Wronguns Flashcards
What are the risk factors for post op urinary retention?
Removal of urinary catheter Constipation Immobility Opiate analgesia Infection Haematuria BPH
How would you test whether H.pylori eradication therapy has been successful?
Urea breath test
What are the first and second line options for secondary stroke prevention?
1st - Clopidogrel
2nd - Aspirin and MR dipyridamole
What effect might constipation have on a cirrhotic patient?
May cause acute decompensation
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) Fludrocortisone
b) Hydrocortisone
c) Prednisolone
What is the first line management of acromegalic pituitary tumours?
Trans-sphenoidal surgery, with octreotide used only if the tumour is unresectable
How would you describe an Osler’s node?
Tender, purple/red raised lesions with a pale centre?
What conditions are associated with Osler’s nodes?
IE
SLE
What is the most common cause of nephrotic syndrome in adults and in children?
Adults - FSGN
Children - Minimal change disease
What investigation should be done in ?orbital cellulitis to assess posterior spread?
Contrast CT of orbit, sinuses and brain
When would you offer a COPD patient prophylactic antibiotic therapy, and which drugs would you give?
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
Which side effect of clindamycin is it important to warn patients about?
Diarrhoea due to high risk of c.dif infection
What is the stepwise management of COPD?
- SABA or SAMA
- Assess steroid responsiveness (atopy, eosinophilia, FEV1 variation, diurnal PEF variation)
a) Not steroid responsive - Add LABA and LAMA
b) Steroid responsive - LABA + ICS (+- LAMA)
Which factors improve survival in patients with COPD?
Smoking cessation
LTOT
Lung volume reduction surgery
What is the acute management of renal colic?
75mg IM diclofenac
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?
Arrange for urgent CABG as it is likely the procedure failed and ischaemia is continuing
What are the contraindications and side effects of pioglitazone?
C-I - Heart failure
Sex - Weight gain, liver failure
Which medication should not be coprescribed with allopurinol and why?
Azathioprine - as the two together cause bone marrow suppression
How should warfarinised patients be managed regarding preoperative anticoagulation?
Stop warfarin and start treatment dose LMWH
Difference between acute cholecystitis and acute pancreatitis 2ary to gallstones?
Acute pancreatitis causes epigastric rather than RUQ pain, and is typically pyrexial unlike cholecystitis
How does carcinoid syndrome affect the heart?
Cusaes right sided disease - often pulmonary stenosis and tricuspid insufficiency
What is the commonest cause of peritonitis secondary to peritoneal dialysis?
Staph epidermis
Migraine prophylaxis and acute management?
Acute - NSAID or triptan + paracetamol
Prophylaxis - Topiramate or Propranolol
What test is most useful to differentiate between IBS and IBD?
Faecal calprotectin
What is electrical alternans and when would you see it?
Pathognomic of cardiac tamponade, it is where there is alternation of QRS complex amplitude between beats
Which bacteria most commonly causes peritonitis in CAPD patients?
Staph epidermis
What is a Bennet’s fracture?
Intra-articular fracture of the first CMC joint, commonly caused by fist fights
What factors overestimate HbA1c?
B12/folate deficiency
IDA
Splenectomy
What factors underestimate HbA1c?
SCD
G6PD
Hereditary spherocytosis
What type of feeding tube is commonly used post oesophagectomy?
Feeding jejunostomy
How does Budd Chiari present?
Sudden onset abdo pain
Ascites
Tender hepatomegaly
What might be the first indicators that a patient has a post op ileus?
Hypovolaemia and electrolyte disturbances which may occur before N/V begin
What most commonly causes a broad complex tacky post MI?
VT
Which HF drugs improve mortality?
ACEi
Beta blockers
Spironalactone
What is the best imaging modality for a meniscal tear?
MRI
What is the firstling management of anal fissures?
Topical CCBs
ECG changes in hypokalaemia?
Flattened T waves Long PR Long QT ST depression U waves
What is a side effect of TNF alpha inhibitors such as Etanercept?
TB reactivation
What is the first line management of plaque psoriasis?
Topical steroid and calcipotriol (VitD analogue)
What is the best diagnostic test for PSC?
ERCP/MRCP
What would cause a dendritic ulcer to be seen on fluorescein eye stain?
Herpes simplex keratitis
What is the most important factor to stop relapses in Crohns?
Stop smoking
What should be prescribed for a PD patient who cannot swallow/is vomiting when acutely unwell?
Dopamine agonist patch
Blood gas requirements for LTOT in COPD?
2x readings of p02<7.3
Which class of Parkinson’s med is most associated with inhibition disorders?
Dopamine agonists
What are the best options for chemical cardioversion in AF with a nd without structural heart disease?
Amiodarone if SHD
Flecanide if no SHD
Investigation if fall following PD diagnosis?
CN eye ones
As may have been misdiagnosed PSP
What is the CK in temporal arteritis?
Normal
What is the management of long QT syndrome?
Beta blockers (not stall)
What is the first line drug for sarcoid?
Pred
What is the first line investigation for stable angina?
Contrast coronary CT
What are the joint aspirate findings in RA?
Turbid fluid with lots of PMNs with no crystals
When is adenosine used and in what dose?
In SVT chemical cardioversion 6->12->12
What is the mechanism of dabigatran?
Direct thrombin inhibitor
Extracapsular fracture management?
DHS
Subtrochanteric fracture management?
Intramedullary nail
Hyperparathyroidism increases the risk of gout or pseudo gout?
Pseudogout
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/
DC cardioversion - as new onset AF may be cardioverted if within 48 hours of presentation
