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MLA Content > QuQuick recall 3 > Flashcards

QuQuick recall 3 Flashcards

1
Q

Pathways!

Warfarin:
Heparin:
LMWH:

A

Warfarin: Extrinsic pathway –> prothrombin time

Heparin: Intrinsic pathway –> APTT

LMWH: enoXaparin - anti-factor Xa levels

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2
Q

Septic arthritis requires prolonged antibiotic therapy of at least

A

4-6 weeks

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3
Q

Standard heparin vs LMWH

A

Adverse effects of heparin:
–> bleeding
–> thrombocytopenia
–> osteoporosis (increased risk of fractures|0
–> hyperkalaemia

Heparin over dose: reversed by protamine sulphate

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4
Q

IgG,A,M,D,E

A

IgG: G for gestational - only Ig that can cross the placenta
IgA: A being the first letter, is the first Ig to be given to baby thru breastfeeding
IgM: M is a simp for the body (M’lady i’ll be the Main protector from pathogens)
IgD: D is like unsolicited dick pics, nobody knows what they’re good for
IgE: E is for Eosinophiles, which are also associated with the allergic response

IgM - pentamer
IgA - monomer / dimer
Rest monomer

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5
Q

The diagnostic criteria for HHS include

A
  • hypovolaemia
  • hyperglycaemia (BM > 30mmol)
  • serum osmolality (320 mosmol/kg)

Clinical features
- fatigue
- lethargy
- altered consciousness
- hypotension
- tachycardia

monitor SERUM OSMOLALITY

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6
Q

Carcinoid syndrome: investigation and management

A

Investigation
–> Urinary 5-HIAA
–> plasma chromogranin A y

Management
–> somatostatin analogues e.g. octreotide
–> diarrhoea: CRYPTOHEPATIDINE

Features
- flushing
- diarrhoea
- bronchospasm
- hypotension
- right heart valvular stenosis
- rare: pellagra

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7
Q

Hyperkalaemia management

mild: 5.5-5.9mmol/l
moderate: 6-6.4 mmol/l
severe: > 6.5mmol/l

A
  1. stabilisation of cardiac membrane: IV calcium gluconate
  2. Short term shift i K+ from ECF to intracellular fluid compartment
    –> combined insulin / dextrose infusion
    –> nebulused salbutamol
  3. Potassium removal from body
    –> calcium resonium (enema&raquo_space; oral)
    –> loop diuretics
    –> dialysis (w/ AKI

ECG: QRS widening and peaked T waves

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8
Q

TIA: assessment and referral

A
  1. ABCDE prognostic score
  2. Immediate antithrombotic therapy
    –> aspirin 300mg
    –> UNLESS: bleeding disorder, already on low dose aspirin or contraindicated
  3. Specialist review
    –> in last 7 days: arrange urgent assessment w/i 24 hrs
    –> post 7 days: asap w/i 7 days

INVESTIGATION:
1. MRI (diffusion-weighted and blood-sensitive sequences)
2. Carotid imaging: urgent carotid dopller

Further management
1. Secondary prevention: clopidogel 1st line
–> OR aspirin + dipyridamole
2. Statin
3. carotid stenosis > 70% –> CAROTID A. ENDARECTOMY (on side contralateral to symptoms)

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9
Q

Episodic, intense, unilateral eye pain, lacrimation, restless →

A

cluster headache
–> high flow oxygen + subcutaneous sumatriptan

Prophylaxis
- verampil

Paroxysmal hemicrania responds well to indomethacin

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10
Q

mnemonic for raised anion gap based on symptoms

In acidosis –> kussmaul breathing

A

K - ketones
u - uraemia
s - sepsis
s - salicylate
m - methanol
a - aldehyde
l - lactic acidosis

OR

MUDPILES for high anion gap

Methanol
Uraemia
DKA
Paracetamol/Paraldehyde
Iron
Lactate
Ethanol
Salicylates/Sepsis

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11
Q

Normal ion gap metabolic acidosis:

normal anion gap (6 - 16 mmol/L)

A

HARD ASS
Hyperalimentation
Addison’s
RTA
Diarrhoea

Acetazolamide
Spironolactone
Saline

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12
Q

Triad of sudden onset abdominal pain, ascites, and tender hepatomegaly: seen in

A

BUDD CHIARI SYNDROME (hepatic vein thrombosis)

  • raised SAAG >11 indicates portal HTN caused the ascites

IX - USS w/ doppler flow studies

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13
Q

Variceal haemorrhage: management

A

ABCDE
1. correct clotting: FFP, vit K
Before endoscopy
2. Vasoactive: terlipressin (or octreotide?)
3. prophylactic IV Abx (quinolones?)
4. Endoscopic varcieal band ligation

UNCONTROLLED HAEMORRHAGE
–> SENGSTAKEN-BLAKEMORE TUBE

TIPS if all else failed!

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14
Q

Prophylaxis of variceal haemorrhage

A
  1. Propranolol
  2. Endoscopic variceal band ligation (at 2 weekly intervals until eradication) + PPI
  3. TIPS if unsuccessful
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15
Q

DVLA: neurological disorders

A

Epilepsy
–> unprovoked: 6 months off IF no abnormalities on EEG (increased to 12 months)
–> established: driving licence if seizure free 12 months, no seizure for 5 years
–> withdrawal of AED: 6 months after last dose

Syncope
–> faint: no restriction!
–> single, explained, treated –> 4 WEEKS OFF
–> single, unexplained –> 6 MONTHS off
–> 2 or more –> 12 months off

Stroke / TIA
–> 1 month off, no need to inform DVLA if no neurological deficiit
–> multiple TIAs: 3 months off driving and inform DVLA

Craniotomy
–> 1 year off driving

Pituitary tumour
–> 6 months

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16
Q

Statin doses for primary and secondary prevention

A
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17
Q

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller →

A

DENGUE fever
–> maculopapular after 3-4 days after onset of illness
–> thrombocytopenia

18
Q

Recent sore throat, rash, arthritis, murmur →

A

rheumatic fever
- following streptococcus pyogenes infection

19
Q

Hyperosmolar hyperglycaemia state: Pathophysiology

A

hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion

Managment:
1. IV fluid replacement (0.5-1L/hr) , monitor K+
2. Insulin (not until BG stops falling while giving IV Fluids)
3. VTE prophylaxis

20
Q

The anion gap is calculated by:

A

(sodium + potassium) - (bicarbonate + chloride). A normal anion gap is 10-18 mmol/L.

21
Q

Paget’s disease of the nipple:

A

Diagnosis made via punch biopsy, mammography and USS of breast

Needs breast clinic referral urgent!

22
Q

THESE are typically spared in motor neurone disease

A

Eye movements

23
Q

CT shows:

A

**Aortic dissection **
- intraluminal tear formed a ‘flap’ in the ascending aorta
- Stanford TYPE A DISSECTION

HTN common in AD aar cathecholamine surge

24
Q

Hoffman’s sign

A

Involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail down.

Degenerative cervical myelopathy.

25
Q

typically presents with abdominal, neurological and psychiatric symptoms

A

acute intermittent porphyria
- autosomal dominant
- enzyme involved in biosynthesis of haem
- leads to toxic accumulation of delta aminolaevulinic acid and porphobilinogen

26
Q

1st line treatment for chronic myeloid leukaemia

A

Imantinib - tyrosine kinase inhibitor

Philadelphia chromosome !

- high white cell
- blast cells would indicate acute anaemia

27
Q

P450 enzyme inducers

A

PC BRATS- inducers

Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol
Topiramate
Sulfonylureas

28
Q

Tracheal deviation, resonant to percussion and absent breath sounds in the context of respiratory distress and shock -

A

TENSION PNEUMOTHORAX

MX: immediate decompression via needle thoracostomy

Causes:
1. Traumatic: blunt / penetrating chest trauma
2. Iatrogenic: thoracentesis, central venous catheter placement, positive pressure mechanical ventilation
3. Spontaneous: COPD / CF, lung blebs may rupture

29
Q

A 25-year-old lady presents with an swelling located at the anterior border of the sternocleidomastoid muscle. The swelling is intermittent and on examination it is soft and fluctuant.

A

Branchial cysts are remnants of the branchial cleft. They may become infected.

30
Q

Differentiating posterior vitreous detachment, retinal detachment and vitreous haemorrhage:

POSTERIOR VITREOUS DETACHMENT

A
  1. Flashes of light (photopsia) in peripheral field of vision
  2. Floaters (often temporal side of central vision)
31
Q

Differentiating posterior vitreous detachment, retinal detachment and vitreous haemorrhage:

  • dense shadow starting peripherally moving towards central vision
  • a veil or curtain over field of vision
  • straight lines appear curved
  • central vision loss
A

RETINAL DETACHMENT

32
Q

Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters

A

Vitreous haemorrhage

33
Q

Anti-GBM disease typically presents with:

A

Haemoptysis + AKI/proteinuria/haematuria

Small vessel vasculitis associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis.
–> may be exacerbated by cold

IX: renal biopsy showing linear IgG deposits

Mx:
–> plasma excahnge
–> steroids
–> cyclophosphamide

key complication is pulmonary haemorrhage!

34
Q

ASA gradings

A
35
Q

Osteomalacia

A

Causes: Vit D deficiency, CKD, Liver disease, coeliacs

Feature: bone pain, muscle tenderness, fractures, proximal myopathy (waddling gait)

IX:
Bloods : vit D, raised ALP
X-RAY: translucent bands (looser’s zones or psuedofractures)

Tx:
1. Vit D supplementation (loading dose needed)
2. calcium supplementation if dietary calcium inadequate

Softening of bones secondary to low vitamin D levels

36
Q

Causes of respiratory alkalosis:

A

Respiratory Alkalosis
PAST PH

Panic attacks
Anxiety attacks
Salicylates
Tumour
Pulmonary embolism
Hypoxaemia

Note: salicylate overdose can cause mixed primary resp alkalosis and metabolic acidosis

37
Q

first-line treatment for magnesium sulphate induced respiratory depression.

A

Calcium gluconate

38
Q

This woman has a symptomatic megaloblastic anaemia associated with glossitis. This is likely due to

A

Pernicious anaemia: B12 deficiency

Intrinsic factor antibodies

Mx: Vit B12 injections, 3 injections weekly for 2 weeks followed by 3 monthly treatment of vitamin b12 injections
–> folic acid supplementation?

B12 important for RBC production and myelination of nerves

39
Q

Different type of cysts

A

Epidermoid cyst - ‘Blackhead’
Sebaceous cyst - ‘Whitehead’
Dermoid cyst - Can contain hair (or teeth/other abnormal growths within -dependent on the location [ovaries])

Desmoid tumours are benign tumours of connective tissue

40
Q

What does the following show:

A
  • papilloedema
  • lurring of the optic disc edges
  • enlargement of the surrounding veins.
  • small haemorrahges surrounding optic disc
41
Q
A

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