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3b > General > Flashcards

General Flashcards

1
Q

How might anaemia present

A

Breathlessness
Fatigue
Itching
Palpitations

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2
Q

Symptoms of horners syndrome

A

Miosis
Ptosis
Anhydrosis
Enopthalmus

(Interruption to the sympathetic nerve supply)

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3
Q

Causes of horners syndrome

A

Carotid artery dissection

Tumour in neck or chest - neuroblastoma& pancoast tumour.

Lesion in the midbrain/ brainstem/ upper spinal cord, neck or eye orbit

Growth of lymph nodes in neck

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4
Q

Hypercalcemia symptoms

A 
Constipation 
Delirium 
Bone pain 
Confusion 
Nausea and vomiting
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5
Q

What are the investigations you would do for MS

A

MRI

LP

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6
Q

What is MS

A

Chronic inflammatory immune related disease of the CNS

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7
Q

What are the complications of peads constipation

A 
Fissures
Dehydration 
Pain
Fissures
Mega colon
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8
Q

What is produced from the medulla of the adrenal gland

A

Catecholamines (fight and flight)

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9
Q

What are the layers of the adrenal cortex

A

GFR
Glomerulosa
Fasciulata
Reticularis

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10
Q

What are the two categories of causes of Cushing’s syndrome

A

ATCH dependent

ATCH Independent

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11
Q

What are the ATCH dependent causes of cushings disease

A

Pit adenoma

Ectopic production of ATCH (SCLC)

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12
Q

What are the ATCH independent causes of Cushing’s syndrome

A

Exogenous glucocorticoids I.e. steroids

Adrenal adenoma

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13
Q

Commonest cause of Addison’s disease in the UK

A

AI

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14
Q

Commonest cause of Addison’s disease world wide

A

TB

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15
Q

What two key things are low in Addison’s disease

A

Low aldosterone
Low cortisol

Hyponatremia
Hypoglycaemia

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16
Q

Symptoms of Addison’s disease

A 
Fatigue 
Wt loss
Abdo pain 
Diarrhoea 
Postural hypotension 
Fever
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17
Q

Where might you see hyperpigmentation in a person with Addison’s disease

A

Buccal mucosa

Palmar creases

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18
Q

What drug is indipamide

A

Thaidize like diuretic

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19
Q

Why is hyoscine butlybromide used in colicky pain

A

It is an antimuscarinic sm relaxant

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20
Q

What sort of drug is metaclopromide

A

Prokinetic antiemetic (promote bowel movements)

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21
Q

What is the analgesic opioid of choice for syringe drivers

A

Diamorphine

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22
Q

What is the leading cause of blindness In the UK?

A

Macular degeneration

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23
Q

What is the finding on fundoscopy for ARMD

A

Drusen

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24
Q

RFs for macular degeneration

A 
Smoking 
Age 
FHX
DM
HTN
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25
Q

What is the most common cause of nephrotic syndrome

A

Minimal change syndrome

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26
Q

What are the features of nephrotic syndrome

A

Proteinuria
Oedema
Hypoalbuminaemia

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27
Q

4 causes of bilateral hydronephrosis

A

Bladder Ca
Urethral stricture/valve
Prostate enlargement
Retroperitonal fibrosis

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28
Q

Causes of unilateral hydronephrosis

A

Calculi
Renal pelvis tumour
Pelvic-uteric obstruction (congenital / acquired)

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29
Q

Treatment for primary sclerosing cholangitis

A

ECRP - symptom relief
Urodeoxycholic acid
Monitor for cholangio carcinoma

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30
Q

What viral hepatitis is most common world wide

A

Hep A

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31
Q

How is Hep A transmitted

A

Feacal oral

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32
Q

How are hep B/C/ E transmitted

A

Blood or bodily fluids

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33
Q

Treatment of AI hepatitis

A

Prednisalone

Azothiaprine

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34
Q

What is raised in hepatic picture LFTs what conditions might this indicate

A

AST
ALT
(Transaminases)
Hepatitis & alcohol excess

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35
Q

What is raised in cholestatic bloods on LFTs

A

ALP

Primary sclerosing cholangitis

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36
Q

Gold standard diagnostic test for primary sclerosing cholangitis

A

MRCP

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37
Q

What is NAFLD

A

Part of a metabolic syndrome

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38
Q

Tx of fibrosis in NAFLD

A

Pioglitazone

Vit E

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39
Q

What chromosome is defective in Wilson’s disease

A

Chromosome 13

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40
Q

Investigations in Wilson’s disease

A

Slit lamp for Keyser - Flescher rings
Caeruloplasmin levels
24 urinary copper assay

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41
Q

What would positive HBsAg and positive HBcAb IgA indicate . What would be the next investigation

A

Active Hep B hepatitis

Do HBV DNA for viral load and HBeAg

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42
Q

What would negative HBsAg and positive HBcAb IgG indicate

A

Previous infection

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43
Q

What would a high HBeAg indicate

A

Highly infective (acute phase of infection)

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44
Q

What does “HBV DNA” indicated

A

Viral load

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45
Q

What disease does Hep D require to occur

A

Hep B

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46
Q

Causes of Hepatitis

A 
Alcoholic hepatitis 
NAFLD
Viral 
AI
Drug (paracetamol OD)
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47
Q

Symptoms of hepatitis

A 
Jaundice / itching
N&V
Abdo pain 
Muscle aches 
Fever 
Fatigue
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48
Q

Investigation in NAFLD

A

ELF Bloods
Fibrosis score
Fibroscan

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49
Q

What are the two scoring systems for cirrhosis

A

MELD

Child-Pugh

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50
Q

What are the scoring systems for upper GI bleed

A

Glasgow-blatchford

Rockall score

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51
Q

What most commonly causes HCC

A

Cirrhosis

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52
Q

What most commonly causes cholangiocarcinoma

A

10% primary sclerosing cholangitis

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53
Q

What is the most common disease to have with primary sclerosing cholangitis

A

UC

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54
Q

What is the medical treatment for HCC

A

Kinase inhibitors

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55
Q

What is the tumour market for HCC

A

Alpha fetoprotein

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56
Q

What is the tumour marker for cholangiocarcinoma

A

Ca19-9

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57
Q

What changes might you see on USS with alcoholic fatty liver

A

Hypoechoic

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58
Q

What changes might you see on USS with cirrhosis

A

Corkscrew a’s
Portal enlargement
Hepatomegally
Nodular surface

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59
Q

Abx for hepatic encephalopathy

A

Rifaximin

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60
Q

Tx for upper GI bleed from varicoses

A 
Terlipressin
Abx
FFP / vit k (solve coag problems)
?CCU
? Endoscopy
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61
Q

What scoring system is used to see if someone withdrawing from alcohol needs intervention

A

CIWA-Ar

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62
Q

Screening tools for alcoholism

A

CAGE

Audit

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63
Q

Tx for acute alcohol withdrawal ?delerium tremans

A

Chlordiazopoxide

Pabrinex -> PO thiamine

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64
Q

Triad in wernickes encephalopathy

A

Abnormal ocular movements
Ataxia
Confusion

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65
Q

What are the two features of Korsakoff’s syndrome

A

Behavioural change

Amnesia

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66
Q

What is torsade de points

A

Polymorphic VT
Due to long QT causing spontaneous afterdepolarisations of myocytes

Appears to twist round baseline

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67
Q

Types of SVT

A

AV nodal re-entrant tachyC
AV re-entrant tachyC (WPW)
Atrial tachyC

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68
Q

Treatment of SVT

A

Adenosine and vagal manoeuvres while on cardiac monitoring

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69
Q

Tx of stable VT

A

Amiodarone

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70
Q

What is the AV bundle equivalent in WPW called

A

Bundle of Kent

71
Q

ECG changes in WPW

A

Short PR interval
Long QRS complex
Delta wave

72
Q

Tx of WPW

A

Radio frequency ablation

73
Q

What risk is there if you give antiarrhythmic medication in WPW if AF / A.flutter is present

A

Risk of polymorphic wide complex tachyC

74
Q

Tx of unstable arrhythmia

A

3x synchronised shocks

Amiodarone infusion

75
Q

Tx of AF

A

Beta blocker

RFA

76
Q

Tx of paroxysmal SVT

A

RFA/CCB/BB

77
Q

Tx of Atrial flutter

A

BB
Tx of underlying cause (thyrotoxicosis /HTN)
Anticoagulate based on CHADSVASC

78
Q

How to give adenosine

A

In ACF as bolus (6mg-12mg-12mg)

Warn Pt of asystole/Feeling of doom

79
Q

Non shockable rhythms

A

Asystole

PEA

80
Q

Shockable rhythms

A

VT

VF

81
Q

What could be the causes of ventricular ectopics

A

Electrolyte abnorms
Anaemia
Thyroid

82
Q

Drugs that cause long QT

A 
Antipsychotics
Sotalol
Citalopram 
Macrolide drugs
Flenicade
83
Q

Management of long QT

A

Correct underlying cause
Magnesium infusion.
Shock if go into VT

84
Q

Tx of stable VT

A

Amiodarone infusion

85
Q

Antimuscarinic SEs

A 
Inhibit parasympathetic :
Pupil dilation 
Urinary retention 
Dry eyes
Constipation
86
Q

What is Cushing’s syndrome

A

Signs and symptoms of prolonged elevated cortisol . Maybe he causes by cushings disease or other.

87
Q

What is cushings disease

A

Pituitary Adinoma (ATCH dependent) causing Cushing’s syndrome

88
Q

What does G3 on MRC dysponea scale equate to

A

Breathless on the flat

89
Q

What does G1 on MRC dysponea equate to

A

SOB w. Strenuous exercise

90
Q

What is S4 of COPD severity scale

A

FEV1 <30% Predicted

91
Q

First stage of COPD long term tx

A 
SABA 
OR SAAM (short acting antimuscarinic) = Ipratropium bromide
92
Q

What is the second stage of COPD long term tx in a non asthmatic non steroid responsive patient

A

+ LABA &LAMA

93
Q

What is the second stage in LR COPD management for a steroid responsive patient

A

ICS+ LABA
I.e. salmeterol & beclamethasone
= fostair / symbicort/ seretide

94
Q

If someone is on both stages of COPD tx what additional tx are there

A 
Home 02
Mucolytics (carbocystine)
Oral theophylline 
Nebulisers
Prophylactic LR abx - azythromycin
95
Q

What is the gold standard test for Cushing’s syndrome

A

Dexamethadone supression test

96
Q

What is the gold standard test for adrenal insufficiency

A

Short synacthen test

97
Q

What diagnosis is reached if Dex sup testing @8mg gives low cortisol and low ATCH

A

Pit adenoma

98
Q

What diagnosis is reached if Dex sup testing @1mg gives low cortisol

A

Physiological response

Rule out cushings disease

99
Q

What diagnosis is reached if Dex sup testing @8mg gives low cortisol and high ATCH

A

Adrenal adenoma

100
Q

What diagnosis is reached if Dex sup testing @8mg gives raised cortisol and raised ATCH

A

Ectopic ATCH

Ie. SCLC

101
Q

If cortisol is raised after 1mg of Dex @10pm the night before what is the next stage in testing

A

This is pathological

Do 8mg dex suppression test

102
Q

What is the diagnosis if a short synacthen test causes a cortisol increase less than double from baseline

A

Primary adrenal insufficiency ?addisons

103
Q

What is the diagnosis if a short synacthen test causes a cortisol increase more than double from baseline

A

Normal

104
Q

What is synacthen

A

Synthetic ATCH

105
Q

What drug is used to replace aldosterone

A

Fludrocortisone

106
Q

What HbA1c is the cut off for T2DM

A

48mmol/mol

107
Q

What is the management of a single HbA1c over 48mmol/mol that is assymptomatic

A

Repeat bloods

108
Q

What should a patient that is prone to COPD infective exacerbation have at home

A

Steroid & abx

109
Q

A patient presents with ENT , resp and kidney symptoms what diagnosis should be considered

A

Granulomatous with polyangiitis (cANCA)

110
Q

How many days should pred be given for in home management of infective exacerbation of COPD

A

5d

111
Q

Management of Addinsonian crisis

A

HC IV 100mcg stat then 100mcg over 6hrs

Correct glucose

Fluids

Monitor electrolytes

Fluid balance

112
Q

Why might someone present in addinsonian crisis

A

First presentation
Concurrent illness or trauma
Come rapidly off steroids

113
Q

What abs would you look for in Addison’s disease

A

Adrenal cortex Abs

21 hydroxylase abs

114
Q

What are the two methods of giving carbimazole

A

Block & replace

Titrate

115
Q

Hyperthyroidism that’s turned to hypothyroidism with fever and a tender neck might point to what diagnosis

A

De quervains thyroiditis

116
Q

What is the tx for de quervains thyroiditis

A

NSAIDs

Beta blockers when in hyperT

117
Q

Tx options for hyper thyroidism

A

Carbimazole
Propylthiouracil
RI
Surgery

118
Q

What is phenoxybenzamine

A

Alpha blocker used to tx pheochromocytoma

119
Q

What is bromocriptine

A

Dopamine agonists used to treat acromegaly

120
Q

What is pegvisomant

A

GH antagonist used in acromegaly

121
Q

Most common cause of acromegaly

A

Pit adenoma

122
Q

What would blood tests of high Ca+ and high PTH point to a diagnosis of

A

Parathyroid tumour
Or
Pit hyperplasia secondary to ca+ deficiency (tertiary hyper para T)

123
Q

What would blood tests of low Ca+ and high PTH point to a diagnosis of

A

Secondary hyperparaT
Vit D deficiency
Or
Chronic renal disease

124
Q

Test for diabetes insipidus

A

Water deprecation test

125
Q

Two types of diabetes insipidus

A

Cranial

Nephrogenic

126
Q

Is plasma Na+ high or low in diabetes insipidus

A

High

127
Q

Causes of nephrogenic diabetes insipidus

A

Lithium

Electrolyte abnormalities

Genetic mutation in gene that codes for ADHR

Intrinsic kidney disease

128
Q

Caudal causes of diabetes insipidus

A

Brain tumour / trauma/ infection
Surgery/ RT

Idiopathic

129
Q

Presentation of diabetes insipidus

A

Polyuria
Polydipsia
HyperNa+
Postural hypoT

130
Q

Presentation of hyperaldosteronism

A

Non responsive HTN
HypoK+
Metabolic alkalosis
+/- Abdo mass

131
Q

Criteria for AKI

A

Cr >/= 25micromol increase in 48hr

Cr >/= 50 in 7d

Urine <0.5ml/kg/hr >6hrs

132
Q

Tx for AKI

A

Tx underlying cause
Hydrate
Stop nephrotixic drugs
Catheterise if obstruction

133
Q

Nephrotixic drugs

A

ACEi

NSAIDs Gent

134
Q

Active TB tx

A

Rifampin 6m
Izoniazide 6m
Pyrazinamide 2m
Ethambutol 2m

135
Q

Tx of latent TB

A

Isoniazide 6m

OR

R & I for 3m

136
Q

What is the criteria for ordering urine sample in kids

A

Fever over 38
Not responding to current tx
Symps of uti

137
Q

What is the best investigation for renal scaring in VUR

A

Scaring - DMSA

138
Q

What test is used to diagnose VUR

A

Micturating cystourethrogram (MCUG)

139
Q

How might VUR come to a doctors attention

A

Hydronephrosis on USS
Recurrent UTIs
Chronic pyleonephrosis / reflux nephropathy

140
Q

Organic causes of constipation

A 
Hirsprungs disease 
Anorectal malformation 
CF - meconium illeus
Coeliac
Drugs
Hypothyroidism
141
Q

Tx for whooping cough

A

Clari (macrolide)

142
Q

Management of <3m old with UTI

A

Hospital IV abx co-amox 5d

143
Q

Management of over 3m well but pyelonephritis

A

Oral co—amox 7-10d

144
Q

Management of Child >3m LUTI , well in slef

A

Trimethoprim 3d

145
Q

How many organisms does there need to be on culture for a diagnosis of UTI

A

10^5

146
Q

What is the most common and second most common bug responsible for UTI

A

E coli

Klebsiella

147
Q

What might a pseudomonas UTI bug indicate

A

Structural abnormality

148
Q

What presentation would you expect with a MCA infarct

A

Homonymous hemianopia
Hemiparesis U>L
Hemisensory loss
+/- aphasia (LMCA)

149
Q

What presentation would you expect with a ACA infarct

A

Urinary incontinence
L>U hemiparesis
Personality chance

150
Q

What presentation would you expect with a PCA infarct

A

Visual changes
Sensory loss
memory issues

151
Q

What presentation would you expect with a basilar / vertebral artery infarct

A

Cerebellar signs ipsilateral

Ipsilateral CN palsy’s

152
Q

Types of MND

A

Amylotrophic lateralising sclerosis (AML)
Primary lateralising sclerosis
Progressive bulbar palsy
Progressive muscular atrophy

153
Q

Treatment of Bell’s palsy

A

Prednisalone 50mg 10d

154
Q

Differentials for facial paralysis

A 
Forehead involved = LMN
Ramsay hunt syndrome 
Bell’s palsy
HIV
Lyme disease
Otitis media
MS
Acoustic neuroma
Parotid tumour

Forehead spared= UMN
Stroke
Tumour

155
Q

Treatment for Ramsay hunt syndrome

A

Pred + acyclovir

156
Q

Types of MND

A

Amylotrophic lateralising sclerosis (AML)
Primary lateralising sclerosis
Progressive bulbar palsy
Progressive muscular atrophy

157
Q

Treatment of Bell’s palsy

A

Prednisalone 50mg 10d

158
Q

Differentials for facial paralysis

A 
Forehead involved = LMN
Ramsay hunt syndrome 
Bell’s palsy
HIV
Lyme disease
Otitis media
MS
Acoustic neuroma
Parotid tumour

Forehead spared= UMN
Stroke
Tumour

159
Q

Treatment for Ramsay hunt syndrome

A

Pred + acyclovir

160
Q

Tx for RRMS

A

Methylprednisalone

Cyclophosphamide

161
Q

What is the triad in MS

A

Chariots triad

Nystagmus
Intention tremor
Dysarthria

162
Q

What are the two key findings with a CNVI palsy

A

Conjugate lateral gaze palsy

Intranuclear opthalmaplegia

163
Q

What are the two investigations and findings for MS

A

LP- oligoclonal bands

MRI - white matter plaques

164
Q

What is a pyramidal pattern of weakness

A

Motor passes through the pyramidal tracts of medulla - cortocospinal - Extensors weaker than flexors in upper limb and opposite in lower limp

165
Q

What is extrapyramidal disfunction

A

It involves subconscious movement I.e. basal ganglia I.e Parkinson’s disease
Drugs can mimic I.e. antipsychotics

166
Q

Treatment dystonias

A

Antimuscarinics

167
Q

Brown sequard results in

A

Contralateral loss of pain and temp

Ipsilateral loss of proprioception & Ipsilateral weakness

168
Q

Management of tetanus

A

Paracetamol for fever
IvIg to mop up toxins
Metronidazole
Muscle relaxant

169
Q

When should you suspect b12 deficiency

A

Glove and stocking parasthesia distribution+ U&LMN signs

170
Q

Investigations for B12 SADC

A

MRI spine
Bloods for anaemia
B12 and folate serology
NCS

171
Q

What investigations would you do for ckd?

A

U&Es
Urine dip
ACR
+/- renal uss

172
Q

What is required for a diagnosis of COPD

A

Proteinuria (A2/A3)

EGFR <60 (not G1 or G2)

173
Q

How do you measure urine protein?

A

albumin creatinine ratio

174
Q

Complications of CKD

A

Anaemia
Renal bone disease
Cardiovascular disease

3b (2 decks)

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