YSKT Flashcards
(141 cards)
<p>Pulsus paradoxus - Associated conditions?</p>
<p></p>
<p>Severe asthma Cardiac tamponade</p>
<p>Conditions associated with collapsing pulse?</p>
<p>Aortic regurgitation
Patent ductus arteriosus
Hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)</p>
<p>Croup - Organism? Epidemiology? Features? Management? Emergency treatment?</p>
<p>Parainfluenza virus
Peak incidence at 6 months - 3 years
Stridor, barking cough, fever, coryzal symptoms (sore throat, runny nose)
Single dose of oral dexamethasone (prednisolone is alternative)
High-flow O2
Nebulised adrenaline</p>
<p>Contraindications to COCP</p>
<p>>35 years old and smokes >15 cigs a day
Migraine with aura
History of thromboemboic disease or stroke or IHD
Breastfeeding < 6 weeks post-partum
Uncontrolled HTN
Immobility
Current breast cancer
Major surgery with prolonged immobilisation</p>
<p>Complications with psoralen and UV A light therapy?</p>
<p>Squamous cell cancer
| </p>
<p>Anal fissures - Risk factors? Features? Management of acute? Management of chronic?</p>
<p>Constipation, IBD, STI
Painful, bright red, rectal bleeding
High-fibre diet with high fluid intake
Bulk-forming laxatives are first line
Lubricant before defacation
Topical glyceryl trinitrate
</p>
<p>Metastatic prostate cancer disease -
| Hormonal therapy?</p>
<p>Goserelin (Zoladex) with Cyproterone acetate </p>
<p>Clozapine -
| Adverse effects?</p>
<p>Agranulocytosis; neutropenia Reduced seizure threshold Constipation Myocarditis Hyper salivation</p>
<p>At birth recommended immunisations</p>
<p>BCG / hepatitis B vaccine if risk factors </p>
<p>2 months immunisations</p>
<p>'6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
PCV
Men B</p>
<p>3 months immunisations</p>
<p>'6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine</p>
<p>4 months immunisations </p>
<p>'6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
PCV
Men B</p>
<p>12-13 months immunisations </p>
<p>Hib/Men C
MMR
PCV
Men B</p>
<p>2-8 years immunisations</p>
<p>Flu vaccine (annual)</p>
<p>3-4 years immunisations</p>
<p>'4-in-1 pre-school booster' (diphtheria, tetanus, whooping cough and polio)
MMR</p>
<p>12-13 years immunisations</p>
<p>HPV vaccination for girls</p>
<p>13-18 years immunisations</p>
<p>'3-in-1 teenage booster' (tetanus, diphtheria and polio)
| Men ACWY</p>
<p>Addison's disease management</p>
<p>Hydrocortisone: usually given in 2 or 3 divided doses
| Fludrocortisone</p>
<p>Whooping cough (pertussis) -
Bacteria?
Management?
Complications?</p>
<p>Gram negative
Oral macrolide (clarithromycin, azithromycin or erythromycin)
Household contacts given abx prophylaxis
School exclusion - 48 hours after commencing abx or 21 days after onset
Subconjunctival haemorrhage
Pneumonia
Bronchiectasis
Seizures</p>
<p>Test for diagnosis of Pagets disease of the nipple?</p>
<p>Punch biopsy</p>
<p>Aspirin -
| Mechanism of action?</p>
<p>Antiplatelet - inhibits the production of thromboxane A2</p>
<p>Clopidogrel -
| Mechanism of action?</p>
<p>Antiplatelet - inhibits ADP binding to its platelet receptor</p>
<p>Enxoaparin -
| Mechanism of action?</p>
<p>Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa</p>
<p>Fondaparinux -
| Mechanism of action?</p>
<p>Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa</p>
Bivalirudin - | Mechanism of action?
Reversible direct thrombin inhibitor
Abciximab, eptifibatide, tirofiban - | Mechanism of action?
Glycoprotein IIb/IIIa receptor antagonists
Right iliac fossa pain - | Ddx
Appendicitis Crohns Mesenteric adenitis Diverticulitis Meckel's Perforated peptic ulcer UTI Testicular torsion PID Ectopic pregnancy Ovarian torsion Abortion
```A 44-year-old man presents to his GP complaining of weakness in his hands and legs and numbness in his feet. He first noticed some problems with walking in his late teens and reports that he’s always been “clumsy” and will often trip over. He is otherwise well and takes no regular medications. On examination, he has a high-stepping gait with wasting of the lower legs and high arches. Power is reduced in all limbs and reflexes are difficult to elicit. There is a reduction in sensation which is more pronounced distally. Coordination is intact.
Charcot-Marie-Tooth disease
RSV - | Organism?
Bronchiolitis
Pseudomonas aeruginosa - | Organism?
Pseudomonas
Treatment - Hypothyroidism? Hyperthyroidism?
Levothyroxine Carbimazole
Acute ITP - Epidemiology? Occurence? Course of illness?
More commonly seen in children Equal sex incidence May follow an infection or vaccination Usually runs a self-limiting course over 1-2 weeks
Chronic ITP - Epidemiology? Course?
More common in young/middle-aged women | Tends to run a relapsing-remitting course
Risk factors for Multiple Sclerosis
Smoking Previous infectious mononucleosis Genetics Hypovitaminosis D
Paracetamol OD Treatment
N-acetylcysteine | (Activated charcoal if ingested <1hour ago)
Salicylate OD Treatment
Haemodialysis
Opiates OD Treatment
Naloxone
Benzodiazepines OD Treatment
Flumazenil (risk of seizures)
TCAs OD Treatment
IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
Warfarin OD Treatment
Vit K | Prothrombin complex
Heparin OD Treatment
Protamine sulphate
Beta-blockers OD Treatment
Bradycardia - Atropine | Resistance - Glucagon
Ethylene glycol (and methanol poisoning) OD management
Fomepizole, an inhibitor of alcohol dehydrogenase | (Or ethanol)
Organophosphate insecticides OD management
Atropine |
Iron OD management
Desferrioxamine
Lead OD management
Dimercaperol | Calcium edetate
Cyanide OD management
Hydroxocobalamin
Pre-eclampsia - Presentation Risk factors Management
Hypertension: typically > 170/110 mmHg and proteinuria, Headache, Visual disturbance, Papilloedema, RUQ/epigastric pain, Hyperreflexia Aged 40 years or older, Nulliparity, Pregnancy interval of more than 10 years, Family history of pre-eclampsia, Previous history of pre-eclampsia, Body mass index of 30kg/m^2 or above, Pre-existing vascular disease such as hypertension, Pre-existing renal disease, Multiple pregnancy Labetalol (or Nifedipine and hydralazine) Delivery of baby
Features of Brown Sequard syndrome
Lateral hemisection of the spinal cord Ipsilateral weakness below lesion Ipsilateral loss of proprioception and vibration sensation Contralateral loss of pain and temperature sensation
GCS - | Modalities
Motor - 6. Obeys commands 5. Localises to pain 4. Withdraws from pain 3. Abnormal flexion to pain (decorticate posture) 2. Extending to pain 1. None Verbal - 5. Orientated 4. Confused 3. Words 2. Sounds 1. None Eye - 4. Spontaneous 3. To speech 2. To pain 1. None
P450 Inducers
C - Carbamazepine R - Rifampicin A - Alcohol (chronic) P - Phenytoin G - Griseofulvin P - Phenobarbitone S - Sulphonylureas St Johns Wort
P450 Inhibitors
S - Sodium valproate I - Isoniazid C - Cimetidine K - Ketoconazole ``` F - Fluconazole A - Acute Alcohol/Amiodarone/Allopurinol C - Chloramphenicol E - Erythromycin S - Sulfonamides ``` C - Ciprofloxacin O - Omeprazole M - Metronidazole (Grapefruit juice)
First-line anti-epileptic in a 17-year-old girl with tonic-clonic seizures. She is not sexually active and does not use any form of contraception currently.
Lamotrigine
Antibodies for limited (central) cutaneous systemic sclerosis?
Anti-centromere antibodies
Anaphylaxis treatment
Adrenaline at a dose of 300 micrograms (0.3ml), repeated every 5 minutes if necessary
Live attenuated vaccines
BCG MMR Oral polio Yellow fever Oral typhoid
```Toxoid vaccines
Tetanus Diphtheria Pertussis
Bacterial vaginosis in pregnancy
Oral metronidazole for 5-7 days - 400mg bd
A 42-year-old man presents with a 2 week history of a worsening sore throat, is complaining of painful swallowing. On examination you notice that he has difficulty opening his jaw, purulent tonsils and his uvula is deviated to the right. Diagnosis? Management?
Peritonsillar abscess (quinsy), a complication of bacterial tonsillitis. IV antibiotics and surgical drainage, and a tonsillectomy should be considered in 6 weeks.
Features of pulmonary oedema on CXR
Interstitial oedema Bat's wing appearance Upper lobe diversion (increased blood flow to the superior parts of the lung) Kerley B lines Pleural effusion
```What is raised on anorexia?
Growth hormone Glucose salivary Glands Cortisol Cholesterol Carotinaemia
```Painless vaginal bleeding typically around 6-9 weeks
Threatened miscarriage
Light vaginal bleeding and symptoms of pregnancy disappear
Missed (delayed) miscarriage
Complete or incomplete depending or whether all fetal and placental tissue has been expelled.
Inevitable miscarriage
Heavy bleeding and crampy, lower abdo pain.
Incomplete miscarriage
Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present
Ectopic pregnancy
Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high
Hydatidiform mole
Constant lower abdominal pain and, woman may be more shocked than is expected by visible blood loss. Tender, tense uterus* with normal lie and presentation. Fetal heart may be distressed
Placental abruption
Vaginal bleeding, no pain. Non-tender uterus* but lie and presentation may be abnormal
Placenta praevia
Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen
Vasa praevia
Which nerve is damaged - | Weakness in knee extension, loss of the patella reflex, numbness of the thigh
Femoral nerve
Which nerve is damaged - | Weakness in ankle dorsiflexion, numbness of the calf and foot
Lumbosacral trunk
Which nerve is damaged - | Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle
Sciatic nerve
Which nerve is damaged - | Weakness in hip adduction, numbness over the medial thigh
Obturator nerve
A 25-year-old female presents to her GP with a mass in her lower neck. She first noticed it around 2 months ago, along with some weight loss and night sweats, which she attributed to the stress of starting a new job. She is particularly worried because the lump in her neck has been growing, now measuring around 2cm, and becomes extremely painful whenever she drinks alcohol. Diagnosis?
Hodgkin's lymphoma Painful on alcohol consumption***
Personality disorder - | Antisocial
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest; More common in men; Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure; Impulsiveness or failure to plan ahead; Irritability and aggressiveness, as indicated by repeated physical fights or assaults; Reckless disregard for safety of self or others; Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Personality disorder - | Avoidant
Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection. Unwillingness to be involved unless certain of being liked Preoccupied with ideas that they are being criticised or rejected in social situations Restraint in intimate relationships due to the fear of being ridiculed Reluctance to take personal risks doe to fears of embarrassment Views self as inept and inferior to others Social isolation accompanied by a craving for social contact
Personality disorder - | Borderline
>Efforts to avoid real or imagined abandonment Unstable interpersonal relationships which alternate between idealization and devaluation Unstable self image Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse) Recurrent suicidal behaviour Affective instability Chronic feelings of emptiness Difficulty controlling temper Quasi psychotic thoughts
Personality disorder - | Histrionic
Inappropriate sexual seductiveness Need to be the centre of attention Rapidly shifting and shallow expression of emotions Suggestibility Physical appearance used for attention seeking purposes Impressionistic speech lacking detail Self dramatization Relationships considered to be more intimate than they are
Personality disorder - | Schizoid
Indifference to praise and criticism Preference for solitary activities Lack of interest in sexual interactions Lack of desire for companionship Emotional coldness Few interests Few friends or confidants other than family
```Personality disorder - | Schizotypal
Ideas of reference (differ from delusions in that some insight is retained) Odd beliefs and magical thinking Unusual perceptual disturbances Paranoid ideation and suspiciousness Odd, eccentric behaviour Lack of close friends other than family members Inappropriate affect Odd speech without being incoherent
```Neonatal bilious vomiting with a double bubble sign on AXR
Duodenal atresia
A 65-year-old woman presents with jaundice, weight loss and passing clay-coloured stools. She also describes recurrent bouts of colicky RUQ abdominal pain. On examination a mass is palpable in the RUQ
Cholangiocarcinoma
Tumour marker for ovarian cancer
CA 125
Tumour marker for pancreatic cancer
CA 19-9
Tumour marker for breast cancer
CA 15-3
A 65-year-old male presents with sudden onset visual disturbance whilst watching TV. He attends the emergency department and is found to have a right homonymous hemianopia. His past medical history includes gout for which he takes allopurinol 100mg OD. ECG shows an irregular narrow complex bradycardia with no discernible P waves. CT head is performed and shows a subacute posterior cerebral artery infarction on the left side. Management?
2 weeks of aspirin 300mg OD before consideration of anti-coagulation in cases of ischaemic stroke and atrial fibrillation.
Rovsing's sign
Used for appendicitis | RIF pain on palpation of LIF
Drugs that cause drug induced lupus
Procainamide Hydralazine Isoniazid Minocycline Phenytoin
```A neonate is admitted to the neonatal intensive care unit with low Apgar scores at birth. On examination he is noted to have a micrognathia, low set ears, overlapping fingers and rocker-bottom feet. Diagnosis?
Edwards syndrome (trisomy 18)
Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions Diagnosis?
```Patau syndrome (trisomy 13)
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism Diagnosis?
```Fragile X
Unilateral tinnitus and deafness Vertigo, hearing loss, tinnitus and an absent corneal reflex Diagnosis?
Acoustic neuroma
Migraine treatment - Acute? Prophylaxis?
Acute: triptan + NSAID or triptan + paracetamol Prophylaxis: topiramate or propranolol
Hyperamylasaemia
Acute pancreatitis Pancreatic pseudocyst Mesenteric infarct Perforated viscus Acute cholecystitis Diabetic ketoacidosis
```Drugs that cause Myasthenia exacerbatation
Penicillamine Quinidine, Procainamide Beta-blockers Lithium Phenytoin Antibiotics: gentamicin, macrolides, quinolones, tetracyclines
```Pioglitazone side effects
Weight gain Fluid retention Liver dysfunction Fractures
Metformin side effects
Lactic acidosis and gastric disturbances (diarrhoea)
Missed pills on the progesterone only pill
If < 3 hours* late: continue as normal If > 3 hours*: take missed pill as soon as possible, continue with rest of pack, extra precautions (e.g. Condoms) should be used until pill taking has been re-established for 48 hours
A 10-month-old infant is brought to accident and emergency with a 3 day history of fever and a new onset rash affecting the arms, legs and abdomen that began today. Despite this fever the child has been his usual self and does not seem to be irritated by the rash. On closer inspection, the rash appears erythematous with small bumps that are merging together. None of the lesions have scabbed over. The rash is predominantly on the limbs and there are no signs of excoriation. The child is now afebrile at 36.9ºC. Diagnosis? Organism?
Roseola infantum HHV 6
Tricyclic antidepressants side effects
Anticholinergic side effects (dry mouth, blurred vision and urinary retention) Antihistaminic side effects (weight gain).
Microaneurysms Blot haemorrhages Hard exudates Cotton wool spots Venous beading/looping and Intraretinal microvascular abnormalities (IRMA)
```Non-proliferative diabetic retinopathy
Gastroenteritis caused by rice - | Organism?
Bacillus cereus is a gram-positive rod, which is highly adaptable to extremes of pH and oxygen levels
A patient is investigated for leukocytosis. Cytogenetic analysis shows the presence of the following translocation: t(9;22)(q34;q11). Diagnosis?
Chronic myeloid leukemia |
t(15;17) - | Haematological diagnosis?
Acute promyelocytic leukaemia (M3) | Fusion of PML and RAR-alpha genes
t(8;14) - Haematological diagnosis? Microscopy?
Burkitt's lymphoma MYC oncogene is translocated to an immunoglobulin gene Starry sky
t(11;14) - | Haematological diagnosis?
Mantle cell lymphoma | Deregulation of the cyclin D1 (BCL-1) gene
t(14;18) - | Haematological diagnosis?
Follicular lymphoma | Increased BCL-2 transcription
Rifampicin - Mechanism? Side effects?
Inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA (inducer) Hepatitis, orange secretions, flu-like symptoms
Isoniazid - Mechanism? Side effects?
Inhibits mycolic acid synthesis Peripheral neuropathy: prevent with pyridoxine (Vitamin B6) Hepatitis, agranulocytosis Liver enzyme inhibitor
Pyrazinamide - Mechanism? Side effects?
Converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I Hyperuricaemia causing gout arthralgia, myalgia hepatitis
Ethambutol - Mechanism? Side effects?
Inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan Optic neuritis: check visual acuity before and during treatment Dose needs adjusting in patients with renal impairment
Causative organism of pneumonia in alcoholics
Klebsiella pneumoniae
Pemphigus vulgaris - Pathophysiology? Epidemiology? Biopsy?
Autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule. Ashkenazi Jewish population Acantholysis on biopsy
Causes of microcytic anaemia
Iron deficiency anaemia Thalassemia Sideroblastic anaemia Anaemia of chronic disease
Causes of normocytic anaemia
Anaemia of chronic disease Acute haemmorhage Haemolytic anaemia Haematological malignancies Aplasia and marrow disorder
```Causes of macrocytic anaemia
Megaloblastic - Pernicious anemia/B12 Folate deficiency ``` Non Megaloblastic - Hypothyroidism COPD ETOH XS Liver disease Reticulocytosis Marrow disorders
```A 46-year-old lady presents with a 2 week history of a worsening sore throat, and is complaining of painful swallowing. On examination you notice that her uvula is deviated to the left. What is the most likely diagnosis?
Peritonsillar abscess
35 year old female with tender erythematous nodules over her forearms Calcium - 2.78 Diagnosis? Causes?
Erythema no do sum ``` Strep,TB Sarcoidosis, IBD Malignancy Penicillin Pregnancy
```Thoracic trauma
Check passmed
56 year old man from Pakistan presents to his GP with numbness and tingling in his feet for one week. Looking at his medical history you discovered he has recently been diagnosed with tuberculosis and hypertension. Which drug is causing the problem?
Isoniazid - peripheral neuropathy is a common side effect
4 week old formula fed infant with persistent non-billows vomiting and increasing lethargy Substantial appetite He appears pale, and you can see visible peristalsis in the left upper quadrant.
Pyloric stenosis
