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passmed qs > 15/06 > Flashcards

15/06 Flashcards

1
Q

tx of orthostatic hypertension

A

> fluid and salt intake
compression stockings
med review
Fludrocortisone or midodrine

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2
Q

status epilepticus mx

A

pre-hosp: PR diazepam or buccalmidazolam
hosp:
IV lorazepam, repeat after 5-10 min
levetiracetam, phenytoin or sodium valproate
GA to control airway

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3
Q

test pt for hep b

A

hbsag

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4
Q

early diastolic murmur

A

aortic regurgitation

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5
Q

high fever, rapid onset and herpes labialis

A

strep pneumo

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6
Q

pneumonia in COPD

A

haemophilus

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7
Q

pneumonia following flu

A

staph aureus

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8
Q

dry cough, atypical chest findings, AI haemolytic anaemia, erythema multiforme

A

mycoplasma

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9
Q

hyponatreamia, lymphopenia, air conditioning units

A

legionella

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10
Q

pneumonia follow up

A

repeat chest X-ray at 6 weeks

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11
Q

Varenicline caution

A

patients with a history of depression or self-harm

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12
Q

bupronion CI/caution

A

epilepsy, breast feeding/eating disorder

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13
Q

pregnancy smoking cessation

A

NRT only

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14
Q

upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes

A

silicosis

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15
Q

sarcoidosis bloods

A

hypercalcaemia
»ACE levels
»ESR

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16
Q

indications for steroids in sarcoid

A

chest x-ray stage 2 or 3 disease who are symptomatic
hypercalcaemia
eye, heart or neuro involvement

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17
Q

psoriasis 1st line

A

potent corticosteroid applied once daily plus vitamin D analogue applied at different time

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18
Q

severe hyperkalaemia

A

A sinusoidal/sine wave ECG pattern

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19
Q

sedative in delirium

A

haloperidol 0.5 mg

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20
Q

tx of delirium in parkinsons

A

< of parkinsons meds
atypical antipsychotics quetiapine and clozapine

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21
Q

mild to mod alzheimers and Lewy body tx

A

acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine

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22
Q

2nd line for alzheimers/Lewy body or severe disease

A

NMDA receptor antagonist - memantine

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23
Q

alzheimers pts at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress

A

antipsychotics

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24
Q

when is donepezil CI

A

bradycardia

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25
Q

donepezil SE

A

insmonia

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26
Q

path changes in alzeheimers

A

widespread cerebral atrophy, particularly involving the cortex and hippocampus

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27
Q

sudden or stepwise deterioration in cognitive function

A

vascular dementia

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28
Q

screen for pts at risk of pressure sores

A

waterloo score

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29
Q

mx of pressure sores

A

moist wound environment - Hydrocolloid dressings and hydrogels
tissue viability nurse
surgical debridement

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30
Q

frailty assessment

A

gait speed, self reported health status, PRISMA-7 questionaire

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31
Q

scan for lewy body

A

SPECT

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32
Q

falls blood screen

A

FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels

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33
Q

vaginal passage of faeces or flatus

A

colovaginal fistula due to diverticular disease

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34
Q

cardiac arrhythmia macrolides

A

torsades de pointes

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35
Q

acromegal invx

A

first line = serum IGF1
if this is&raquo_space;, OGTT

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36
Q

tx of acromegaly

A

transphenoidal surgery
2nd line = somatostatin analogue eg ocreotide, GH receptor antagonist pegvisomat

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37
Q

commonest cause of addisons uk

A

AI destruction of adrenal glands

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38
Q

diagnosis of addisons

A

ACTH stimulation test, short synacthen test
if not available, 9am cortisol

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39
Q

addisons electrolyte abnormalities

A

hyperkalaemia
hyponatraemia
hypoglycaemia
metabolic acidosis

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40
Q

mx of addisonian crisis

A

hydrocortisone 100mg im or iv
1 l saline infused over 30-60 mins or with dextrose if hypoglycaemic
continue hydrocortisone 6 hourly until the patient is stable
oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days

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41
Q

CARBIMAZOLE adverse effect

A

agranulocytosis

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42
Q

congenital adrenal hyperplasia inheritance

A

autosomal recessive

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43
Q

congenital adrenal hyperplasia endocrine

A

affect adrenal steroid biosynthesis
in response to resultant low cortisol levels the anterior pituitary secretes high levels of ACTH
ACTH stimulates the production of adrenal androgens

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44
Q

presentation of congenital adrenal hyperplasia

A

virilisation in females
precocious puberty in males
salt losing crisis

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45
Q

most common cause of congenital adrenal hyperplasia

A

21-hydroxylase deficiency

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46
Q

congenital hypothyroidism

A

prolonged neonatal jaundice
delayed mental & physical milestones
short stature
puffy face, macroglossia
hypotonia

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47
Q

Minimal glucocorticoid activity, very high mineralocorticoid activity

A

fludrocortisone

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48
Q

Glucocorticoid activity, high mineralocorticoid activity

A

hydrocortisone

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49
Q

Predominant glucocorticoid activity, low mineralocorticoid activity

A

prednisolone

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50
Q

Very high glucocorticoid activity, minimal mineralocorticoid activity

A

dexamethasone
betamethasone

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51
Q

sick day rules pt on long term steroids

A

double dose

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52
Q

when to take statins

A

last thing in evening

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53
Q

restless legs syndrome tx

A

dopamine agonists such as ropinirole

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54
Q

salicylate poisoning

A

iv bicarb

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55
Q

hypothermia ECG

A

J waves

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56
Q

afro carribean hypertension

A

CCB

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57
Q

when to co-prescribe in SSRI

A

when already taking an NSAID, give a PPI

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58
Q

valvulae conniventes extending across bowel

A

small bowel obstruction

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59
Q

Bone pain, tenderness and proximal myopathy

A

?osteomalacia

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60
Q

when can pts be tested for coeliac

A

when they have eaten gluten for 6 wks

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61
Q

why is nephrotic syndrome assoc with a hypercoagulable state

A

loss of antithrombin III by the kidneys

62
Q

Stopping of voluntary movement or staying still in an unusual position

A

catatonia

63
Q

TLCO in IPF

A

reduced

64
Q

when is platelet transfusion indicated

A

platelet count <30 and clinically significant bleeding

65
Q

CLL transformation

A

richters = non-hodgkins lymphoma

66
Q

severe diverticulitis flare

A

72 hours, admission to hospital for IV ceftriaxone + metronidazole is indicated

67
Q

critical limb ischaemia

A

pain at rest for greater than 2 weeks, often at night, not helped by analgesia

68
Q

why is albumin prescribed in large volume ascites paracentesis

A

reduces paracentesis-induced circulatory dysfunction and mortality

69
Q

parkinsons delerium

A

lorazepam

70
Q

Rupture of the papillary muscle due to a myocardial infarction ->

A

mitral regurgitation

71
Q

pH NG tube

A

safe to use if <5.5 on aspirate

72
Q

what is reccomended after WLE breast cancer

A

whole breast radiotherapy

73
Q

timolol eyedrops MOA

A

reduce aqueous secretion

74
Q

gynae disease RF for ectopic

A

endometriosis

75
Q

which other antidepressent do SSRIs interact with -> serotonin syndrome

A

MAOs eg phenelzine

76
Q

prophylaxis for contacts of meningitis

A

Oral ciprofloxacin or rifampicin

77
Q

most common MOA of ankle sprain

A

inversion

78
Q

what should be checked prior to prescribing EPO in CKD

A

iron studies

79
Q

when should lithium levels be checked

A

7 days, 12 hours post-dose

80
Q

vision worse going down stairs

A

4th nerve palsy - trochlear

81
Q

T1DM antibodies

A

anti-GAD
islet cell antibodies
insulin autoantibodies

82
Q

symptomatic DM diagnosis

A

fasting glucose >= 7.0 mmol/l
random glucose >= to 11.1 mmol/l (or after 75g OGTT)

83
Q

asymptomatic DM diagnosis

A

same applies but must be demonstrated x2

84
Q

atypical features of T1DM - order C peptide or antibodies

A

age 50 years or above, BMI of 25 kg/m² or above, slow evolution of hyperglycaemia or long prodrome

85
Q

HBA1C T2DM diagnostic

A

> =48 (repeat test to confirm diagnosis)

86
Q

conditions where HBA1C cannot be diagnostic

A

haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
suspected GDM
children
HIV
CKD
ptstaking medication that may cause hyperglycaemia (eg steroids)

87
Q

pre-diabetes

A

HBA1C 42-47
fasting glucose 6.1-6.9

88
Q

metformin MOA

A

Increases insulin sensitivity
Decreases hepatic gluconeogenesis

89
Q

metformin SEs

A

lactic acidosis
GI upset

90
Q

metformin CI

A

eGFR <30

91
Q

sulfonylureas eg gliclazide, glimepiride

A

Stimulate pancreatic beta cells to secrete insulin

92
Q

sulfonylureas eg gliclazide, glimepiride SEs

A

hypoglycaemia
wt gain
hyponatramia

93
Q

Thiazolidinediones eg pioglitazone MOA

A

Activate PPAR-gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake

94
Q

Thiazolidinediones eg pioglitazone SE

A

weight gain
fluid retention

95
Q

DPP4 inhibitors eg gliptins MOA

A

Increases incretin levels which inhibit glucagon secretion

96
Q

DPP4 inhibitors eg gliptins potential but rare SE

A

pancreatitis

97
Q

SGLT-2 inhibitors (-gliflozins) MOA

A

inhibits reabsorption of glucose in the kidney

98
Q

SGLT-2 inhibitors (-gliflozins) SE

A

UTIs

99
Q

SGLT-2 inhibitors (-gliflozins) benefit

A

wt loss

100
Q

GLP-1 agonists (-tides) (SC) MOA

A

Incretin mimetic which inhibits glucagon secretion

101
Q

GLP-1 agonists (-tides) (SC) SEs

A

Nausea and vomiting
Pancreatitis

102
Q

how often HBA1C monitored in T1

A

3-6 monthly

103
Q

blood glucose targets

A

5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day

104
Q

hba1c target when taking drug which may cause hypo eg sulfonylureas

A

53

105
Q

Already on one drug, but HbA1c has risen to 58 mmol/mol target

A

53

106
Q

DKA path

A

uncontrolled lipolysis (not proteolysis) which results in an excess of free fatty acids that are ultimately converted to ketone bodies

107
Q

DKA diagnostic criteria

A

glucose > 11 mmol/l or known DM
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick

108
Q

what electrolyte should be added to fluid in DKA

A

potassium

109
Q

DKA resolution

A

pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

110
Q

DKA resolution timeframe

A

should be within 24 hrs -> endocrinologist

111
Q

diabetic peripheral neuropathy

A

SENSORY loss in a glove and stocking distribution

112
Q

indicator kidney disease is chronic not acute

A

hypocalcaemia

113
Q

how long do symptoms need to be present for a diagnosis of chronic fatigue syndrome

A

3 months

114
Q

lower than exptected HBA1C (due to <RBC lifespan)

A

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

115
Q

higher than expected HBA1C (due to >RBC lifespan)

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

116
Q

graves disease main antibodies

A

TSH receptor stimulating antibodies

117
Q

CIs radioactive iodine tx

A

pregnancy
age <16
eye disease

118
Q

hashimotos antibodies

A

anti-thyroid peroxidase (TPO) and also anti-thyroglobulin (Tg) antibodies

119
Q

cancer assoc with hashimotos

A

MALT lymphoma

120
Q

key invx for pts with hypercalcaemia

A

PTH

121
Q

HHS features

A

hypovolaemia
hyperglycaemia
> serum osmolality
no sig ketones or acidosis

122
Q

insulin in HHS

A

should not be given unless blood glucose stops falling when fluids given

123
Q

complciations in HHS

A

vascular eg stroke or MI

124
Q

tx of primary hyPOPTH

A

alfacalcidol

125
Q

pseudohyperparathyroidism phenotype

A

low IQ, short stature, shortened 4th and 5th metacarpals

126
Q

psuedohyperparathyroidism features

A

low calcium, high phosphate, high PTH

127
Q

levothyroxine SEs

A

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

128
Q

levothyroxine interaction

A

iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart

129
Q

dermatophyte nail infection

A

terbinafine

130
Q

candida nail infection

A

itraconazole

131
Q

tx of MODY

A

sulfonylureas eg gliclazide

132
Q

High uric acid + renal impairment following chemotherapy

A

tumour lysis syndrome

133
Q

kallman syndrome

A

lack of smell in a boy with delayed puberty

134
Q

kallman syndrome findings

A

everything low

135
Q

klinefelters

A

tall but 2ndary sexual characteristics, small firm testes and infertile

136
Q

klinefelters findings

A

fsh lh high
testosterone low

137
Q

MEN 1 (MEN 1)

A

3 Ps
Parathyroid: hyperparathyroidism due to parathyroid hyperplasia
Pituitary
Pancreas: e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)

138
Q

MEN IIa (RET oncogene)

A

1M
Medullary thyroid cancer

2P’s
Parathyroid
Phaeochromocytoma

139
Q

MEN IIb (RET oncogene)

A

2Ms
Medullary thyroid cancer
Marfanoid body habitus

1P
Phaeochromocytoma

Neuromas

140
Q

raised urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels

A

neuroblastoma (adrenal tumour)

141
Q

what is orlistat

A

pancreatic lipase inhibitor

142
Q

anti-thyroid drugs in preg

A

propylthiouracil in first trim
switch back to carbimazole at start of 2nd trim

143
Q

features of primary hyperaldosteronism

A

hypertension
hypokalaemia
metabolic alkalosis

144
Q

when would starting plasma osmolality be low in water deprivation test

A

psychogenic polydipsia

145
Q

modifiable RF thyroid eye disease

A

smoking

146
Q

most common and best prognosis thyroid cancer

A

papillary

147
Q

Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness

A

anterior inferior cerebellar artery

148
Q

MSH2/MLH1 gene mutations

A

HNPCC

149
Q

SAH mx

A

aneurysm coiling

150
Q

early diastolic murmur

A

aortic regurgitation

151
Q

when would you choose sputum culture over smear for TB testing

A

PLWH

152
Q

PSC diagnosis

A

MRCP

passmed qs (18 decks)

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