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4th year passmed > Wronguns > Flashcards

Wronguns Flashcards

1
Q

What are the risk factors for post op urinary retention?

A 
Removal of urinary catheter
Constipation
Immobility
Opiate analgesia
Infection
Haematuria
BPH
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2
Q

How would you test whether H.pylori eradication therapy has been successful?

A

Urea breath test

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3
Q

What are the first and second line options for secondary stroke prevention?

A

1st - Clopidogrel

2nd - Aspirin and MR dipyridamole

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4
Q

What effect might constipation have on a cirrhotic patient?

A

May cause acute decompensation

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5
Q

Which steroids have the following properties:

a) Low glucocorticoid, high mineralocorticoid
b) Glucocorticoid activity with high mineralocorticoid activity?
c) Mostly glucocorticoid with low mineralocorticoid activity

A

a) Fludrocortisone
b) Hydrocortisone
c) Prednisolone

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6
Q

What is the first line management of acromegalic pituitary tumours?

A

Trans-sphenoidal surgery, with octreotide used only if the tumour is unresectable

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7
Q

How would you describe an Osler’s node?

A

Tender, purple/red raised lesions with a pale centre?

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8
Q

What conditions are associated with Osler’s nodes?

A

IE

SLE

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9
Q

What is the most common cause of nephrotic syndrome in adults and in children?

A

Adults - FSGN

Children - Minimal change disease

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10
Q

What investigation should be done in ?orbital cellulitis to assess posterior spread?

A

Contrast CT of orbit, sinuses and brain

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11
Q

When would you offer a COPD patient prophylactic antibiotic therapy, and which drugs would you give?

A

Azithromycin (check LFT and ECG first)

Must be non smoker with continued exacerbations despite adequate control

These patients should also be given a home supply of prednisolone

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12
Q

Which side effect of clindamycin is it important to warn patients about?

A

Diarrhoea due to high risk of c.dif infection

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13
Q

What is the stepwise management of COPD?

A
  1. SABA or SAMA
  2. Assess steroid responsiveness (atopy, eosinophilia, FEV1 variation, diurnal PEF variation)
    a) Not steroid responsive - Add LABA and LAMA
    b) Steroid responsive - LABA + ICS (+- LAMA)
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14
Q

Which factors improve survival in patients with COPD?

A

Smoking cessation
LTOT
Lung volume reduction surgery

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15
Q

What is the acute management of renal colic?

A

75mg IM diclofenac

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16
Q

Patient undergoes PCI for STEMI
It has been four hours since the PCI, and the patient is now complaining of increasing, severe chest pain.
What is the single most appropriate treatment option?

A

Arrange for urgent CABG as it is likely the procedure failed and ischaemia is continuing

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17
Q

What are the contraindications and side effects of pioglitazone?

A

C-I - Heart failure

Sex - Weight gain, liver failure

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18
Q

Which medication should not be coprescribed with allopurinol and why?

A

Azathioprine - as the two together cause bone marrow suppression

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19
Q

How should warfarinised patients be managed regarding preoperative anticoagulation?

A

Stop warfarin and start treatment dose LMWH

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20
Q

Difference between acute cholecystitis and acute pancreatitis 2ary to gallstones?

A

Acute pancreatitis causes epigastric rather than RUQ pain, and is typically pyrexial unlike cholecystitis

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21
Q

How does carcinoid syndrome affect the heart?

A

Cusaes right sided disease - often pulmonary stenosis and tricuspid insufficiency

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22
Q

What is the commonest cause of peritonitis secondary to peritoneal dialysis?

A

Staph epidermis

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23
Q

Migraine prophylaxis and acute management?

A

Acute - NSAID or triptan + paracetamol

Prophylaxis - Topiramate or Propranolol

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24
Q

What test is most useful to differentiate between IBS and IBD?

A

Faecal calprotectin

25
Q

What is electrical alternans and when would you see it?

A

Pathognomic of cardiac tamponade, it is where there is alternation of QRS complex amplitude between beats

26
Q

Which bacteria most commonly causes peritonitis in CAPD patients?

A

Staph epidermis

27
Q

What is a Bennet’s fracture?

A

Intra-articular fracture of the first CMC joint, commonly caused by fist fights

28
Q

What factors overestimate HbA1c?

A

B12/folate deficiency
IDA
Splenectomy

29
Q

What factors underestimate HbA1c?

A

SCD
G6PD
Hereditary spherocytosis

30
Q

What type of feeding tube is commonly used post oesophagectomy?

A

Feeding jejunostomy

31
Q

How does Budd Chiari present?

A

Sudden onset abdo pain
Ascites
Tender hepatomegaly

32
Q

What might be the first indicators that a patient has a post op ileus?

A

Hypovolaemia and electrolyte disturbances which may occur before N/V begin

33
Q

What most commonly causes a broad complex tacky post MI?

A

VT

34
Q

Which HF drugs improve mortality?

A

ACEi
Beta blockers
Spironalactone

35
Q

What is the best imaging modality for a meniscal tear?

A

MRI

36
Q

What is the firstling management of anal fissures?

A

Topical CCBs

37
Q

ECG changes in hypokalaemia?

A 
Flattened T waves
Long PR
Long QT
ST depression
U waves
38
Q

What is a side effect of TNF alpha inhibitors such as Etanercept?

A

TB reactivation

39
Q

What is the first line management of plaque psoriasis?

A

Topical steroid and calcipotriol (VitD analogue)

40
Q

What is the best diagnostic test for PSC?

A

ERCP/MRCP

41
Q

What would cause a dendritic ulcer to be seen on fluorescein eye stain?

A

Herpes simplex keratitis

42
Q

What is the most important factor to stop relapses in Crohns?

A

Stop smoking

43
Q

What should be prescribed for a PD patient who cannot swallow/is vomiting when acutely unwell?

A

Dopamine agonist patch

44
Q

Blood gas requirements for LTOT in COPD?

A

2x readings of p02<7.3

45
Q

Which class of Parkinson’s med is most associated with inhibition disorders?

A

Dopamine agonists

46
Q

What are the best options for chemical cardioversion in AF with a nd without structural heart disease?

A

Amiodarone if SHD

Flecanide if no SHD

47
Q

Investigation if fall following PD diagnosis?

A

CN eye ones

As may have been misdiagnosed PSP

48
Q

What is the CK in temporal arteritis?

A

Normal

49
Q

What is the management of long QT syndrome?

A

Beta blockers (not stall)

50
Q

What is the first line drug for sarcoid?

A

Pred

51
Q

What is the first line investigation for stable angina?

A

Contrast coronary CT

52
Q

What are the joint aspirate findings in RA?

A

Turbid fluid with lots of PMNs with no crystals

53
Q

When is adenosine used and in what dose?

A

In SVT chemical cardioversion 6->12->12

54
Q

What is the mechanism of dabigatran?

A

Direct thrombin inhibitor

55
Q

Extracapsular fracture management?

A

DHS

56
Q

Subtrochanteric fracture management?

A

Intramedullary nail

57
Q

Hyperparathyroidism increases the risk of gout or pseudo gout?

A

Pseudogout

58
Q

A 67-year-old man with a history of hypertension presents to the emergency department with a 24hr history of dyspnoea and palpitations. He also complains of mild chest discomfort. On examination, you note an irregularly irregular pulse of 115 beats per minute, blood pressure 95 / 70 mmHg and a respiratory rate of 20 breaths/min. He denies any regular medication and insists he has never experienced anything like this before. An ECG shows absent P waves with QRS complexes irregularly irregular intervals.

How should this be managed/

A

DC cardioversion - as new onset AF may be cardioverted if within 48 hours of presentation

4th year passmed (28 decks)

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