Year 4 Flashcards
1
Q
Most common side effect of macrolides?
A
Jaundice
2
Q
What is Polymyalgia Rheumatica?
A
Pain and inflammation in many joints and tissues around the joints Particularly effects: ○ Shoulders ○ Neck ○ Hip
3
Q
What is Bigeminy
A
alternating ventricular ectopic beat (wide QRS) and sinus beat (with narrow QRS).
4
Q
What is HPOA?
A
HPOA - hypertrophic pulmonary osteoarthropathy
• Clubbing and periostitis
• Test for be palpating the wrists for tenderness
Mechanism thought to be the same as for clubbing - megakaryoctes and large platelets manage to find their way into the systemic circulation and release lots of growth factors
5
Q
What is tazocin?
A
Piperacillin and tazobactam combo antibiotic
6
Q
What is tazocin’s range of effect?
A
Includes
• Gram positive
• Gram negative
• Pseudomonas aeriginosa
7
Q
What is Indapamide?
A
A thiazide like diuretic
Generally used in the treatment of HT
8
Q
What is the common low molecular weight heparin?
A
Enoxaparin/ Clexane
9
Q
What is apixaban?
A
A Factor Xa inhibitor
Used for treatment of thromboembolism and for prophylaxis also
10
Q
Nimodipine
A
Ca channel blocker
11
Q
Classes of antiarrhythmics?
A
- Na channel blockers
- Beta Blockers
- K channel Blockers
- Ca Channel blockers
- Other
12
Q
What are some Type 1 Antiarrythmics?
A
Lignocaine
13
Q
What is atropine
A
An Ach receptor antagonist, can be given for bradycardia.
14
Q
What are some Type 2 Antiarrythmics?
A
Atenolol, metoprolol, carvedilol, propranolol, bisoprolol
15
Q
What are some Type 3 Antiarrythmics?
A
Amiodorone
Sotalol
16
Q
What are some Type 5 Antiarrythmics?
A
Adenosine
Digoxin
17
Q
Name a K binder
A
Resonium
18
Q
Trimethoprim
A
An Abx used to treat UTIs
19
Q
Aspirin’s antithrombosis MOA
A
Decreased production of Thromboxane A2 by COX-1. Thromboxane A2 normally mediates the expression of GP IIb/ IIIa on platelet membranes. This is usually responsible for fibrinogen binding to and binding the platelets together.
20
Q
Narrow spectrum Penecillin with staph action?
A
flucloxacillin
21
Q
What class of Abx is gentamycin
A
aminoglycaside
22
Q
What are some Type 4 Antiarrythmics?
A
Verapamil
23
Q
Treatment for migraines?
A
Acute: Mg
If severe: Triptan (sumitriptan)
Supportive: NSAIDs/ Aspirin, anti-emetics, hydration
24
Q
Donepezil
A
- Reversible cholinesterase inhibitor
* Used to treat dementia
25
Acute abdomen causes
* Appendicitis
* Kidney stone - ureteric colic
* Biliary colic / cholecystitis
* Ectopic pregnancy
* Salpingitis
* Bowel obstruction
* Bowel ischaemia
* AAA
* Diverticulitis
* Pancreatitis
26
borders of the anterior triangle of the neck
sternomastoid
line from chin to manubrium
inferior aspect of the jaw
27
what anti-arrhythmic can be used to cardiovert?
amiodorone, sotolol, lignocaine (only in emergencies for ventricular arrhythmias)
28
Diff between Bell's palsy and stroke on examination
Bell's palsy also causes weakness of forehead muscles as is a LMNL. Forehead gets dual innervation from both cerebral cortexes so the deficit isnt pronounced in stroke.
29
borders of the anterior triangle of the neck
sternomastoid
line from chin to manubrium
inferior aspect of the jaw
30
Most common cause of facial nerve palsy
Bell's palsy
31
Diff between Bell's palsy and stroke on examination
Bell's palsy also causes weakness of forehead muscles as is a LMNL. Forehead gets dual innervation from both cerebral cortexes so the deficit isnt pronounced in stroke.
32
sialolithiasis most common gland affected
submandibular (90%)
33
Sentinal node is....
any LN which receives DIRECT drainage from a particular area (not just the FIRST node)
34
histology of papillary thyroid carcinoma
```
psammoma bodies
(concentric lamellated calcified structures)
```
35
cells found in histology suggestive of lymphoma
Reed-Sternberg cells
36
histology of papillary thyroid carcinoma
psammoma bodies
37
most common type of thyroid ca
papillary carcinoma (70%)
38
surveillance marker for disease recurrence after total thyroidectomy for papillary carcinoma
thyroglobulin
39
thyroid papillary carcinoma prognosis after thyroidectomy
90% 10year survival
40
Which NOAC is not a factor Xa inhibitor?
Dabigatran (direct thrombin inhibitor)
41
What is Bivalirudin?
A direct thrombin inhibitor,
| Doesn't cause HITTS, recommended in ACS
42
What nerve are you likely to damage with a mid humoral fracture?
Radial
43
What muscles does the median nerve supply?
- All the flexors of the forearm except flexor Capri ulnaris
- LOAF muscles
- Lumbricals (1st and second)
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
44
Side effects of parotidectomy...?
Frey's syndrome (gestatory diaphoresis)
Damage to the facial nerve
Salivary fistula
45
What is Uhthoff's phenomenon...?
Worsening of neurological symptoms with heat/exercise. Seen with demyelinating disorders e.g. MS
46
Investigation to confirm TB eradication...?
Sputum culture with Ziel Nielson stain for acid fast bacilli
47
What is a Colles fracture...?
FOOSH with extra-articular fracture of distal radius and dorsal displacement.
48
What is a Smith fracture...?
FOOSH (flexed), with extra-articular fracture of distal radius and palmar displacement.
49
Type 1 vs Type 2 statistical error?
Type 1: false positive (incorrectly rejecting the null hypothesis)
Type 2: false negative
50
What is the inheritance and pathology of Haemophilia A?
X linked recessive, decreased factors VIIIc.
| Some carriers can have decreased factor VIII which can lead to heavier bleeding
51
DDx for Acute abdomen with pain in RLQ
```
Appendicitis
Mesenteric adenitis (young)
Salpingitis
Ectopic pregnancy
Ureteric colic
Pyelonephritis
Diverticulitis
Crohn's disease
```
52
Orientations/Locations of the appendix
Retrocaecal (75%)
Pelvic (20%)
Ileal (5%)
53
Muscles inserting into Pes Anserinus...?
Gracilis, Sartorius and Semitendinosus
54
Causes of hyperuricaemia...?
Overproduction: ETOH, psoriasis, myeloproliferative disorders.
Underexcretion: Renal failure, diuretics, dehydration, starvation, low dose aspirin.
55
What is a Colles fracture...?
FOOSH with extra-articular fracture of distal radius and dorsal angulation.
56
What is a Smith fracture...?
FOOSH (flexed), with extra-articular fracture of distal radius and palmt5frar angulation.
57
What is tennis elbow...?
Lateral epicondylitis, caused by tear of extensor carpi radialis brevis.
58
What is golfer's elbow...?
Medial epicondylitis, caused by tear to flexor carpi redialis
59
Muscles of the rotator cuff...?
Supraspinatus, infraspinatus, teres minor, subscapularis
60
Criteria for rheumatic fever
```
Jones criteria
Evidence of streptococcal infection
Major
- pancardiits
- migratory polyarthritis
- erythema marginatum
- sydenham chorea
- subcut nodules
```
Minor
- fever
- arthalgia
- PHx rheumatic heart disease or fever
- Acute phase reactions (ESR, CRP, leukocytosis)
- prolonged PR
61
Management of Colles fracture...?
Closed reduction to restore radial height + dorsal slab/below elbow cast for 5-6 weeks.
62
2 commonest causes of pneumoperitoneum
perforated peptic ulcer
| perforated diverticulum during diverticulitis
63
Risk factors for cholelithiasis and cholecystitis
```
Female
Forty
Fertile
Fat
Fair
```
64
What is a useful scale in determining severity of pancreatitis
Ranson's criteria
65
complications of severe pancreatitis
SIRS (systemic inflammatory response syndrome)
ARDS (acute respiratory distress syndrome)
DIC (disseminated intravascular coagulation)
MOF (multiple organ failure)
66
Causes of transudative pleural effusion...?
```
CHF
Liver failure
Nephrotic syndrome
Pulmonary Embolism
Fluid Overload
Constrictive Pericarditis
```
67
Beck's triad (for cardiac tamponade)...?
Raised JVP
Pulsus Paradoxus/Hypotension
Dull heart sounds
68
Treatment of Opioid overdose
Naloxone
69
Treatment of paracetomol overdose
N-acetylcystine
70
Class I haemorrhage
| % blood loss and clinical findings
0-15%
BP maintained
minimal tachycardia
normal RR
71
Class II haemorrhage
| % blood loss and clinical findings
15-30%
BP maintained
tachycardia >100bpm
tachypnoea >20
pale
diaphoretic
delayed capillary refill
72
Class III haemorrhage
| % blood loss and clinical findings
30-40%
Low BP
Tachycardia >120bpm
RR >30
Pale
diaphoretic
delayed capillary refill
confusion
73
Class IV haemorrhage
| % blood loss and clinical findings
>40%
significant hypotension
HR 140bpm
RR >35
significant acidosis
depressed mental state/unconscious
74
prognostic tool for liver cirrhosis
Childs-Pugh score
75
1 Year survival for Childs-Pugh A
100%
76
1 year survival for Childs-Pugh B
80%
77
1 Year survival for Childs-Pugh C
45%
78
Risk factors for Gastric Ca
```
Asian ethnicity (esp Japan)
smoking
GORD
pernicious anaemia
H. pylori
diet: preserved foodstuff (nitrosamines)
```
79
Troisier's sign
Finding of an enlarged Virchow's node
80
Virchow's node
L) Supraclavicular node
sign of metastatic abdominal malignancy (e.g. gastric ca)
81
ABx for suspected appendicitis
amoxycillin
gentamicin
metronidazole
82
Charcot's triad
Jaundice
Rigors
RUQ pain
Combination of signs found in typical cholangitis
83
Features of acute cholecystitis on US
Stones
Thick-walled gallbladder
echogenic shaddowing
pericholecystic fluid
84
pancreatic Ca tumour marker
CA 19-9
85
Colorectal Ca tumour marker
CEA (carcinoembryonic antigen)
86
HCC tumour marker
AFP (alpha-fetoprotein)
87
CML genetic abnormality
BCR-ABL fusion gene
88
NET (Neuroendocrine Tumour) tumour marker
CgA (chromogranin A)
89
complications of diverticulitis
fistula formation
abscess formation
perforation + faecal peritonitis
90
preferred imaging technique for diverticulitis
CT
91
dysphagia vs odynophagia
difficulty swallowing = dysphagia
| painful swallowing = odynophagia
92
procedures considered high risk for VTE
hip and knee arthroplasty
cancer surgery
intra-abdominal procedure
surgery taking >45min
93
CHADS2 score
```
Congestive Heart Failure
Hypertension
Age >75
Diabetes Mellitus
Stroke or TIA symptoms previously (2 points)
```
score >2 = significant risk of stroke
94
HAS-BLED score
```
Hypertension
Abnormal renal or liver function
Stroke
Bleeding
Labile INR
Elderly
Drugs/alcohol
```
95
Individual risk factors for VTE (other than immobility)
```
obesity
age >60
Prev Hx DVT
IBD
HRT (and OCP)
malignancy
sepsis
dehydration
```
96
AF causes
Pulmonary disease (COPD, PE)
Ischemia (ACS)
Rheumatic heart disease (mitral stenosis)
Anemia (high output failure/tachycardia)/Atrial myxoma
Thyrotoxicosis (tachycardia)
Ethanol/Endocarditis
Sepsis/Sick Sinus Syndrome
97
What are anti Smith antibodies associated with?
SLE
98
benztropine
an anticholinergic, used to treat acute dystonic reaction.
99
What is the mechanism of anterior shoulder dislocation?
abduction, extension, external rotation
100
What is hippocratic reduction of a shoulder dislocation?
As its name suggests the Hippocratic method of reducing the dislocation by counter-traction against the foot placed gently immediately below the axilla, is the most ancient of the methods described.
http://www.emedici.com/images/CPL572.jpg
101
Cause of a 'Dinner fork deformity'...?
Colles fracture. I tried to insert a picture but it didn't work... yeah just put a link in maybe
102
what's the most common clavicle fracture?
Middle third (> 2/3 of clavicle fractures)
103
Triggers for migraine?
```
Chocolate/ Cheese
Hormonal
OCP
Caffeine
alcohOL
Anxiety
Travel
Exercise
```
104
Medical treatment for patient with paroxysmal AF with BP 160/80
Beta Blocker e.g. atenolol or metoprolol.
| usually use oral unless urgent rate control required and then give IV metoprolol tartrate.
105
Medical treatment for patient with paroxysmal AF with BP 110/60 and known heart failure
digoxin (dose according to age, eGFR and monitor plasma digoxin concentration)
106
half life of digoxin in pts with normal renal function
at least 24hrs
107
When would you use ticagrelor
It is an antiplatelet.
can be co-administered with aspirin.
used to prevent atherothrombotic events in patients with ACS.
it is reversible and has a short half life so can be used in pts who need to undergo PCI or CABG.
108
What causes acute rheumatic fever?
antibodies after Lancefield group A Beta-Haemolytic streptococci infection --> antibodies cross-react with the valve tissue.
109
Describe the arthritis from rheumatic fever
migratory polyarthritis, mostly affecting larger joints
110
antibiotics for HAP
ceftriaxone + metronidazole
111
antibiotics for severe HAP
tazocin + metronidazole
112
antibiotics for osteomyelitis in non-diabetic patient
high dose flucloxacillin
113
How do you treat a Kolles or a Smith fracture?
Smith needs ORIF as it's generally unstable.
| Kolle's can be managed conservatively with closed ruction and a cast.
114
What disease does VZV cause?
Early infection: varicella (chicken pox)
| Later re-activation: herpes zoster (shingles)
115
What's the antidote to benzodiazapine oversedation?
Flumazenil
116
How many dopamine receptors are there?
5
117
Signs of C diff infection?
- significant diarrhoea (smells of horse amnure)
- recent antibiotic use
- fever
- abdominal pain
118
Meanings of Spondylosis vs Spondylolysis vs Spondylolisthesis
Sponylosis: osteoarthritis of the facet joints
Spondylolysis: degenerations of the pars inter-articularis
Spondylolithesis: one vertebra is pushed forwards on another
119
Acute Pancreatitis Causes
```
I GET SMASHED
Idiopathic
Gallstones (45%)
Ethanol (35%)
Tumours: pancreas, ampulla, choledochocele (cyst)
Scorpion stings
Microbiological
○ CMV, EBV, VZV
○ M pneumoniae, salmonella, campylobacter
Autoimmune:
Surgery/trauma
Hyperlipidemia, Hypercalcemia, Hypothermia, hereditary
○ CFTR
○ Hypercalcaemia - vit D, Ca,
○ Developmental abnormalities
Emboli or ischemia
Drugs/toxins
○ SAND
○ Steroids
○ Azothiaprine
○ NSAIDs
○ diuretics
Frusomide
```
120
Which ankle ligaments usually are injured?
lateral ones usually sprained
| - specifically the anterior talo-fibular ligament and the calcaneo-fibular ligament are most commonly affected
121
Garden Classification
1. incomplete fracture
2. complete fracture, non-displaced
3. Partially displaced
4. Fully displaced
122
Definition of clean vs clean-contaminated vs contaminated vs dirty.
Clean wound
No entering of a viscus that is normally contaminated by bacteria. Risk of infection is 2%.
Clean - contaminated
A colonised viscus is entered but in a controlled environment. Risk of infection is 4-10%.
Contaminated
There is already a perforation or bacteria are able to get into the area.
Dirty
The surgery takes place at a site where there is already infection.
123
Charcot's triad? Raynaud's pentad.
1. fever
2. RUQ pain
3. Jaundice
4. Confusion
5. Low BP
124
what are the features of limited cutaneous systemic sclerosis?
CREST syndrome
```
Calcinosis
Raynaud's
Oesophageal dysmotility
Sclerodactyly
Telangiectasia
```
125
Immune mediated disease types
1. Anaphylactc
2. Cytotoxic
3. IC
4. Cell-mediated/ delayed hypersensitivity
126
What causes pseduogout?
calcium pyrophosphate crystal deposition
127
DDx Hypercholesterolaemia...?
```
Familial hypercholesterolemia
Obesity
Cushing's Syndrome
Nephrotic Syndrome
Multiple Myeloma
```
128
Medications to lower cholesterol...? (there are more than one)
Statins: HMG-CoA reductase inhibitors, achieve a 55% reduction
Ezetimibe: Blocks cholesterol absorption in the small intestine, achieves a 20% reduction.
129
Diagnostic criteria for Pericarditis...?
1. Typical chest pain (sharp, retrosternal, worse on leaning forwards)
2. Pericardial rub
3. New/Worsening pericardial effusion
4. ECG changes - widespread ST elevation, PR depression
130
Causes of Pericarditis...?
Infection: Coxsackie A & B, echovirus, HIV, staph, pneumo, TB, Hib, histoplasmosis
Malignancy: Breast, Hodgkin Lymphoma, ANYTHING else.
Radiotherapy
Trauma
Connective tissue disease
Renal failure
Drugs (Penicillin, Isoniazed, chemotherapy)
131
Management of pericarditis...?
Ibuprofen and Colchicine
132
Treatment of acute pulmonary oedema...?
LMNOP;
```
Loop diuretics
Morphine
Nitrates
Oxygen
Positive pressure ventilation + Position patient with legs hanging down
```
Plus nitroprusside or hydralazine if that fails
133
Contraindications/Precautions with Beta-blockers...?
Contra; 2nd or 3rd degree heart block, bradycardia, hypotension, Wolff-Parkinson-White syndrome.
Precautions; worsens Asthma and Raynaud's
134
C-P450 inhibitors...?
```
Grapefruit juice
SSRIs
PPIs
Amiodarone
Valproate
Sulfamethoxazole
Ketoconazole
```
135
What is Carcinoid syndrome and what investigation is useful...?
Episodic flushing, diarrhoea and bronchospasm
Caused by a tumour of the bronchi or GIT which secretes various products, one of which is 5-hydroxytryptophan, which is what you test for in urine.
136
Acute seizure management...?
Turn patient to lateral decubitus position and clear/suction airway
Give high dose O2
Do a pin-prick glucose test
Obtain IV access and give Midazolam, Phenytoin.
Investigate cause
137
Acute Asthma management...?
IV hydrocortisone
Oxygen, lots
Nebulized salbutamol
138
Acute Anaphylazis management...?
ABCs, remove trigger
IM adrenaline 500 micrograms
high flow O2, SABA
IV access, begin fluid administration (Hartmann's)
139
Criteria for Sepsis/SIRS...?
1. Temp 38.8
2. HR >90bpm
3. Resp rate >20 or paCO2 12
140
Empiric Abx for Infective endocarditis...?
IV Benzylpenicillin, flucoxicillin, gentamycin
141
Acute COPD exacerbation, what O2 sats are you aiming for...?
88-92%, any higher may remove hypxic drive in CO2 retainers.
142
Lights criteria...?
Determines exudate vs transudate in pleural effusion
1. Pleural/Serum protein >0.5
2. Pleural/Serum LDH >0.6
3. Pleural LDH >0.45 upper limit normal serum LDH
If any one is positive --> exudate.
143
Contraindications for exercise stress testing...?
Acute MI, PE, dissection, pericarditis, severe AS, inability to exercise.
144
Indications for open reduction...?
NO CAST
Non-union
Open fracture
Compromise (neurovascular)
Articular involvement
Salter harris 3,4,5
Trauma (poly)
145
What causes pseduogout?
calcium pyrophosphate crystal deposition
146
What laboratory screening test can you perform for HCC?
Alpha-feto protein
147
Empirical antibiotics for CAP?
Macrolide (e.g. erythromycin) or doxycycline
148
Empirical antibiotics for HAP?
Ceftriaxone
OR quinolones (e.g. moxifloxacin)
OR beta-lactam and inhibitor
149
5 types of psoriatic arthritis
```
asymmetric oligoarthritis
arthritis of distal interphalangeal joints
destructive/mutilans arthritis
symmetric polyarthritis
sacroiliitis and spondylitis
```
150
Criteria for breast conserving surgery?
single lesion
tumour <3cm (<4cm in a larger breast)
lesion more than 2cm away from the nipple/areola
lower histological grade
no extensive nodal involvement
