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Year 3 difficult topics > 16/05/22 > Flashcards

16/05/22 Flashcards

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1
Q

heart failure management

is oxygen given? if so when/why

A

Iv loop diuretics
only when sats are below 94%
nitrates- ONLY if not aortic stenosed or hypotensive

cpap

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2
Q

HF when in hypotension?
management
why does it happen?

A

drugs like loop diuretics and nitrates can make things worse

give inotropic agents: dobutamine

vasopressor agent: norepinephrine

mechanical assistance: intra aortic balloon

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3
Q

what regular meds can be continued in HF?

A

beta blockers
acei
but beta blockers stop if HR <50

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4
Q

chronic HF mx

1st line
if preserved ejection fraction?

2nd line- what needs to be monitored at this point?

A

1- acei and beta blocker

2- spironolactone - K+ risk of hyperkalaemia

3-digoxin

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5
Q

what can better outcome in heart failure

A

implantable cardioverter device as risk of death from arrythmias

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6
Q

pleural aspiration

A

21g needle and 50ml syringe

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7
Q

lights criteria
exudate?
transudate

A

have a protein level of >30 g/L

25-35 g/L

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8
Q

exudative causes of pleural effusion

these increase the capillary permeability

A

infection such as pneumonia or TB
malignancy: mesothelioma/ lung cancer

inflammatory cause: RA, lupus

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9
Q

if a pneumonia caused a pleural effusion what would the aspiration be
protein?
LDH

A

pleural fluid : protein ratio >0.5
pleural fluid to serum LDH >0.6
ldh >2/3

as this would be an exudative cause of effusion

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10
Q

what is a transudative cause of a pleural effusion?

A

this is when interstitial fluid is imbalanced due to starling forces

like conditions that increase cap hydrostatic pressure
congestive HF

or cap oncotic pressure is reduced like cirrhosis, nephrotic syndrome / coeliac

HF is the most common cause

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11
Q

guidelines for pneumothorax

when can you discharge?

A

rim of air <2cm

and NOT breathless

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12
Q

if a pneumothorax is 3cm on a 25yr old and he is sob ?

A

aspiration attempt

then chest drain

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13
Q

when do you put a chest drain for a pneumothorax straight away?

A

> 50yrs and secondary >2cm and SOB

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14
Q

when do you admit and give oxygen over 24hours if pneumothorax rim is 1cm?

A

if secondary

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15
Q

complications of pneumothorax

A

fitness to fly
2 weeks after a successful

1 week post xray

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16
Q

testicular torsion of appendage

A

Testicular appendage torsion is the twisting of a small piece of tissue above a testicle. The appendage doesn’t have a function in the body. But it can twist and cause pain and swelling that gets worse over time. It is not the same as testicular torsion

blue dot is signifying

tender nodule with blue discoloration on the upper pole of the testis

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17
Q

what drugs are commonly used to treat UTI?

and what are the common side effects?

A

nitrofuntein- pulmonary fibrosis

trimethopram - folate metabolism so avoid in first trimester

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18
Q

lung nodule
diarrhoea
facial flushing
asthma

what Ix ?

A

urinary 5-HIAA excretion

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19
Q

what type of lung nodules does RCC present with?

A

cannon ball mets

in whihc case EPO

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20
Q

nicotine replacement

if pregnant?

A

NRT / varencline/ buproprion

NRT only

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21
Q

prescription for NRt??

A

2 weeks after stop date

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22
Q

prescription for buproprion / varencline

end date ?

A

3-4 weeks

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23
Q

which is most effective smoking cessation drug?

A

varenicline

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24
Q

acute asthma attack what abg finding is most alarming and requires escalation?

A

normal Paco2 as it indicates exhausation

life threateneing asthma

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25
what should you give when giving salbutamol? in an asthma attack?
potassium IV 20mmol / 6 hours | as salbutamol drives K+ into cells
26
how can you treat deteriorating acute asthma patients further?
IV magnesium IV salbutamol/ theophylline ventillatory support
27
life threatening asthma?
``` PEFR < 33% best or predicted Oxygen sats < 92% Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma ```
28
haemopytsis differential | saddle nose/ flat nose
granulomatosis with polyangitis
29
haemoptysis with glomerulonephritis | differentials?
good pastures - systemically unwell, nauses | Granulomatois with polyangitis - saddle nose, URT signs
30
30-49% fev1 | copd stage?
severe | 3
31
what is very severe stage 4 copd?
fev1 <30%
32
SCLC associated with which endocrine with neuro condition?
acth and adh hypokalaemia, hyponatraemia, cushings lambert eaton syndrome
33
In MG why is it important to do one imaging?
CT because it presents with thymoma anterior mediastinal mass.
34
what causes nephrotic syndrome inchildren - affects eyes; bitemporal periorbital oedema
minimal change disease - non proliferative glomerulonephritis
35
what joints are spared in RA? | what deformaties occur
distal interphalangeal joints radial deviation of wrist z deformaty thumb swan neck boutonniere and trigger finger
36
what causes ataxia?
finger to nose ataxia is caused by cerebeller hemisphere lesion
37
headache dull fever down and out eye with nausea and seizure on fundoscopy - pappiloedema seen what mx?
brain abscess? due to focal neurology signs of infection - fever and raised ICP dexamethasone cepholosporin and metronidazole
38
presents with hand weakness and inability to use the fingers on associated hand 24hours strong association with hypertension common sites include the basal ganglia, thalamus and internal capsule
lacunar stroke
39
Ipsilateral: facial pain and temperature loss Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus
posterior inferior cerebellar artery
40
what happens with a brainstem stroke?
Brainstem infarction | may result in more severe symptoms including quadriplegia and lock-in-syndrome
41
nause and vomiting decrease in. conciousness headache seizure is more common in what type of stroke
Brainstem infarction | may result in more severe symptoms including quadriplegia and lock-in-syndrome
42
criteria for thrombolysis
no haemorrhages - no hyperdensity >4.5 always give 300mg of aspirin
43
when is an urgent neuro assemenet required within 24 hours when within 7 days? TIA
if tia within 7 days is outside of 7 days
44
in a stroke a contrast CT head is done T/F?
false | non contrast
45
typically show areas of hyperdense material (blood) surrounded by low density (oedema)
haemorrhagic stroke
46
what is Rosier used for
stroke
47
how long after ischaemic stroke can AF medication be started?
14 days
48
Offer thrombectomy between 6 hours and 24 hours?
confirmed occlusion of anterior. circ and limited infarct core volume
49
offer thrombectomy - 6 hours
with alteplase if within 4.5hrs or 6 hours alone if proximal anterior circulation CTA / MRA
50
when can you consider thrombectomy if its within 24 hours
basilar / posterior cerebral artery | limied infarct core volume
51
when is a carotid artery endarterectomy recommended
should only be considered if carotid stenosis > 70% according ECST** criteria or > 50% if symptomatic
52
sudden transient loss of vision in one eye
(amaurosis fugax) TIA sign
53
PT has SLE presents with a DVT on examination has a mottled lace like appearance of skin recently had a miscarriage on blood results there is thrombocytopenia CLOT
``` antiphospholipid syndrome Clots Livedo reticularis Obstetric loss Thrombocytopenia ```
54
what IX confirms anti phospholipid syndrome?
anti cardiolipin anti beta2GPI lupus - anti dsdna , ana
55
Nicotinic acid deficiency pt presents with dermatitis, diarrhoea, dementia brown scaly rash on sun-exposed sites - termed Casal's necklace if around neck what TB drug can also cause this?
pellagra vit b3 deficiency isoniazid carcinoid syndrome can also cause this
56
how is carcinoid tumour investigated?
urinary 5 HiAA
57
what causes glossitis
b12 deficiency - pernicious anaemia
58
embryo sign? obstructed bowel defn
caecum volvulus | stomach or loop of bowel twist on its own mesentery
59
Coffee bean sign?
sigmoid volvulus | stomach or loop of bowel twist on its own mesentery
60
in raised ICP you get cushings reflex what is the criteria?
bradycardia hypertension weird breathing
61
complete heart block JVP sign?
a wave is increased
62
adenosine? what is the one side effect to warn pt of?
to restore rhythm in supraventicular tachycardia 3mg this is emergency if haemodynamically stable then vagal moves first chest pain as they already have it so might think theyre getting worse
63
what is flucloxacillin used for?
soft cell and tissue infection eg cellulitis treats staph aureus as it is gram +
64
RA spares what part of spine?
thoracic and lumbar | it only affects the C part
65
what is the most common se of dialysis ?
dialysis induced hypotension
66
how should you image prostate? first line?
MRI
67
what electrolyte is an indicator of pancreatitis severity
calcium hypocalcaemia hypercalcaemia can cause pancreatitis
68
HF medication step wise
acei beta blocker add hydrazalineif acei not possible 2) loop diuretics furesomided/ bumetanide 3)spironolactone / epelerone hydrazaline and a nitrate - if afro-caribbean ivabradine - sinus rhythm and impaired ejection fraction arb 4) digoxin
69
when is cardiac resynchronistaion indicated?
``` QRS interval <120ms, high risk sudden cardiac death, NYHA class I-III QRS interval 120-149ms without LBBB, NYHA class I-III QRS interval 120-149ms with LBBB, NYHA class I ```
70
what is medium sized AAA? what is guideline ?
4.5-5.4 | repeat ultrasound 3 months
71
high risk of rupture of AAA?
>5.5 | surgery within 2 weeks
72
low risk of AAA rupture but repeat ultrasound yearly?
3-4.4cm
73
when is there no need to repeat uss for AAA
if it is less than 3cm | normal
74
what immune conditions are risk factors for PE?
anti phospholipid syndrome | factor V leiden
75
what is a sign of sub massive PE?
right heart strain
76
what is a sign of massive PE?
hypotension | IV fluids <90
77
mx of massive PE? when is embolectomy indicated?
IV alteplase DOAC - apixaban massive PE with thrombolysis contraindicated
78
wells score of 4?
PE unlikely arrange a d dimer if + CTPA > interim doac if - consider alternative
79
wells score of 5?
PE likely CTPA doac in interim if ctpa - consider DVT uss
80
when is V/Q scan preferred
renal impairment and pregnancy
81
what is an insulinoma? | how to Ix?
functional neuroendocrine tumour of pancreas 72hour fast at moment of true hypoglycaemia - measure plasma insulin and pre insulin and ketones
82
has chronically swollen feet and ankles for the last 10 years. X-rays demonstrate destruction and deformities of the joints, mainly affecting the tarsometatarsal joints. The bones are dense and there is limited sensation in a glove and stocking distribution. What is the most common aetiology underlying this presentation?
diabetes this is charcots arthropathy
83
sore throat treated in 18yr old presents week later with rash what is the rash called? what has happened?
amoxicillin given and pt has EBV - morbilliform eruption
84
Autoimmune hepatitis serology?
anti smooth muscle ab | and ana
85
lft raised ALT and bilirubin with midly raised alp igG hypergammaglobulinaemia 14yr pt has PMHx graves?
``` autoimmune hepatitis palpable liver edge fatigue loss of appetite splenomegaly ```
86
PR interval prolongation on ecg pt has splinter haemorrhage osler nodes and janeway lesions and a new murmur
in a patient with Infective Endocarditis this is an indication for surgery as it can be secondary to aortic root abscess
87
if a pt with variceal bleed must take an NSAID say for RA which one is best?
celocoxib
88
coagulase - staphylococci | which abx?
vancomycin - this is nephorgenic however
89
Upper GI series may show the 'string sign of Kantour
crohns | narrowed terminal ileum
90
peri-anal abscess mx?
ceftriaxone + metronidazole. | under anaesthetic and incision and drainage.
91
crohns cx peri-anal fistulae what complication do you want to avoid?
seton drainage trans sphincteris fistuale division of anal sphincter and incontinence
92
perianal pain and swelling no bleeding fluctuant peri anal swelling PR not tolerated what is this? mx?
anorectal abscess | early drainage- surgical immediately LA
93
reinfarct MI diagnostic serum marker? why?
CK MB clear 72hours more than 3x upper limit indicative troponin remains high for 2 weeks
94
tall tented t waves and a VBG showing hyperkalaemia nausea vomiting, disturbance in colour vision and palpitations how do you manage
digoxin toxicity give digiband
95
what antibodies associated with psoriatic arthritis?
none - it is seronegative
96
RA abx?
anti ccp
97
causes of a long QT interval? | TIMMES
``` toxins- anti arrhythmatics tricyclin inherited: lange nielson ischaemia myocarditis mitral valve prolapse electrolyte imbalance :hypokalaemia/hypocalcaemia subarachnoid haemorrhage ```
98
salmonella and shigella treated with?
ciprofloxacillin
99
camplylobacter?
macrolide - erythromycin
100
cholera mx?
tetracycline
101
high SAAG | what does this mean?
``` cirrhosis HF budd chiari constrictive pericarditis hepatic failure raised portal pressure forcing water into peritoneal cavity whilst albumin remains in vessels = high {difference} between serum and ascitic fluid ```
102
low saag causes?
Causes of a low SAAG (<1.1g/dL) ``` biliary leak Cancer of the peritoneum Tuberculosis and other infections Pancreatitis Nephrotic syndrome ```

Year 3 difficult topics (22 decks)

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