year 2 passmed Flashcards
what are the ottawa rules for ankle x-ray
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
- bony tenderness at the lateral malleolar zone
- bony tenderness at the medial malleolar zone
- inability to walk four weight bearing steps immediately after the injury and in the emergency department
how often is methotrexate taken
weekly
how quickly do patients with PMR respond to steroids
dramatically quickly
which antibiotic if prescribes with methotrexate could cause bone marrow suppression
trimethoprim
what does a patient need to have to confirm a diagnosis of diffuse systemic sclerosis
systemic fibrosis
what does this patient have
ankylosing spondylitis
which type of osteomyelitis are sickle cell patients prone to
salmonella osteomyelitis
how long does the morning stiffness last in osteoarthritis
less than 30 mins
if the biopsy is normal in a potential giant cell arteritis patient, do you stop prednisolone
no
skip lesions may occur
which SLE drug is safe to use in pregnancy
azathioprine
if syndesmophytes are found on plain radiograph of the spine what does this indicate
ankylosing spondylitis
what does spondylolisthesis mean
displacement of one spinal vertebra over the other
what should patients with anti phospholipid syndrome who haven’t had a thrombosis before be started on
low dose aspirin
patients who are allergic to what drug may also be allergic to sulfasalazine
aspirin
co-timoxazole
causes of trigger finger
- rheumatoid arthritis
- diabetes
what does a positive simmonds sign mean
achilles tendon rupture
which hypersensitivity reaction is anaphylaxis
type 1
what does joint aspiration of gout show
needle-shaped negatively birefringent monosodium urate crystals under polarised light
early x-ray findings of rheumatoid arthritis
juxta-articular osteoporosis
loss of joint space
soft-tissue swelling
JLS!!!!!
late x-ray findings os rheumatoid arthritis
- periarticular erosion
- subluxation
Knee pain and swelling, typically after exercise
Knee catching, locking and/or giving way: more constant and severe symptoms are associated with the presence of loose bodies
Feeling a painful ‘clunk’ when flexing or extending the knee - indicating the involvement of the lateral femoral condyle
diagnosis?
osteochondritis dissecans
if a patient presents with an auricular haematoma what is done first
referral to ENT
if a patient presents with a unilateral polyp what is the first thing that should be done
urgent referral to ENT
side effect of azathioprine
myelosuppression
how long should you wait after taking methotrexate before having a baby
6 months
first line treatment for tonsillitis
Phenoxymethylpenicillin
where does webers lateralise to
affected ear
side effect of gentamicin
sensorineural hearing loss
what causes viral warts in rheumatoid arthritis
secondary to immunosuppression from etanercept treatment
-nothing should be done tho
halos around lights
closed angle glaucoma
what diseases can cause angular cheilitis
crohns and UC
what does pyoderma gangrenosum present as
an enlarging blister usually on the shins
what does erythema multiforme present as
many target lesions over 24 hours
what is lupus vulgaris
a type of cutaneous tuberculosis
what does lichen planus present as
a violaceous, polygonal, papular eruption that is commonly pruritic
-it can form plaques
what does lichen sclerosus present as
itchy white spots seen on vulvas and penises
what does drusen affecting the fovea suggest
ARMD
does a thyroglossal cyst protrude when the patient sticks their tongue out
yes
histology of a SCC of the skin
lesion containing irregular masses of anaplastic epidermal cells proliferating down to the dermis with keratin pearls
what is an eye manifestation of giant cell arteritis
anterior ischaemic optic neuritis
if a patient with psoriasis is on oral steroid and vit D analogue what is the next step in management
stop the steroid and do twice daily vit D analogue
in bullous pemphigoid, which adhesive structure is disrupted by autoimmune mechanisms
hemidesmosome
treatment for scabies
topical permethrin
which drug can cause acne vulgaris
isoniazid
what is changed about levothyroxine in pregnancy
dose increased
what is elevated in the blood results for polymyositis
creatine photokinase and aldolase
which arteritis is the pulseless one
takayasu’s
what is skiers thumb
a complete or partial tear of the UCL of the thumb
which nerve is associated with tear formation
intermediate nerve
what does positive anti-endomysial antibody mean
coeliac
blood results for pseudohypoparathyroidism
elevated PTH
low calcium
high phosphate
if someone has right homonymous superior quadrantanopia where is the lesion
left temporal lobe optic radiation
first line treatment for a pregnant woman with conjunctivitis
topical fusidic acid eye drops
-chloramphenicol contraindicated in pregnancy
treatment for actinic keratoses
5-flourouracil cream
treatment for actinic keratoses
5-flourouracil cream
which type of collagen is affected in alport syndrome
type IV
what causes oslers nodes
infective endocarditis
treatment for moderately severe eczema
regular diprobase ointment and once daily betamethasone valerate 0.025% plus 10 days oral flucloxacillin
what is found on biopsy in diabetic nephropathy
kimmelstein-wilson nodes
treatment for patients with rheumatoid arthritis who have not responded to two DMARDs
biologics
infliximab
in a suspected osteosarcoma, what is first line management
order a whole body bone scan, CT chest, and MRI of the entire femur
which thyroid cancer tends to affect young patients and has a good prognosis
papillary
which thyroid cancer has the worst prognosis
anaplastic
what would explain these abdo x-ray findings
medullary sponge kidney
what does the long head of the biceps brachii tendon attach to
the supraglenoid tubercle of the scapula
side effect of bisphosphonates
oesophagitis (most common)
osteonecrosis of jaw (less common)
if psammoma calcification is found on biopsy of a thyroid lump, what is the diagnosis?
papillary cancer
what does the patient have if they have a negative anterior drawer test but the test in painful
ACL injury
testosterone effect on fertilisation
increases infertility
-exogenous testosterone suppresses GnRH and so FSH and LH
intrinsic hand muscle wasting suggests that the lesion is where
T1
what is fat embolism syndrome
an acute respiratory disorder caused by embolized fat globules that may enter the bloodstream as a result of acute long bone fractures or intramedullary instrumentation
what can cause sensory problems and reduction in grip and pinch strength in the hand
ulnar neuropathy
if a patient gets an intertrochanteric fracture and gets a dynamic hip screw for it, then a few months there the hip screw is backed out slightly what does this suggest
trochanteric bursitis from the metal work
if a patient with T2DM on metformin and gliclazide is getting surgery and needs to fast, what changes should be made to their medication
omit gliclazide and continue metformin
what drug can cause hyponatraemia
bendroflumethiazide
what causes the hyponatraemia in SIADH
increased water absorption in collecting duct
investigation for osteomalacia
serum 25-OH cholecalciferol
floaters in eye
retinal detachment
first thing to do in a patient with a painful eye and loss of visual acuity
refer to opthalmology department as an emergency
which anatomical structure in most likely to be affected in an orbital blowout fracture
inferior rectus muscle at fracture site
which nerve is responsible for closing the lids
facial (7th)
does otosclerosis result in conductive or sensorineural hearing loss
conductive
abdo thrusts or chest thrusts in a conscious choking baby
chest
what needs to be done in children with UTIs
abdo ultrasound
preterm baby with vomiting, lethargy and abdo distension
necrotising enterocolitis
when would jaundice due to haemolysis present
within 24 hours of birth
what jaundice is pathological
jaundice in first 24 hours of life
causes noisy breathing in baby with fever, cough, reduced oral intake
bronchiolitis
who gets kawasaki disease
children younger than 5
what are the 5 principal clinical features of kawasaki disease
- bilateral conjunctival injection
- changes in the lips and oral cavity
- cervical lymphadenopathy
- extremity changes
- polymorphous rash
what medication improves survival in chronic congestive heart failure
ACEis
what is the test for glandular fever (epstein barr)
monospot test
