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Oishi's Final year flashcards > Medicine > Flashcards

Medicine Flashcards

1
Q

Medication for metastatic hepatocellular cancer?

A

Sorafenib

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2
Q

When is denosumab prescribed in cancer?

A

When 2 bisphosphonates have failed

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3
Q

When is interferon-alpha used as a tx?

A

Hep B and C
Kaposi’s sarcoma
Metastatic renal cell cancer
Hairy cell leukaemia

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4
Q

What is infliximab used for?

A

refractory and fistulating Crohn’s disease

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5
Q

How is severity of UC flare graded?

A

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

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6
Q

Tx for mild to moderate proctitis?

A

Topical (rectal) aminosalicylate (mesalazine)
If remission is not achieved within 4 weeks + oral aminosalicylate
If remission still not achieved + topical or oral corticosteroid

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7
Q

Tx for mild to moderate proctosigmoiditis or left-sided UC?

A

Topical (rectal) aminosalicylate
If remission is not achieved within 4 weeks, + high-dose oral aminosalicylate OR switch to high-dose oral aminosalicylate + topical corticosteroid
If remission still not achieved stop topical tx and offer oral aminosalicylate + oral corticosteroid

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8
Q

Tx for mild to moderate extensive UC?

A

Topical (rectal) aminosalicylate + high-dose oral aminosalicylate:
If remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate + oral corticosteroid

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9
Q

Tx for severe UC?

A

Admit
IV steroids
IV ciclosporin

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10
Q

Maintenance tx for UC?

A

Oral/topical salicylates

If severe relapse/2+ exacerbations:
+ Azathioprine PO
+ Mercaptopurine PO

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11
Q

Most common extra-colonic malignancy of HNPCC?

A

Endometrial

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12
Q

Drugs known to induce TEN?

A 
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
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13
Q

What is a Curlings Ulcer?

A

Stress ulcers may occur in the duodenum of burns patients and are more common in children

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14
Q

4 features of Horner’s syndrome?

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

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15
Q

Causes of obstructive lung disease?

A

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

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16
Q

Causes of restrictive lung disease?

A 
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
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17
Q

Tx for life-threatening Clostridium difficile infection?

A

ORAL vancomycin

IV metronidazole

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18
Q

What is Conduction dysphasia?

Where is the defect?

A 
speech fluent, but repetition poor. Comprehension is relatively intact
supramarginal gyrus (parietal lobe)
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19
Q

Why do patients with coeliac disease require regular immunisations?

A

functional hyposplenism

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20
Q

Which organism most commonly causes peritonitis secondary to peritoneal dialysis?

A

Coagulase-negative Staphylococcus (Staphylococcus epidermidis)

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21
Q

Indications for wide local excision of breast tumour?

A

Solitary lesion
Peripheral tumour
DCIS <4cm
Small lesion in large breast

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22
Q

Indications for mastectomy?

A

Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm

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23
Q

Tx for ascending cholangitis?

A 
IV Abx (piptaz)
ERCP after 24 - 48 hours
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24
Q

Drugs to stop in AKI? (DAMN)

A

Diuretics
Aminoglycosides and ACE inhibitors
Metformin
NSAIDs

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25
Q

What tx for ascites?

A

Conservative: salt restrict
Medical: Spironolactone or amiloride +/- abx prophylaxis for SBP
Surgical: therapeutic abdominal paracentesis (if tense ascites)
TIPS in some cases

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26
Q

Light’s criteria for transudate/exudate?

A

Only used if protein 25-35g/L

Protein >30g/L = exudate
Protein <30g/L = transudate
ALSO fluid is exudate if:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

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27
Q

What needs to be checked before starting terbinafine?

A

LFTs

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28
Q

Morphine conversions to know?

A

Weak Opioids are 10 TIMES WEAKER than Oral Morphine
Subcutanous Morphine is TWICE AS STRONG as Oral Morphine
Oral Morphine is TWICE AS STRONG as Oral Oxycodone (bnf uses 1.5)
Oral codeine is 10 TIMES WEAKER than Oral Morphine
PRN dose should be 1/6th dose of total daily dose
Morphine SUSTAINED release you should divide immediate release dose by 2

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29
Q

When to refer a burn to secondary care?

A

all deep dermal and full-thickness burns.
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
any inhalation injury
any electrical or chemical burn injury
suspicion of non-accidental injury

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30
Q

What does the SAAG tell you in ascites?

A

If it is caused by portal HTN

A raised SAAG (>11g/L) = portal hypertension

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31
Q

Causes of Budd Chiari syndrome?

A

polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
COCP

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32
Q

How does myocarditis present?

A

ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness

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33
Q

What ix confirms C diff colitis?

A

Stool C diff Toxin

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34
Q

Causes of a normal anion gap or hyperchloraemic metabolic acidosis? ABCD

A

Addison’s disease
Bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula, renal tubular acidosis, diuretics
Chloride: ammonium chloride injection, NaCl
Drugs: acetazolamide

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35
Q

Causes of a raised anion gap metabolic acidosis? MUDPILES

A

lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use

Methanol
Uraemia (in CKD)
Diabetic ketoacidosis
Paracetamol
Isoniazid/iron
Lactate
Ethylene glycol (antifreeze)
Salicylates
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36
Q

What QRISK score should tx be started?

A

10%

Atorvastatin 10mg

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37
Q

What might cause a falsely low HbA1c?

A

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Blood donation

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38
Q

What might cause Higher-than-expected levels of HbA1c?

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

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39
Q

How much should once daily insulin be reduced the day before and on the day of surgery?

A

20%

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40
Q

Causes of drug induced cholestasis?

A

COCP
Abx: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

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41
Q

Causes of erythema nodosum?

A 
infection
 - streptococci
 - TB
 - brucellosis
systemic disease
 - sarcoidosis
 - IBD
 - Behcet's
malignancy/lymphoma
drugs
 - penicillins
 - sulphonamides
 - COCP
pregnancy
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42
Q

SE of vincristine?

A

Peripheral neuropathy

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43
Q

SE of bleomycin?

A

Lung fibrosis

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44
Q

SE of doxorubicin?

A

Cardiomyopathy

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45
Q

Cause in young female patients who develop AKI after the initiation of an ACE inhibitor?

A

Fibromuscular dysplasia

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46
Q

Causes of secondary HTN?

A 
ENDOCRINE
Cushing's
Conn's
Phaeo
Acromegaly
Hypothyroid

RENAL
Polycystic kidney disease

VASCULAR
Renal artery stenosis
Coarctation of aorta

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47
Q

Clinical signs of SVCO?

A 
facial swelling and erythema
distended neck and chest wall veins (non-pulsatile)
arm swelling and distended arm veins
papilloedema (a late sign)
stridor (if severe)
cyanosis (less common)
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48
Q

Which antiemetic in opioid induced nausea?

A

Metoclopramide

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49
Q

Which antiemetic in chemo/radiotherapy induced nausea?

A

Ondansetron

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50
Q

What conditions are associated with osteosclerosis?

A

Prostate cancer mets
Sickle cell disease
Breast Ca mets

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51
Q

Initial tx for metastatic prostate Ca?

A

gonadotrophin-releasing hormones

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52
Q

When considering whether a patient should be referred for a chest x-ray, what do the NICE guidelines for the diagnosis of lung cancer define as the duration of a persistent cough/haemoptysis or other symptom?

A

> 3 weeks

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53
Q

Causes of a cavitating lung lesion?

A 
Cavitating pneumonia
Septic emboli (bacterial or fungal)
Wegener’s granulomatosis or pulmonary vasculitis
Pulmonary infarction
Infected bullae or cysts
Neoplasia: primary or secondary
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54
Q

1st line tx in prophylaxis of variceal bleeds?

A

Non-cardioselective beta-blockers

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55
Q

Duration of tx in autoimmune hepatitis?

A

At least 2 years after normalisation of LFTs

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56
Q

CIs to using loperamide?

A

Bloody stools
Fever
Abx associated colitis

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57
Q

Metabolic findings in tumour lysis syndrome?

A

Hyperkalaemia
Hyperphosphataemia
Hyperuricaemia
Hypocalcaemia

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58
Q

Indications for dialysis?

A

Uraemic encephalopathy
Refractory hyperkalaemia
Refractory metabolic acidosis
Pulmonary oedema with oliguria

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59
Q

1st line tx for patients with both hypertension and albuminuria?

A

ACEi

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60
Q

Most common cause of nephrotic syndrome in adults? What would you see on light microscopy and silver staining?

A

Membranous glomerulonephritis
Light microscopy: Thickened basement membrane
Silver staining: Sub-epithelial spikes

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61
Q

What should a recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with?

A

oral fidaxomicin

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62
Q

management of Crohn’s patients who develop a perianal fistula?

A

Oral metronidazole

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63
Q

What verterbral levels do the coeliac trunk, SMA, IMA and ovarian/testicular arteries originate?

A 
t12 = Coeliac trunk has 12 letters
L1 = SMA “S for Single”
L2 = testis/ovarian artery (we have two testis/ovaries)
L3 = IMA
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64
Q

What score is to assess risk of pressure sore?

A

Waterlow

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65
Q

What score is to assess risk of malnutrition?

A

MUST

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66
Q

Define malnutrition

A

BMI < 18.5
unintentional weight loss >10% within the last 3-6 months
BMI < 20 and unintentional weight loss > 5% within the last 3-6 months

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67
Q

Tx for achalasia?

A

Heller cardiomyotomy

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68
Q

Gene in FAP?

A

APC

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69
Q

Gene in HNPCC?

A

MSH2/MLH1

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70
Q

RFs for Focal segmental glomerulosclerosis?

A 
idiopathic
secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport's syndrome
sickle-cell
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71
Q

Cancers with raised platelets? LEGO-C

A
  • Lung
  • Endometrial
  • Gastric
  • Oesophageal
  • Colorectal
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72
Q

What do we use to monitor tx in haemochromatosis and what is the characteristic iron study profile?

A

Ferritin and transferrin saturation (1st line)

Would expect a raised transferrin saturation and ferritin, with low TIBC

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73
Q

Tx for haemochromatosis and aims?

A

Venesection

transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l

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74
Q

What do you see on xray in haemochromatosis?

A

Joint x-rays characteristically show chondrocalcinosis

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75
Q

Causes of cranial DI?

A 
idiopathic
post head injury
pituitary surgery
craniopharyngiomas
histiocytosis X
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
haemochromatosis
76
Q

Causes of nephrogenic DI?

A

genetic: the more common form affects the vasopression (ADH) receptor, the less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes: hypercalcaemia, hypokalaemia
Drugs: lithium, demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

77
Q

most important HLA to match in renal transplantation?

A

HLA DR > B > A

78
Q

When do NICE guidelines suggest referring to a nephrologist from primary care in CKD?

A

if eGFR falls below 30 or progressively by > 15 in a year

79
Q

AKI Stage 1?

A

Increase in creatinine to 1.5-1.9 times baseline, or
Increase in creatinine by ≥26.5 µmol/L, or
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours

80
Q

AKI Stage 2?

A

Increase in creatinine to 2.0 to 2.9 times baseline, or

Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours

81
Q

AKI Stage 3?

A

Increase in creatinine to ≥ 3.0 times baseline, or
Increase in creatinine to ≥353.6 µmol/L or
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
The initiation of kidney replacement therapy, or,
In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2

82
Q

Causes of a raised TLCO (transfer capacity)

A 
asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
83
Q

Causes of a lower TLCO

A 
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
84
Q

Some conditions may cause an increased KCO with a normal or reduced TLCO?

A

pneumonectomy/lobectomy
scoliosis/kyphosis
neuromuscular weakness
ankylosis of costovertebral joints e.g. ankylosing spondylitis

85
Q

palliative pain relief in severe renal impairment?

A

egfr <10 = fentanyl/buprenorphine, 10-50 = oxycodone, >50 = morphine

86
Q

What ix for PSC?

A

ERCP/MRCP (first line)

87
Q

What does proteinuria on dipstick in context of aki mean?

A

Intrinsic renal injury

88
Q

Anion gap formula?

A

Na+ K - (Bicarb + Cl)

89
Q

Tx for proteinuria in CKD?

A

ACEi/ARB if they have an ACR > 30 mg/mmol

90
Q

Acute interstitial nephritis presentation?

A

Fever and rash
Renal impairment
HTN
Urine dip: high white cells/eosinophilic casts
Bloods: raised serum creatinine and eosinophilia

91
Q

Threshold for severe hypokalaemia for IV tx?

A

<2.5mmol/L

92
Q 
What disease gives this picture?
prolonged bleeding time 
increased APTT
normal PT 
normal platelet count
A

Von Willebrand

93
Q 
What disease gives this picture?
normal bleeding time 
increased APTT
normal PT 
normal platelet count
A

Haemophilia

94
Q

Typical findings in type 2 renal tubular acidosis?

A

Hypokalaemia

Osteomalacia

95
Q

How to convert from oral morphine to diamorphine?

A

Total daily morphine DIVIDED by 3

96
Q

What electrolyte abnormality does long term PPI tx cause?

A

Hypomagnesemia

97
Q

the only recommended test for H. pylori post-eradication therapy?

A

Urea breath test

98
Q

Why is nephrotic syndrome associated with hypercoagulability?

A

Loss of antithrombin III via kidneys

99
Q

What does urine sodium > 40 mmol/L suggest?

A

ATN

100
Q

Granulomatosis with polyangiitis features?

A

pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum)

101
Q

SBP acute abx and prophylactic (ascites + protein<15) abx?

A

Acute: IV cefotaxime
Prophylactic: ciprofloxacin

102
Q

Most common extra renal manifestation of ADPKD?

A

Liver cysts

103
Q

Mx of severe alcoholic hepatitis?

A

Prednisolone

104
Q

Why might you see hyaline casts in urine?

A

If a pt takes loop diuretics

105
Q

causes of Rapidly progressive glomerulonephritis?

A

Goodpasture’s syndrome
Wegener’s granulomatosis
others: SLE, microscopic polyarteritis

106
Q

causes of Exudative pleural effusion? (> 30g/L protein)

A

infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome

107
Q

causes of transudative pleural effusion? (< 30g/L protein)

A

heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

108
Q

Which cancer leads to cannon ball mets in the lungs?

A

Renal cell carcinoma

109
Q

Investigations of small bowel bacterial overgrowth syndrome?

A

Hydrogen breath test
Small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
Clinicians may sometimes give a course of antibiotics as a diagnostic trial

110
Q

Risk factors for SBBOS?

A

neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus

111
Q

Mx of SBBOS?

A

correction of underlying disorder

antibiotic therapy: 1st line = rifaximin (Co-amoxiclav or metronidazole are also effective)

112
Q

Causes of minimal change disease?

A

Idiopathic
Drugs: NSAIDs, rifampicin
Cancer: Hodgkin’s lymphoma, thymoma
Infection: infectious mononucleosis

113
Q

Urinary sodium and osmolality in pre-renal AKI?

A

Low urine sodium <20

High urine osmolality

114
Q

When do you see brown casts in urine?

A

Acute tubular necrosis

115
Q

Urinary sodium and osmolality in ATN?

A

High urine sodium >40

Low urine osmolality

116
Q

Adenocarcinoma of the lung paraneoplastic syndromes?

A

Gynaecomastia

Hypertrophic pulmonary osteoarthropathy

117
Q

Causes of upper lobe pulmonary fibrosis?

A 
C- Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
118
Q

characteristic pleural fluid findings for glucose, amylase and blood staining?

A

low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis

119
Q

Ix for pleural effusion?

A

PA CXR
USS guided aspiration
Consider contrast CT

120
Q

How do you know if it is cardiac pulmonary oedema?

A

pulmonary capillary wedge pressure raised

121
Q

What does melanosis coli (pigment-laden macrophages) on colonoscopy histology suggest?

A

Laxative abuse

122
Q

cholestatic jaundice, raised IgM and positive anti-mitochondrial M2 antibodies - dx?

A

PBC

123
Q

1st and 2nd line tx in PBC?

A 
Ursodeoxycholic acid (slows disease progression so give even if asymptomatic)
Obeticholic acid
124
Q

When might liver transplant be considered in PBC?

A

If bilirubin >100

125
Q

What is a Dieulafoy lesion?

A

abnormally large artery in the lining of the GI system - most common 6 cm from the O-G junction on the lesser curve of the stomach

126
Q

What can aggressive fluid resus with NaCl cause?

A

hyperchloraemic metabolic acidosis

127
Q

What sign may be seen on CT of pancreatic cancer?

A

Double duct sign

128
Q

What is a patient’s glucose requirement?

A

50-100 g/day irrespective of the patient’s weight

129
Q

What type of nephropathy is associated with cancer?

A

Membranous nephropathy

130
Q

Tx of nephrogenic DI?

A

hydrochlorothiazide

131
Q

Contraindications to lung cancer surgery?

A

SVC obstruction
FEV < 1.5
MALIGNANT pleural effusion
vocal cord paralysis

132
Q

time taken for an arteriovenous fistula to develop?

A

6 to 8 weeks

133
Q

Extra-renal features of ADPKD?

A

Hepatic cysts which manifest as hepatomegaly
Diverticulosis
Intracranial aneurysms
Ovarian cysts

134
Q

Initial management of CKD-mineral bone disease?

A

Correct hyperphosphataemia first; start with dietary changes before starting a phosphate binder

135
Q

Tx for Hiccups in palliative care?

A

chlorpromazine or haloperidol

136
Q

6 tests to confirm brain death?

A

pupillary reflex, corneal reflex, oculo-vestibular reflex, cough reflex, absent response to supraorbital pressure, and no spontaneous respiratory effort

137
Q

Rhabdomyolysis value for it to cause AKI?

A

5x upper limit of normal

138
Q

What to do if someone comes in with ascites with other symptoms e.g. fever/confusion etc and why?

A

Ascitic tap

Rule out SBP

139
Q

Tx of PE if recent bleeding history?

A

IV heparin (easier to reverse than SC)

140
Q

When do we use IVC filter?

A

Recurrent PE

PE despite anticoagulation

141
Q

Rigler’s triad for gallstone ileus?

A

Air in bile ducts
Gallstone visible outside gallbladder
Small bowel obstruction

142
Q

How is liver cirrhosis screened for? What are the indications?

A

transient elastography (Fibroscan)
people with hepatitis C virus infection
men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
people diagnosed with alcohol-related liver disease

143
Q

How is hepatocellular carcinoma screened for? What are the indications?

A

Liver USS
patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
men with liver cirrhosis secondary to alcohol

144
Q

Gold standard ix in achalasia? What would it show?

A

High resolution oesophageal manometry

  • Elevated resting LOS pressure (>45 mmHg)
  • Incomplete LOS relaxation
  • Absence of peristalsis in smooth muscle portion of the oesophagus
145
Q

what is carbohydrate-deficient transferrin used for?

A

very specific biomarker for heavy alcohol use

146
Q

Indication for prophylactic abx in ascites and what would you give?

A

Oral ciprofloxacin

Patients with cirrhosis + ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved

147
Q

Grading of hepatic encephalopathy?

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

148
Q

Mx of CKD mineral bone disease?

A

reduced dietary intake of phosphate is the first-line management
phosphate binders: sevelamer
vitamin D: alfacalcidol, calcitriol
parathyroidectomy may be needed in some cases

149
Q

Tx for allergic bronchopulmonary aspergillosis?

A

Oral Glucocorticoids

150
Q

Indications for NIV?

A

COPD with respiratory acidosis pH 7.26-7.35, CO2 >6kpa
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation

151
Q

Criteria for dx of myeloma?

A

Monoclonal plasma cells in the bone marrow >10%
Monoclonal protein within the serum or the urine (as determined by electrophoresis)
Evidence of end-organ damage e.g. hypercalcaemia, elevated creatinine, anaemia or lytic bone lesions/fractures

152
Q

What is PBC associated with?

A

Sjogren’s

Rheumatoid arthritis

153
Q

Staging of sarcoid xray?

A 
Stage 0: normal
Stage 1: bilateral hilar lymphadenopathy
Stage 2: bilateral hilar lymphadenopathy + lung involvement
Stage 3: lung involvement only
Stage 4: lung fibrosis
154
Q

Tx in haemochromatosis?

A
  1. Venesection

2. Desferrioxamine

155
Q

Mesenteric ischaemia triad?

A

CVD, high lactate and soft but tender abdomen

156
Q

Tx of Bile-acid malabsorption? Watery green diarrhoea after cholecystectomy?

A

Cholestyramine

157
Q

What to do if dysplasia is found on biopsy in Barrett’s oesophagus?

A

Endoscopic mucosal resection

158
Q

Alcoholic ketoacidosis mx?

A

IV thiamine + 0.9% saline

159
Q

What type of cancer does achalasia increase your risk of?

A

SCC of oesophagus

160
Q

Investigation of choice for suspected perianal fistulae in patients with Crohn’s?

A

MRI pelvis

161
Q

2 scores for assessing risk in an upper GI bleed before endoscopy?

A

AIMS65 - risk of in-hospital mortality

Glasgow-Blatchford - before a procedure to determine whether ‘low-risk’ patients need admission or not

162
Q

What might sudden weight loss cause in patients with NASH?

A

An exacerbation - raised LFTs and bilirubin

163
Q

Deficiencies in coeliac disease?

A

Iron
B12
Folate - big one

164
Q

Gene in Wilson’s?

Findings on copper studies?

A

ATP7B gene on Chr13
Low serum copper
Low serum caeruloplasmin
increased 24hr urinary copper excretion

165
Q

Mx of variceal bleed?

A
  1. Terlipressin + IV Abx
  2. Endoscopy: band ligation > sclerotherapy
  3. Sengstaken-Blakemore if uncontrolled bleed
  4. TIPSS
166
Q

When to drain a pleural effusion in infection?

A

If diagnostic pleural fluid sampling shows:
Purulent/turbid fluid
Clear fluid with pH <7.2

167
Q

Features of acute bronchitis?

A 
cough: may or may not be productive
sore throat
rhinorrhoea
wheeze
No focal signs O/E
168
Q

Tx of acute bronchitis?

A

Mainly conservative
Consider abx - doxycycline if:
systemically unwell
CRP >100 (consider delayed prescription if 20-100)

169
Q

When to intubate in COPD?

A

When pH <7.25

170
Q

Tx for type 2 resp failure in COPD?

A

controlled o2 therapy - 24% o2 [resp could be driven by hypoxic drive ie. resp centre insensitive to co2] Target spo2 88-92%

  • recheck abg after 20 mins, if CO2 is lower or steady increase O2 to 28%
  • if CO2 has risen >1.5kpa and patient is still hypoxic consider assisted ventilation or doxapram
  • in rare case if this fails -> intubation
171
Q

Who to start bisphosphonates in?

A
  1. Anyone with a BMD 7.5mg for >3months)
172
Q

Indications for surgery in bronchiectasis?

A

Localised disease

Uncontrollable haemoptysis

173
Q

Truelove and Whitt’s criteria for severe UC flare?

A 
Blood in stools and >6 stools per day AND
T - Temp > 37.8
R - Rate > 90
U - (Uh)naemia Hb < 105
E - ESR >30
174
Q

Vit D supplement in end stage renal failure?

A

Alfacalcidol - doesn’t require activation

175
Q

Acceptable rise in creatinine/fall in GFR with ACEi?

A

decrease in eGFR of up to 25%

rise in creatinine of up to 30% is acceptable

176
Q

How to step down asthma tx?

A

aim for a reduction of 25-50% in the dose of inhaled corticosteroids

177
Q

Diagnostic criteria for asthma?

A

Exhaled FeNO of >/= 40 parts per billion
Post-bronchodilator improvement in lung volume of 200 ml
Post-bronchodilator improvement in FEV1 of >/= 12%
Diurnal Peak Flow variability of >/= 20%
FEV1/FVC ratio <70%

178
Q

Tx for hepatorenal syndrome?

A

Albumin + terlipressin

179
Q

What needs to be co-administered when doing a a large volume paracentesis with an ascitic drain?

A

IV albumin

Reduces paracentesis-induced circulatory dysfunction and mortality

180
Q

definition of an Upper GI Bleed?

A

haemorrhage with an origin proximal to the ligament of Treitz

181
Q

Tx for small bowel bacterial overgrowth syndrome?

A

Rifaximin

182
Q

Relative contraindications for inserting a chest drain?

A

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions

183
Q

Indications for inserting a chest drain?

A

Pleural effusion
Pneumothorax not suitable for conservative management or aspiration
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
In some cases of penetrating chest wall injury in ventilated patients

184
Q

When should tx with bisphosphonates be re-evaluated?

A

After 5 years of oral bisphosphonates
After 3 years for IV zoledronate
Repeat DEXA and FRAX

185
Q

What platelet levels should be aimed for pre-op?

A

> 50×109/L for most patients
50-75×109/L if high risk of bleeding
100×109/L if surgery at critical site

Oishi's Final year flashcards (10 decks)

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