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Yr 4 - PassMed Corrections > Corrections 4 > Flashcards

Corrections 4 Flashcards

1
Q

What is the most appropriate investigation to visualise fibroids?

A

Transvaginal US

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2
Q

Is salbutamol safe in breastfeeding?

A

Yes

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3
Q

When should women with dichorionic twins be offered an elective c section?

A

37 weeks

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4
Q

FSH and LH levels in premature ovarian insuffiency?

A

High FSH and LH in response to lack of oestrogen release from ovaries.

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5
Q

Symptoms of a cystocele?

A
  • symptoms of stress incontinence
  • sensations of heaviness or dragging in vagina
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6
Q

Is anti-D required after light spotting <12 weeks gestation?

A

no

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7
Q

Is anti-D require before amniocentesis?

A

Yes

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8
Q

Is HRT or COCP preferred for management of premature ovarian insufficiency?

A

HRT

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9
Q

What does WHO performace status 3 mean?

A

An individual is confined to a bed or chair for more than 50% of their waking hours and that they are capable of only limited self-care.

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10
Q

Is post-term gestation a risk factor for poly or oligohydramnios?

A

Oligohydramnios

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11
Q

Is oesophageal atresia a risk factor for poly or oligohydramnios?

A

Polyhydramnios

Prevents the foetus from swallowing

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12
Q

What is the best treatment for PID?

A

Ceftriaxone + doxycyline + metronidazole

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13
Q

What is given 1st line in active management of 3rd stage of labour?

A

IM oxytocin

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14
Q

How soon after mifepristone should misoprostol be given in a TOP?

A

24-48 hours later

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15
Q

Dose of folic acid in pregnant women with coeliac disease?

A

5mg (considered higher risk)

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16
Q

When is ECV offered?

A

37 weeks

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17
Q

What is the danger of correcting a low serum sodium level too quickly?

A

Can lead to central pontine myelinosis (where the osmotic pressure of the influx of Na+ molecules strips water from the brain).

This causes destruction of the pontine myelin.

This leads to osmotic demyelination syndrome –> dysarthria, quadriparesis, seizures, coma, locked-in syndrome.

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18
Q

What are some complications of a SAH?

A

1) Hyponatraemia

2) Seizures

3) Vasospasm

4) Chronic hydrocephalus (due to effects of haemorrhage on resorption of CSF)

5) Cognitive impairment

6) Re-bleeding

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19
Q

What can be given to reduce risk of vasospasm in SAH?

A

Nifedipine

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20
Q

What are the vitamin K dependent clotting factors?

A

II, VII, IX and X.

Mneumonic 2 + 7 = 9, not 10

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21
Q

What are the management options for a subdural haematoma?

A

1) Conservative

2) Medical:
- prophylactic antiepileptics
- coagulopathy reversal

3) Surgical:
- decompressive craniotomy
- Burr hole decompression
- craniectomy

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22
Q

What are the features suggestive of hypernatraemic dehydration?

A

1) jittery movements

2) increased muscle tone

3) hyperreflexia

4) convulsions

5) drowsiness or coma

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23
Q

How soon should any person on anticoagulants with a head injury receive a CT head?

A

Within 8 hours

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24
Q

1st line investigation in suspected prostate cancer?

A

Multiparametric MRI

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25
Q

1st line management of a strangulated inguinal hernia?

A

Immediate open surgical repair

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26
Q

What are 2 treatment options for achalasia?

A

1) Endoscopic injection with botulinum toxin (but not long lasting)

2) Cardiomyotomy (more durable alternative)

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27
Q

What are 4 recognised complications of enteral feeding?

A

1) Diarrhoea

2) Aspiration

3) Hyperglycaemia

4) Refeeding syndrome

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28
Q

What is the 1st line investigation of choice in SAH?

A

Non-contrast CT head

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29
Q

CT head rules for SAH?

A

If CT head is done within 6 hours of symptom onset and is normal –> do NOT do LP, consider alterantive

If CT head is done >6 hours of symptom onset and is normal –> perform LP

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30
Q

When should an LP be done in suspected SAH?

A

If CT head is done >6 hours after symptom onset and is normal.

LP should be performed at least 12 hours following onset of symptoms.

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31
Q

How long after onset of symptoms in SAH should be LP be performed?

Why?

A

At least 12 hours after

To allow the development of xanthochromia (the result of RBC breakdown).

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32
Q

What 2 CSF findings on an LP indicate SAH?

A

1) Xanthochromia

2) Normal or raised opening pressure

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33
Q

1st & 2nd line management of diverticulitis flare?

A

1st –> oral Abx at home

2nd –> if they do not improve within 72 hours, admission to hospital for IV ceftriaxone + metronidazole is indicated

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34
Q

What are 4 absolute contraindications to laparoscopic surgery?

A

1) haemodynamic instability/shock

2) raised ICP

3) acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)

4) uncorrected coagulopathy

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35
Q

What medications are indicated in PAD? (2)

A

1) Atorvastatin 80mg

2) Clopidogrel

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36
Q

What type of renal stone does not show up on XR?

A

Uric acid stones

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37
Q

What time limit for retrograde amnesia following a head injury is an indicaction for a CT head?

A

Over 30 mins of retrograde amnesia

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38
Q

Is anterograde amnesia an indication for a CT head following head injury?

A

No

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39
Q

What is beck’s triad?

A

Indicates the presence of cardiac tamponade.

1) Hypotension

2) Muffled heart sounds

3) Raised JVP

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40
Q

1st line in BPH if the patient has troublesome symptoms?

A

Alpha-1 antagonists e.g. tamsulosin, alfuzosin

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41
Q

What does neurogenic shock most commonly occur following?

A

Spinal cord transection (usually at a high level).

There is an interruption of the autonomic nervous system.

The result is either decreased sympathetic tone or increased parasympathetic tone, the effect of which is a decrease in peripheral vascular resistance mediated by marked vasodilation.

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42
Q

What is indicated in recurrent balanitis?

A

Circumcision

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43
Q

What is the most effective management option in renal cell carcinoma?

A

Radical nephrectomy (RCC is usually resistant to radiotherapy or chemotherapy)

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44
Q

What condition is associated with pigmented gallstones?

A

Pigmented gallstones are primarily made of bilirubin and are associated with haemolytic anemia (e.g. sickle cell) and liver cirrhosis.

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45
Q

What early imaging is indicated in acute pancreatitis?

A

US abdomen –> to determine the aetiology as this may affect management (e.g. patients with gallstones/biliary obstruction)

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46
Q

How can pelvic fractures cause urinary retenion?

A

Pelvic fractures may cause laceration of the urethra.

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47
Q

What is the appropriate surgical management for caecal, ascending or proximal transverse colon cancer?

A

Right hemicolectomy

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48
Q

In haemorrhagic shock, at what blood loss does BP start to fall?

A

Doesn’t start to fall until around 30% of blood volume is lost (class III).

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49
Q

What class of haemorrhagic shock is BP reduced in?

A

III and IV

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50
Q

Symptoms of haemorrhagic shock in class I to IV?

A

I - normal
II - anxious
III - confused
IV - lethargic

51
Q

Blood loss in haemorrhagic shock in class I to IV?

A

I: <750ml
II: 750-1500ml
III: 1500-2000ml
IV: >2000ml

52
Q

What cancer marker may be raised in cholangiocarcinoma?

A

Ca 19-9

53
Q

What is a useful test for determining whether the cause of the isolated hyperbilirubinaemia is due to haemolysis or Gilbert’s syndrome?

A

FBC

54
Q

Mx of Bell’s palsy with eye involvement (i.e. patient unable to fully close eye)?

A

Prednisolone + eye care advice e.g. drops, lubricants and night time taping

55
Q

Mx of extensive otitis externa?

A

Flucloxacillin

56
Q

How can steroids affect neutrophils?

A

Can cause neutrophilia

57
Q

Which diabetic drug is contraindicated in HF?

A

Pioglitazone –> has been found to cause fluid retention and exacerbate heart failure

58
Q

Presentation of a pontine haemorrhage?

A

1) Reduced GCS
2) Paralysis
3) Bilateral pin point pupils

59
Q

What is diptheria?

A

A bacteria that commonly affects the throat, causing a sore throat with a ‘diphtheric membrane’ - grey, pseudomembrane on the posterior pharyngeal wall.

60
Q

What is Beck’s triad of cardiac tamponade?

A

1) Falling BP
2) Rising JVP
3) Muffled heart sounds

61
Q

In patients with an adenoma causing 1ary hyperparathyroidism who are not suitable for surgery, what is the management?

A

Cinacalcet –> a calcimimetic

This ‘mimics’ the action of calcium on tissues by allosteric activation of the calcium-sensing receptor.

62
Q

How is uptake of radioactive iodine-131 affected in De Quervain’s thyroiditis?

A

Reduced

63
Q

How is uptake of radioactive iodine-131 affected in Grave’s disease?

A

Globally increased uptake

64
Q

How is uptake of radioactive iodine-131 affected in a thyroid nodule?

A

Locally increased uptake

65
Q

Mx of a DVT with a Wells score of ≤1?

A

1) Arrange a D-dimer with result within 4 hours

if this is not possible (i.e. results are delayed)

2) Arrange a D-dimer + prescribe interim anticoagulation

66
Q

How soon after possible exposure should you test for HIV in asymptomatic patients?

A

4 weeks

67
Q

What type of diuretic can worsen glucose tolerance?

A

Thiazides

68
Q

What paraneoplastic syndrome is most commonly associated with squamous cell lung cancer?

A

PTHrP

69
Q

Mx of an acute ischaemic stroke in patients who present within 4.5 hours?

A

Alteplase + thrombectomy

70
Q

What is the goal of phases 0 to IV of a clinical trial?

A

0 –> Exploratory studies (involves a very small number of participants and aim to assess how a drug behaves in the human body i.e. pharmacokinetics and pharmacodynamics)

1 –> Safety assessment

2 –> Assess efficacy

3 –> Assess effectiveness

4 –> Postmarketing surveillance

71
Q

What type of organism is Trichomonas vaginalis?

A

Protozoa

72
Q

What is the typical presenting feature of a ductal papilloma?

A

Discharge from nipple (can be blood stained)

73
Q

What is pyoderma gangrenosum?

A

A rare, non-infectious, inflammatory disorder.

It is an uncommon cause of very painful skin ulceration.

Lower legs are most common site.

74
Q

Causes of pyoderma gangrenosum?

A

1) Idiopathic (50%)

2) IBD (10-15%): Crohn’s & UC

3) Rheum: RA & SLE

4) Haem: lymphoma, myeloid leukaemias, myeloproliferative disorders

5) Granulomatosis with polyangiitis

6) Primary biliary cirrhosis

75
Q

What implies a poor prognosis in HL?

A

1) Presence of B symptoms

2) Age >45

3) Stage IV disease

4) Hb <105

5) Male

6) WBC >15,000

76
Q

What cancer is Hashimoto’s thyroiditis associated with the development of?

A

MALT lymphoma

77
Q

Which type of medication are known to induce neutrophilia?

A

Corticosteroids

78
Q

What is the most common malignancy in renal transplant patients?

A

Skin cancer (particularly squamous cell) –> 2ary to immunosuppression.

79
Q

Pepperpot skull is a characteristic XR finding of what?

A

Hyperparathyroidisim

High circulating levels of PTH stimulate increased osteoclast activity. Increased uptake of trabecular bone leads to the formation of multiple small radiolucent lesions of the skull which gives the appearance of a pepperpot.

80
Q

What is a key contraindication of metformin?

A

CKD

  • Review if eGFR <45 or creatinine >130
  • STOP if eGFR is <30 or creatinine is >150
81
Q

When is SGLT-2 monotherapy indicated in diabetes?

A

If meformin is contraindicated AND has a risk of CVD, established CVD or chronic heart failure.

82
Q

What should be used for diabetes if metformin is contraindicated but the patient doesn’t have a risk of CVD, established CVD or chronic heart failure?

A

DPP-4 inhibitor or pioglitazone or a sulfonylurea

83
Q

Which diabetes drug can cause fluid retention?

A

Pioglitazone

84
Q

Which diabetes drug can cause SIADH?

A

Sulfonylureas e.g. gliclazide, glimepiride

85
Q

What class of drug is glimepiride?

A

Sulfonylurea

86
Q

What is key blood test to get in suspected pancreatitis?

A

1) Amylase/lipase

2) +/- G&S

3) Lactate

87
Q

Mx of patients treated with insulin who have good glycaemic control and are undergoing minor procedures?

A

Can be managed during the operative period by adjustment of their usual insuline regimen

88
Q

Mx of patients having surgery requiring a long fasting period of more than one missed meal, OR whose diabetes is poorly controlled?

A

Will usually require a variable rate IV insulin infusion (VRIII)

89
Q

Most patients taking only oral antidiabetic drugs may be managed by manipulating medication on the day of surgery, depending on the particular drug.

What are 3 exceptions to this?

A

1) if more than one meal is to be missed

2) patients with poor glycaemic control

3) risk of renal injury (e.g. low eGFR, contrast being used)

In such cases –> a VRIII should be used.

90
Q

Mx of patients on metformin prior to surgery:

1) day prior to admission
2) day of surgery (morning op)
3) day of surgery (afternoon op)

A

1) take as normal

2a) If taken OD or BD a day - take as normal
b) If taken TDS - omit lunchtime dose

3a) If taken OD or BD - take as normal
3b) If taken TDS - omit lunchtime dose

91
Q

Mx of patients on sulfonylureas prior to surgery:

1) day prior to admission
2) day of surgery (morning op)
3) day of surgery (afternoon op)

A

1) take as normal

2a) If taken OD in the morning - omit the dose that
day
b) If taken BD - omit the MORNING dose that day

92
Q

Mx of patients on SGLT-2 inhibitors prior to surgery:

1) day prior to admission
2) day of surgery (morning op)
3) day of surgery (afternoon op)

A

1) take as normal

2) omit on day of surgery

3) omit on day of surgery

93
Q

Mx of patients on once daily insulins prior to surgery:

1) day prior to admission
2) day of surgery (morning op)
3) day of surgery (afternoon op)

A

1) reduce dose by 20%

2) reduce dose by 20%

3) reduce dose by 20%

94
Q

Mx of patients on twice daily biphasic or ultra long acting insulins prior to surgery:

1) day prior to admission
2) day of surgery (morning op)
3) day of surgery (afternoon op)

A

1) no dose change

2) Halve the usual morning dose. Leave evening dose unchanged.

3) Halve the usual morning dose. Leave evening dose unchanged.

95
Q

What is the diagnostic threshold for gestational diabetes?

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

96
Q

Features of subacute degeneration of the spinal cord

A

1) dorsal column involvement:
- distal tingling/burning/sensory loss is symmetrical and tends to affect the legs more than the arms
- impaired proprioception and vibration sense

2) lateral corticospinal tract involvement:
- muscle weakness, hyperreflexia, and spasticity
- UMN signs typically develop in the legs first
- brisk knee reflexes
- absent ankle jerks
- extensor plantars

3) spinocerebellar tract involvement:
- sensory ataxia → gait abnormalities
- positive Romberg’s sign

97
Q

What condition does hypokalaemia associated with HTN point towards?

A

Primary hyperaldosteronism

98
Q

What condition should you suspect in patients with T2DM and/or obesity + abnormal LFTs?

A

NAFLD

99
Q

Acute vs chronic mesenteric ischaemia?

A

Acute –> typically caused by an embolism resulting in occlusion of an artery which supplies the small bowel e.g. the SMA.

Chronic –> ‘intestinal angina’, colickly, intermittent abdominal pain

100
Q

What do patients classically have a history of in acute mesenteric ischaemia?

A

AF

101
Q

Ischaemia to the lower GI tract can be separated into what 3 categories?

A

1) acute mesenteric ischaemia
2) chronic mesenteric ischaemia
3) ischaemic colitis

102
Q

What is the investigation of choice in bowel ischaemia?

A

CT

103
Q

What is ischaemic colitis?

A

An acute but transient compromise in the blood flow to the large bowel.

This may lead to inflammation, ulceration and haemorrhage.

104
Q

Where is ischaemic colitis most likely to occur?

A

‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries

105
Q

What is seen on AXR in ischaemic colitis?

A

‘thumbprinting’ may be seen on AXR due to mucosal oedema/haemorrhage

106
Q

Mx of alcoholic ketoacidosis?

A

IV saline 0.9% + thiamine

107
Q

What are 4 drugs that can cause SIADH

A

1) Carbamazepine

2) Sulfonylureas e.g. gliclazide

3) SSRIs

4) TCAs

108
Q

1st line investigation is TCA OD?

A

ECG –> if changes such as QRS widening are seen then IV bicarbonate should be given

109
Q

Why should flumenazil not be given in a mixed benzo + TCA OD?

A

The potential risk of doing this would be inducing a seizure given the coexistent TCA OD

110
Q

How to calculate alcohol units?

A

Per day;

alcohol units = volume (ml) x % /1000

111
Q

What are the 5 features that make up the ORBIT score?

A

1) Hb <130 g/L for males and < 120 g/L for females, or haemtocrit < 40% for males and < 36% for females (2)

2) Age >74 (1)

3) Bleeding history (GI bleeding, intracranial bleeding or haemorrhagic stroke) (2)

4) Renal impairment (GFR < 60 mL/min/1.73m2) (1)

5) Treatment with antiplatelet agents (1)

112
Q

What ORBIT score is ‘high risk’ for bleeding?

A

4-7

113
Q

What ORBIT score is ‘low risk’ for bleeding?

A

0-2

114
Q

What is the definitive diagnostic investigation for SBO?

A

Abdo CT

115
Q

What is the key risk factor for transient tachypnoea of the newborn (TTN)?

A

C-section

116
Q

Features of TTN?

A

Slightly raised RR and increased work of breathing.

All other obs normal.

117
Q

When does TTN present?

A

Within first few hours of birth

118
Q

In what 4 situations would you see hyaline casts in urine?

A

1) normal urine

2) after exercise

3) during fever

4) loop diuretics e.g. furosemide

119
Q

In what situation would you seen brown granular casts in the urine?

A

Acute tubular necrosis

120
Q

In what situation would you seen red cell casts in the urine?

A

Nephritic syndrome

121
Q

What should you check before starting azathioprine therapy?

A

Check thiopurine methyltransferase deficiency (TPMT).

TPMT deficiency is present in about 1 in 200 people and predisposes to azathioprine related pancytopaenia

122
Q

What does TPMT deficiency predispose to in azathioprine therapy?

A

azathioprine related pancytopaenia

123
Q

What is Asherman’s syndrome?

A

Intrauterine adhesions that may occur following dilation and curettage.

This may prevent the endometrium responding to oestrogen as it normally would –> 2ary amenorrhoea.

124
Q
A

Yr 4 - PassMed Corrections (36 decks)

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