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Y4 Medicine > Year 5 > Flashcards

Year 5 Flashcards

1
Q

Indications for urgent head CT < 1 hour

A
  • GCS <13 on initial assessment
  • GCS <15 2 hours post injury
  • Suspected open or depressed skull fracture
  • signs of basal skull fracture (e.g panda eyes or battle sign or CSF from ears/nose)
  • Post traumatic seizure
  • Focal neurological deficits
  • > 1 episode of vomitting
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2
Q

Indications for CT head <8 hours

A

For anyone who has had loss of concioussness/reduced conciousness and;
* Age >65
* History of bleeding/clotting disorders OR on anticoagulation
* dangerous mechanism of injury
* >30 minutes of retrogade amnesia following event

NOTE - if on warfarin patient must have CT head <8hours regardless of conciousness level.

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3
Q

Clinical presentation of anastamotic leak post surgery

A

Typically presents 2-7 days following surgery (usually day 5)
May present with new onset AF
Feculent material in wound drain
Tachycardia
Pyrexia
Absent bowel sounds / signs of peritonitis

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4
Q

1st line investigation for appendicitis

A

Abdo ultrasound - especially in females to rule out ovarian causes of RIF pain.
2nd line do a CT scan

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5
Q

AAA management

A

Screening offered at age 65
<3cm = no further action
3 - 4.4 = small aneurysm, rescan in 12 months
4.5 - 5.4 = rescan in 3 months
>5.5cm = 2ww referal to vascular for intervention

If growth >1cm per year or Symptomatic refer for intervention.

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5
Q

Single most useful blood test (not LP) in pts with subarachnoid haemorrhage

A

U&Es - to detect hyponatremia (a common complication of SAH)

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6
Q

1st line investigation for suspected prostate cancer

A

Multiparametric MRI scan

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7
Q

diagnostic investigation for small bowel obstruction

A

CT abdo

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8
Q

Bladder cancer RF & Types

A

Transitional cell (urothelial) = most common:
* Smoking
* Alanine dyes (printing/textile industry)
* rubber manufacture
* cyclophosphamide (chemo drug)

Squamous cell - <10% of cases;
* Schistosomiasis
* smoking

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9
Q

Causes of hydronephrosis

A

Bilateral (PACT)
* Abberant renal vessels
* Calculi
* Tumours of renal pelvis

Unilateral (SUPER)
* Stenosis of urethra
* Urethral valve
* Prostatic enlargement
* Extensive bladder tumour
* Retro-peritoneal fibrosis

Management = urethral catheter

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10
Q

Serotonin syndrome

A

Causes;
* SSRIs
* MAOIs
* Ecstasy/amphetamines
* NOTE - tramadol + SSRIs often causes serotonin syndrome

Features;
* Neuromuscular excitation - Hyperreflexia, myoclonus + rigidity
* Autonomic excitation - sweating + hyperthermia
* Confusion

Mx = benzos + chlorpromazine

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11
Q

Neuroleptic malignant syndrome

A

Causes;
* Antipsychotics

Features;
* Slow onset (hours-days)
* Decreased reflexes
* lead pipe rigidity
* hyperthermia
* CK will be raised

Mx if severe = dantrolene

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12
Q

Primary sclerosing cholangitis

A

Associated with UC & HIV

Features;
* cholestasis
* RUQ pain
* Fatigue
* Increased risk of Cholangiocarcinoma + CRC

INVx = ERCP/MRCP shows beading appearance to biliary tree (biliary strictures)
p-ANCA +ve
Onion skin appearance on liver biopsy (not v helpful)

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13
Q
A
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14
Q

Churg strauss syndrome

A

Eosinophilic granulomatosis with polyangitis

Features;
* Asthma
* Blood eosinophilia
* Paranasal sinusitis
* nasal polyps
* mononeuritis multiplex
* Vasculitis
* Dyspnoea

p-ANCA +ve

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15
Q

Wegener’s granulomatosis

A

Granulomatosis with polyangitis

Features;
* Renal failure
* Saddle nose deformity
* Epistaxis / Haemoptysis
* Vasculitis
* Dyspnoea

C-ANCA +ve

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16
Q

Rosacea

A

Features;
* typically affects nose, cheeks and forehead
* Flushing often first sx
* telangiectasia
* pustules/papules + persistent erythema
* Rhinophyma
* Sunlight may exacerbate sx

Mx = Conservative mx (sunscren)
* Topical brimonidine gel for flushing
* Topical ivermectin 1st line if pustules or papules present
* Topical metronidazole / azelaic acid is an alternative

If severe pustules/papules then give Oral doxy + topical ivermectin

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17
Q

Tumour lysis syndrome

A

Typically occurs in pts with lymphoma or leukemia on the introduction of chemotherapy.
Prophylaxis with allopurinol will prevent it.

Features; Mainly related to electryolyte abnormalities
* Abdo pain, N&V
* weakness
* arrythmias
* seizures

Cairo-bishop scoring system (used for diagnosis)
* Uric acid >475
* K+ >6
* Hyperphosphatemia
* Low calcium

Mx;
* IV fluids
* Rasburicase (high risk pts) or allopurinol (in lower risk groups)

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18
Q

Which oral anti-hyperglycemic agents are contraindicated in heart failure?

A

Pioglitazone (the glitazones) as they can cause fluid retention which would worsen HF.

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19
Q

Rapid correction of hypernatremia can cause what?

A

Cerebral oedema

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19
Q

Rapid correction of hyponatremia can cause what

A

Central pontine myelinosis

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20
Q

A cavitating lung lesion indicates which type of lung cancer?

A

Typically squamous cell

21
Q

Management of life threatening C.diff infection

A

Oral vancoymycin and IV metronidazole

22
Q
A
23
Q

Management of severe cellulitis

A

IV Co-amoxiclav, clindamycin or ceftriaxone

Mild-moderate cellulitis is treated with flucoxacillin

24
Q

Causes of PAINLESS genital ulcers

A
  1. Syphillis - Caused by Treponema pallidum. Infection is characterised b primary, secondary adn tertiary stages. A painless chancre is seen. incubation 9-90 days.
  2. Lymphogranulpoma vereneum - caused by chlamydia. Infection comprises 3 stages; (1 = small painless pustule, later forms an ulcer) ( 2=Painful inguinal lymphadenopathy) (3=protocolitis)
25
Q

Causes of PAINFUL genital ulcers

A
  1. Genital herpes - usually caused by HSV2. Typically multiple painful ulcers.
  2. Chancroid - tropical disease caused by hameiphilus ducreyi. Causes painful genital ulcers associated with unilateral painful inguinal lymphadenopathy. Ulcers have shaprly defined, ragged, undermined borders.
26
Q

Which antibiotic is best to treat MRSA infection

A

Vancomycin

Clindamycin can be used as monotherapy once sensitivities are available due to high rates of resistance. (Also associated with C.diff so avoid in elderly!)

27
Q

Severe side effet of Etomidate?

A

Adrenal suppresion

28
Q

Tx of prostatitis

A

Quinolone antibiotic (e.g Ciprofloxacin) for 14 days.

29
Q

Enteric fever (Typhoid)

A

Caused by Salnonella typhi/parathyphi.

Faeco-oral transmission.

Features;
* Systemic upset initially - headache, fever & arthralgia
* Relative bradycardia
* Abdo pain & distension
* Constipation
* Rose spots - typically on the trunk

Complications = osteomyelitis, GI bleed, meningitis, cholecystitis.

30
Q

Malaria

A

Cause = plasmodium (P.Falciparum most common. P.Vivax ‘benign malaria’)

Features;
* Systemic features - fever, headache & splenomegaly.
* Cyclical fever (every 48hrs)
* Hypoglycemia
* Acidosis
* Severe anemia
* Schizonts on a blood film

31
Q

Dengue fever

A

Viral infection - may progress to viral haemoharrgic fever.

RNA virus of the Flavivirus - transmitted by Aedes mosquito.

Features;
* Fever & Retro-orbital headache & Myalgia/arthralgia - A.K.A break-bone fever
* Pleuritic pain
* Maculopapular rash
* Haemorrhagic manifestations e.g petechiae, purpura, epistaxis.

Severe dengue gives a DIC type picture (spontaneous bleeding & thrombocytopenia)

Invx = serology or NAAT for viral RNA.

32
Q

Amoebiasis

A

Caused by entamoeba histolytica.

Features;
* Profuse bloody diarrhoea
* Long incubation period
* Stool microscopy - may show trophozoites if examined within 15 mins.

*May cause liver abscess - Typically a single mass in right lobe (anchovy sauce)
This presents with fever & RUQ pain & hepatomegaly.

Tx = oral metronidazole

33
Q

Giardiasis

A

Caused by giardia lamblia.

RF = foregin travel, swimming/drinking from river or lake. MSM.

Features;
* May be asymptomatic.
* Non-bloody diarrhoea
* Bloating, abdo pain
* Steattorhoea
* Lethardy
* Weight loss
* Malabsoprtion and lactose intolerance can occur.

Tx = metronidazole

34
Q

Leptospirosis

A

Caused by the spirochete leptospira interrogans.

Typically spread by contact with infected rat urine (sewage workers, farms, abbotoir etc)

Features;
* Fever, flu-like Sx.
* Subconjunctival redness/haemorrhage
* Second immune phase (weil’s disease) = AKI + Jaundice + hepatomegaly + aseptic meningitis.

Mx = Benpen or doxy.

35
Q

Management of legionella pneumonia

A

Macrolide antibiotics (Clarithromycin)

36
Q

Legionella diagnosis

A

Urinary antigen testing

37
Q

What electyrolye imbalance may be caused by Legionella pneumonia

A

Hyponatremia

38
Q

Treatment of syphillis genital ulcers

A

IM Benzylpenecillin

39
Q

Treatment of latent TB

A

3 months of Isoniazid + rifampicin

OR

6 months of Isoniazid

(dont forget to prescribe pyroxidine with isoniazid to reduce risk of peripheral neuropathy)

40
Q

Most common cause of travellers diarrhoea

A

E.coli

Features = watery stools + severe abdo cramps.

41
Q

Q fever

A

caused by coxiella burnetti. (found on cattle & sheep)

Features;
* Typical prodrome = fever & malaise
* Pyrexia
* Transaminitis
* Atypical pneumonia
* Endocarditis

Mx = doxycycline

42
Q

What antibiotic should be added in pneumonia if staphyloccic suspected (influenza)

A

Flucoxacillin

43
Q

ebola

A

Filoviridae family
west africa
human-human transmission
incubation = 2-21days (only infectious once sx start)

Features;
* suspect ebola in pts presenting with a fever >37.5 with recent history in africa/affected areas.
* Other features = Fatigue + muscle pain + headache + sore throat + vomitting + diarrhoea + impaired kidney/liver function.

44
Q

Management of metastatic bone pain

A

Typically responds to strong opiates, bisphosphanates or radiotherapy.

45
Q

Which beta blockers should be used in CVD?

A

Bisoprolol and Carvedilol

46
Q

What rash/skin change can you get in reactive arthritis

A

Keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles of feet)

47
Q

What is the brownish disclouration called seen in chronic venous insufficiency?

A

Haemosiderin staining

48
Q

What causes the ‘inverted champagne bottle’ apperance to the legs in Chronic venous insufficiency

A

Lipodermatosclerosis (chronic inflammation of the subcutaneous tissue)

49
Q

Atrophy blanche

A

Smooth porcelain white scar tissue - usually surrounded by haemosiderin deposition. Caused by chronic venous insufficiency

50
Q

Side effects of adenosine

A

Flushing
Chest pain
abdo pain
headache
hypotension
dry mouth
Dyspnoea

51
Q
A

Y4 Medicine (22 decks)

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