams
High dose steroids
Antihistamines for itching

61
Q

Recalcitrant psoriasis management

A

1) UV light therapy
2) Oral drugs
○ Methotrexate
○ Cyclosporin
○ Acitretin
○ Hydroxycarbimide
If still unresponsive:
Monoclonal antibodies (Infliximab)

62
Q

Vaccinations if had splenectomy

A

Men A&C
HiB
Pneumoccal
Seasonal Flu

63
Q

GBS symptoms

A
  • Lower motor neurone signs
    ○ Decreased power
    ○ Hypotonia
    ○ Absent reflexes EVEN WITH REINFORCEMENT
    • Ascending symmetrical weakness and paraesthesia
      ○ Lower>upper limbs
    • Cranial nerve involvement
      ○ Dysphagia, dysarthria (slowed/slurred speech)
      ○ Facial weaknesss (LMN pattern)
      ○ Signs of bulbar palsy
    • Can involve ANS e.g.:
      ○ Bladder dysfunction
      ○ Constipation
      ○ Sweating & Tachycardia
      ○ Dysthymias
      Postural hypotension
64
Q

When to give antibiotics in surgery

A

within 60 minutes before the skin is incised and as close to time of incision as practically possible

65
Q

Ix for food stuck in oropharynx

A

Lateral soft tissue x ray

66
Q

How to statisfy the causes of ascities

A

Ascitic tap and Serum-ascites albumin gradient (SAAG)
High SAAG (>11g/l) - low protein (TRANSUDATE)

Low SAAG (<11g/l) - high protein (EXUDATE)

67
Q

Criteria for exudate vs transudate

A

Transudate (protein content <30g/l)
Exudate (protein content >30g/l)

If equivocal (25-30g/l) use lights crtieria for diagnoiss
Exudate if:
* Pleural fluid:serum protein >0.5
* Pleural fluid:serum LDH >0.6
* Pleural fluid LDH >2/3 upper limit of serum LDH

68
Q

Cause of transudative ascities

A

High SAAG (>11g/l) - low protein (TRANSUDATE)
* Heart failure
* Constrictive pericarditis
* Portal hypertension - most common
* ○ Cirrhosis
* ○ Alcoholic hepatitis
* ○ Portal vein thrombosis
* Budd-Chiari syndrome

69
Q

Causes of exudative ascities

A

Low SAAG (<11g/l) - high protein (EXUDATE)
Peritoneal cause of ascites
* Malignancy
* Infections (inc TB)
* Pancreatitis
* Bowel obstruction

Exception = nephrotic syndrome
Loosing huge amount of protein in your urine
So very low serum protein as its all being lost
Therefore, although ascities protein content normal it is high relative to the serum levels

70
Q

Pseudomonas antibiotcs

A

Ciprofloxacin
Gentamicin
Tazocin (pipercillin tazobactam)

71
Q

Ix of chice in osteomyeltitis

A

MRI

72
Q

Management of Ventricular arryhtmias if pt is conscious?

A

Sedate them and do synchronised DC cardioversion

73
Q

What is pityriasis rosea

A

Pink rash appearing on the chest and back
intensley itchy
self limiting caued by virus

74
Q

Rosacea management

A

Topical: metronidazole/ivermectin
Oral: if severe give tetracyclines e.g. doxycycline

75
Q

Ix of choice in laryngeal pathology?

A

Laryngoscopy

76
Q

Causes of ring enhancing lesions in HIV

A

Toxoplasmosis
Lymphoma

77
Q

Symptoms of opiate withdrawal

A
  • Chills
  • Fever
  • Myalgia
  • Diarrhoea
  • Insomnia
  • Nausea
  • Dilated pupils
    Peaks 72 hours after last dose

6th year Writtens (3 decks)

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