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Yr 4 - PassMed Corrections > Corrections 3 > Flashcards

Corrections 3 Flashcards

1
Q

What type of cancer can H. pylori lead to?

A

Gastric lymphoma (MALT)

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2
Q

Where do gastric lymphomas typically arise?

A

Antrum of stomach

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3
Q

What type of cancer are Reed-Sternberg cells associated with?

A

Hodgkin’s lymphoma

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4
Q

What is the best test to initially diagnose Cushing’s syndrome?

A

The LOW-dose (overnight) dexamethasone suppression test

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5
Q

When is the high dose suppression test used in the diagnsois of Cushing’s?

A

Once Cushing’s syndrome has been confirmed (i.e. by the low-dose test), additional localisation tests can be completed.

The high-dose dexamethasone suppression test is used to discriminate between Cushing’s disease (i.e. pituitary adenoma) or ectopic ACTH production.

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6
Q

What is it called when neurological symptoms are exacerbated by increases in body temperature?

A

Uhthoff’s phenomenon

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7
Q

What is Uhthoff’s phenomenon usually associated with?

A

MS

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8
Q

Which type of stroke is characterised by the an ipsilateral CN III palsy and contralateral hemiparesis?

A

Weber’s syndrome (a type of midbrain stroke)

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9
Q

What is the most common type of Hodgkin’s lymphoma?

A

Nodular sclerosing

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10
Q

What are the 2 first line medications for spasticity in MS?

A

Baclofen & gabapentin

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11
Q

1st line medication for oscillopsia (visual fields appear to oscillate) in MS?

A

Gabapentin

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12
Q

1st line management of polymorphic ventricular tachycardia?

A

IV magnesium sulphate

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13
Q

1st line for cellulitis in pencicillin allergic patients?

A

erythromycin, clarithromycin or doxycycline

Note - if pregnant, use erythromycin

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14
Q

Contraindication of pioglitazone?

A

Bladder cancer

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15
Q

When is a platelet transfusion indicated?

A

Platelet count of <30x10^9 AND clinically significant bleeding.

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16
Q

1st line medical management of myoclonic seizures in females?

A

Levetiracetam

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17
Q

What is Guillain-Barre syndrome classically triggered by?

A

Campylobacter jejuni

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18
Q

Symptoms of Guillain-Barre syndrome?

A
  • double vision
  • proximal muscle weakness
  • ataxic gate
  • diminished reflexes
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19
Q

What is Kaposi’s sarcoma?

A

Caused by the human herpes virus 8 (HHV-8).

Presents as purple papules or plaques on the skin or mucosa (e.g. GI and respiratory tract).

This is an AIDS-defining condition.

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20
Q

Kaposi’s sarcoma indicates what underlying condition?

A

HIV

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21
Q

1st line imaging in suspected aortic dissection in clinically unstable patients?

A

Transoesophageal echocardiography (TOE)

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22
Q

1st line management of Pneumocystis jiroveci penumonia (PCP)?

A

Oral co-trimoxazole (trimethoprim and sulfamethoxazole).

Or IV pentamidine in severe cases.

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23
Q

Which HIV patients should receive PCP prophylaxis?

A

All patients with a CD4 count of <200/mm^3

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24
Q

What is a common complication of PCP?

A

Pneumothorax

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25
Q

What is broad complex tachycardia following a myocardial infarction almost always due to?

A

Ventricular tachycardia

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26
Q

What is necessary before diagnostic imaging to prevent contrast-induced nephropathy (on the background of CKD)?

A

1L before and 1L after of 0.9% NaCl

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27
Q

What is Bell’s palsy?

A

Acute, unilateral, idiopathic facial nerve paralysis.

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28
Q

Who is Bell’s palsy more common among?

A
  • 20-40 y/o
  • pregnant women
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29
Q

Features of Bell’s palsy?

A

1) LMN facial nerve palsy –> forehead affected

2) Post-auricular pain (may precede paralysis)

3) Altered taste

4) Dry eyes

5) Hyperacusis

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30
Q

What should ALL patients with Bell’s palsy receive?

A

All patients should receive ORAL PREDNISOLONE within 72 hours of onset of Bell’s palsy.

Eye care is also important to prevent exposure keratopathy –> consider artificial tears & eye lubricants

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31
Q

What is the most common clinical pattern seen in motor neuron disease?

A

Amyotrophic lateral sclerosis (ALS)

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32
Q

What is the most important test when when investigating vitamin B12 deficiency?

A

Serum intrinsic factor antibodies

Note - these are more useful than gastric parietal cell antibodies

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33
Q

What type of anion gap does DKA cause?

A

Raised

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34
Q

What is a normal anion gap?

A

10-18 mmol/L

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35
Q

How do you calculate an anion ga?

A

(Sodium + potassium) - (bicarb + chloride)

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36
Q

What condition should you consider in diastolic murmur + AF?

A

Mitral stenosis

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37
Q

Describe the murmur in mitral stenosis

A

Mid-diastolic murmur heard loudest over the apex

Accentuated with the patient in the left lateral position.

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38
Q

What complication does mitral stenosis commonly cause?

A

AF (2ary to left atrial enlargement)

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39
Q

How does mitral stenosis cause AF?

A

Due to atrial enlargement

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40
Q

What is the 1st line anti-motility agent for diarrhoea in IBS?

A

Loperamide

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41
Q

What is the 1st line medication for constipation in IBS?

A

Linaclotide (this is a laxative)

42
Q

What 4 investigations are required in patients with GORD being considered for fundoplication surgery?

A

1) oesophageal pH monitoring

2) manometry studies

3) endoscopy

4) Barium swallow

43
Q

What is the purpose fof manometry studies?

A

This measures the pressures within the lower oesophageal sphincter and helps to confirm the diagnosis of GORD

44
Q

What scoring system can be used to quantify the disability in activities of daily living?

A

Barthel index

45
Q

What can autoimmune haemolytic anaemia (AIHA) be divided into?

A

‘Warm’ and ‘cold’ types, according to at what temperature the antibodies best cause haemolysis.

46
Q

Features of autoimmune haemolytic anaemia?

A
  • anaemia
  • reticulocytosis
  • low haptoglobin
  • raised LDH and indirect bilirubin
  • blood film: spherocytes and reticulocytes
47
Q

What is seen on a blood film in autoimmune haemolytic anaemia?

A

spherocytes and reticulocytes

48
Q

What test can be done in autoimmune haemolytic anaemia?

A

direct antiglobulin test (Coombs’ test) –> this will be positive

49
Q

Which type of Hodgkin’s lymphoma carries the worst prognosis?

A

Lymphocyte depleted.

50
Q

How is 3ary hyperparathyroidism characterised?

A

By extremely high PTH with moderately raised serum calcium

51
Q

Which electroylte is required for both PTH secretion and its action on target tissues?

A

Magnesium

52
Q

What electrolyte deficiency can cause hypocalcaemia?

A

Hypomagnesaemia –> may both cause hypocalcaemia and render patients unresponsive to treatment with calcium and vitamin D supplementation.

53
Q

What is the second most common association of HNPCC after colorectal cancer?

A

Endometrial cancer

54
Q

What 2 medications are used 1st line to PREVENT angina attacks?

A

Beta blocker or a CCB

55
Q

If a CCB is used as monotherapy in prevention of angina attacks, what is used?

A

A rate-limiting one e.g. verapamil or diltiazem

56
Q

If a CCB is used in combination with a beta blocker for the prevention of angina attacks, what is used?

A

A longer-acting dihydropyridine calcium channel blocker e.g. amlodipine or modified-release nifedipine

57
Q

What is Lymphogranuloma venereum (LGV)?

A

An STI caused by Chlamydia trachomatis

58
Q

Describe the 3 stages of LGV infection

A

stage 1: small painless pustule which later forms an ulcer

stage 2: painful inguinal lymphadenopathy

stage 3: proctocolitis

59
Q

Management of LGV infection?

A

Doxycycline (think - same as Chlamydia)

60
Q

What does isolated rise in GGT in the context of a macrocytic anaemia suggest?

A

Alcoholism

61
Q

If a patient present with a painful CN III (oculomotor nerve) palsy with pupil involvement, what is this a classic presentation of?

A

Posterior communicating artery aneurysm rupture, leading to compression of CN III fibres between the midbrain and the occiput.

Note - This can occur without rupture of the aneurysm and the patient will present solely with a painful CN III palsy.

62
Q

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

A

Urea breath test

63
Q

How is Vitamin B12 deficiency typically managed?

A

IM B12 replacement, a loading regime followed by 2-3 monthly injections

E.g: vitamin B12 1mg IM 3x/week followed by 1mg IM every 3 months

64
Q

What should sickle cell patients be started on long term to reduce the incidence of complications and acute crises?

A

Hydroxycarbamide

65
Q

When should all cases of pneumonia have a repeat chest X-ray?

A

6 weeks after clinical resolution

66
Q

What condition causes an ‘empty delta sign’ seen on venography?

A

Sagittal sinus thrombosis

67
Q

What is the 1st line investigation in rhabdomyolysis?

A

plasma creatine kinase (CK)

68
Q

In a patient with suspected anaemia of chronic disease secondary to CKD, what should be checked prior to starting EPO?

A

Iron status

69
Q

Name some drugs that cause haemolysis in G6PD deficiency

A

1) Anti-malarials: primaquine

2) Ciprofloxacin

3) Sulph- group drugs:
- sulphonamides
- sulphasalazine
- sulphonylureas e.g. gliclazide, glipizide

70
Q

Is prothrombin time or albumin a better measure of acute liver failure?

A

Prothrombiin time - as has a shorter-half life than albumin

71
Q

What is the gold standard test for diagnosing venous sinus thrombosis?

A

MR Venogram

72
Q

Should you treated asymptomatic bacteria in catheterised patients?

A

No - just safetynet

73
Q

What does the diagnostic criteria for T2DM vary according to?

A

Whether the patient is symptomatic or not (e.g. polyuria, polydipsia)

74
Q

If the patient IS symptomatic, what:

a) fasting glucose
b) random glucose

is diagnostic of T2DM?

A

a) ≥7 mmol/l

b) ≥11.1 mmol/l (or after 75g OGTT)

75
Q

If the patient is asymptomatic, how does diagnostic criteria for T2DM change?

A

The above critera (i.e. fasting & random glucose measurements) must be demonstrated on TWO separate occasions.

76
Q

What HbA1c indicates pre-diabetes?

A

42-47 mmol/mol

77
Q

In paeds BLS, what is the ratio of compresions to breath?

A

15:2

(is 30:2 in adults)

78
Q

Autoimmune haemolytic anaemia (AIHA) may be divided in to ‘warm’ and ‘cold’ types based on what?

A

According to at what temperature the Abs best cause haemolysis.

79
Q

What is the nice criteria for starting a GLP-1 mimetics (e.g. liraglutide, exenatide) in T2DM? (3)

A

1) BMI >35

2) >1% HbA1c red§uction after 6 months

3) Weight loss >3% at 6 months

80
Q

If there is a delay in CTPA in PE, what can be offered?

A

Offer treatment dose of DOAC whilst waiting for CTPA.

81
Q

How does renal tubular acidosis affect the anion gap?

A

Causes a hyperchloremic normal anion gap metabolic acidosis.

82
Q

Pathophysiology in HHS?

A

Hyperglycaemia –> increased serum osmolality –> osmotic diuresis –> severe volume depletion.

83
Q

What are some precipitating factors for HHS?

A
  • intercurrent illness
  • dementia
  • sedative drugs
84
Q

Onset of HHS vs DKA?

A

DKA - acute (hours)

HHS - gradual (days) so the dehydration and metabolic disturbances may be more extreme

85
Q

What is the mainstay of management of HHS?

A

Fluid replacement with 0.9% saline

86
Q

Is insulin indicated in HHS?

A

No - only given if blood glucose stops falling while giving IV fluids

87
Q

What is the danger of giving insulin in HHS?

A

Can provoke sudden and dramatic fluid shift between compartments –> can result in central pontine myelinloysis.

88
Q

In any patient with T2DM with established CVS disease, what shoud always be added to metformin?

A

SGLT-2 inhibitor

Start metformin first and titrate upwards as tolerated, add an SGLT-2 inhibitor regardless of glycaemic control.

89
Q

Can SGLT-2 inhibitors cause weight loss?

A

Yes

(often offered 2nd line after metformin in patients with BMI >35)

90
Q

What medication is used to vasospasm in aneurysmal subarachnoid haemorrhages?

A

Nimodipine

91
Q

In the treatment of anaphylaxis, how often can you repeat dose of adrenaline?

A

Every 5 mins

92
Q

Why is polyhydramnios a risk factor for placental abruption?

A

This is due to an increase in pressure within the uterine space, caused by the extra fluid.

93
Q

What does an ‘unrecordable’ blood glucose mean?

A

That the blood sugar is high

94
Q

What is the criteria to diagnose AKI in adults? (3)

A

1) Rise in creatinine >26µmol in 48 hours

2) Rise in creatinine >50% in 7 days

3) Decrease in urine output <0.5ml/kg/hr for more than 6 hours

95
Q

What artery is affected in a contralateral homonymous hemianopia with macular sparing and visual agnosia?

A

Posterior cerebral artery

96
Q

What is persistent ST elevation after a previous MI very suggestive of?

A

LV aneurysm

97
Q

What is a key complication of a LV aneurysm?

A

Ischaemic stroke

Blood stagnates around a LV ventricle aneurysm, promoting platelet adherence and thrombus formation –> embolism.

98
Q

What is the initial Abx therapy in suspected meningitis in young adults (before the identification of the causative organism)?

A

IV ceftriaxone

99
Q

When is IM benzylpencillin indicated in suspected meningitis?

A

In a pre-hospital setting (for e.g. a GP surgery), as long as the transit to the hospital is not delayed.

100
Q

What medication should patients with CKD be started on if they have an ACR >30 mg/mmol?

A

ACEi

101
Q
A

Yr 4 - PassMed Corrections (36 decks)

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