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Finals Revision > 22/05 > Flashcards

22/05 Flashcards

1
Q

age of onset of west syndrome

A

4 to 8 months

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2
Q

prognosis of west syndrome

A

poor

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3
Q

features of west syndrome

A

salaam attacks

progressive mental handicap

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4
Q

describe salaam attacks

A

flexion of head, trunk and arms followed by extension of the arms

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5
Q

investigation in west syndrome

A

EEG= Hypsarrhythmia in two-thirds

CT demonstrates diffuse or localised brain diseases

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6
Q

management of west syndrome

A

vigabatrin 1st line

ACTH used

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7
Q

side effect of hydroxychloroquine

A

severe and permanent retinopathy

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8
Q

is hydroxychloroquine safe in pregnancy

A

yes if needed

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9
Q

GCS scoring

A

Motor response

  1. Obeys command
  2. localises to pain
  3. withdraws from pain
  4. abnormal flexion to pain (decorticate posture)
  5. extending to pain
  6. none

Verbal response

  1. orientated
  2. confused
  3. words
  4. sounds
  5. none

eye opening

  1. spontaenous
  2. to speech
  3. to pain
  4. none

TAKE THE BEST SIDE

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10
Q

DIC classical blood picture

A
  • thrombocytopenia
  • low fibrinogen
  • high PT & APTT
  • increased fibrinogen degradation products
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11
Q

in homeostatic condition coagulation and fibrinolysis are _____

A

coupled

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12
Q

what is the central proteolytic enzyme of coagulation

A

plasmin

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13
Q

the activation of the coagulation cascade yields ______ that converts fibrinogen to ____; the stable fibrin clot being the final product of hemostasis. The fibrinolytic system breaks down fibrinogen and fibrin. Activation of the fibrinolytic system generates _____ (in the presence of thrombin), which is responsible for the lysis of _____ clots. The breakdown of fibrinogen and fibrin results in ______ (fibrin degradation products).

A

the activation of the coagulation cascade yields thrombin that converts fibrinogen to fibrin; the stable fibrin clot being the final product of hemostasis. The fibrinolytic system breaks down fibrinogen and fibrin. Activation of the fibrinolytic system generates plasmin (in the presence of thrombin), which is responsible for the lysis of fibrin clots. The breakdown of fibrinogen and fibrin results in polypeptides (fibrin degradation products).

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14
Q

critical mediator of DIC

A

tissue factor

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15
Q

how does TF play an important role in DIC

A

TF is present on the surface of many cell types (including endothelial cells, macrophages, and monocytes) and is not normally in contact with the general circulation, but is exposed to the circulation after vascular damage. For example, TF is released in response to exposure to cytokines (particularly interleukin 1), tumour necrosis factor, and endotoxin.

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16
Q

what does TF do

A

bind with coagulation factors that trigger the intrinsic pathway of coagulation

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17
Q

what is the extrinsic pathway

A

tissue damage causing formation of TF:VIIIa complec activating factor X to factor Xa

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18
Q

what is the intrinsic pathway

A

This pathway is slower than the extrinsic pathway, but more important. It involves factors XII, XI, IX, VIII.

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19
Q

warfarin bloods

A

prolonged PT
normal APTT
normal bleeding time
normal platelet coun

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20
Q

aspirin bloods

A

normal PT time
normal APTT
prolonged bleeding time
normal platelet count

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21
Q

heparin bloods

A

prolonged PT time
prolonged PT time
normal bleeding time
normal platelet count

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22
Q

action of unfractionated heparin

A

activated antithrombin III
forms a complex that inhibits thrombin, factors Xa, Ixa,XIA, and XIIIa
stops fibrin formation and thrombin from activating factors V, VIII and XI

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23
Q

reversal of unfractionated heparin

A

protamine sulphate

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24
Q

platelet threshold for transfusion for patients with severe bleeding or bleeding at critical sites

A

< 100 x10(9) /L

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25
Q

using hypotonic (0.45%) in paediatrics

A

hyponatraemic encephalopathy

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26
Q

women aged > 30 with unexplained breast lump

A

suspected cancer- two week wait referral to the breast clinic

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27
Q

what is HSMN

A

hereditary sensorimotor neuropathy

encompasses charcot-marie-tooth disease

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28
Q

types of HSMN

A

type I: demyelinating pathology (CMT)

type II: axonal pathology

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29
Q

features of CMT

A
  • autosomal dominant
  • due to defect in PMP-22 gene (codes for myelin)
  • features start at puberty
  • motor symptoms predominate
  • distal muscle wasting, pes cavus, clawed toes
  • foot drop, leg weakness
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30
Q

sickle cell bloods

A

low Hb, normal MCV, raised reticulocytes

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31
Q

moderate asthma PEFR

A

50-70%

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32
Q

average patient who is taking metformin for T2DM,:
you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of __ mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to __ mmol/mol (7.5%)

A

48, 58

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33
Q

dietary advice in diabetes

A
  • high fibre
  • low GI sources of carbs
  • controlled intake of saturated fate & trans fatty acids
  • discourage foods marketed at diabetics
  • initial weight loss in overweight person 5-10%
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34
Q

HbA1c targets

A

lifestyle- 48mmol/mol (6.5%)
lifestyle + metformin - 48mmol/mol (6.5%)
any drugs causing hypo- 53mmol/mol (7.0%)

35
Q

management of diabetes needing medication

A
  • metformin

if HbA1c > 58

metformin + gliptin
metformin + sulfonylurea
metformin + pioglitazone
metformin + SGLT-2

if HbA1c > 58
triple therapy ; OR insulin

metformin + gliptin + sulfonylurea
metformin + pioglitazone + sulfonylurea
Metformin + sulfonylurea + SGLT-2 inhibitor
metformin + pioglitazone + SGLT-2 inhibitor

if this is not effective, not tolerated or contraindicated AND BMI still > 35
metformin + sulfonylurea + GLP-1 mimetic

36
Q

metformin not tolerated

A

gliptin OR sulphonylurea OR pioglitazone

if HbA1c > 58

gliptin + pioglitazone
gliptin+ sulfonylurea
pioglitazone + sulfonylyurea

then insulin

37
Q

names of sulfonylureas

A 
DiaBeta, Glynase, or Micronase (glyburide or glibenclamide)
Amaryl (glimepiride)
Diabinese (chlorpropamide)
Glucotrol (glipizide)
Tolinase (tolazamide)
Tolbutamide.
38
Q

The initial management of open fractures

A

administration of intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film.

The wound should only be handled to remove gross contamination.

The patient is then likely to require definitive skeletal and soft tissue reconstruction.

39
Q

Surgery / metformin on day of surgery:

A

Surgery / metformin on day of surgery:
OD or BD: take as normal
TDS: miss lunchtime dose
assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure

40
Q

Patients with a documented allergy to a sulfa drug (i.e. co-trimoxazole) should not take …

A

sulfasalazine

41
Q

In the BNF section ‘Prescribing in dental practice’ it advises that patients in this situation should….

A

continue taking anti-platelets as normal

42
Q

Chronic myeloid leukaemia treatment

A

tyrosine kinase inhibitor

43
Q

presentation of yellow fever

A

present in two phases where the patient experiences a brief remission in between

  • may cause mild flu-like illness lasting less than one week
  • classic description involves sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop. A brief remission is followed by jaundice, haematemesis, oliguria
  • if severe jaundice, haematemesis may occur
  • Councilman bodies (inclusion bodies) may be seen in the hepatocytes
44
Q

associations with mitral valve prolapse

A 
congenital heart disease: PDA, ASD
cardiomyopathy
Turner's syndrome
Marfan's syndrome, Fragile X
osteogenesis imperfecta
pseudoxanthoma elasticum
Wolff-Parkinson White syndrome
long-QT syndrome
Ehlers-Danlos Syndrome
polycystic kidney disease
45
Q

features of mitral valve prolapse

A

patients may complain of atypical chest pain or palpitations
mid-systolic click (occurs later if patient squatting)
late systolic murmur (longer if patient standing)
complications: mitral regurgitation, arrhythmias (including long QT), emboli, sudden death

46
Q

Malaria prophylaxis (e.g. primaquine) can trigger ….

A

haemolytic anaemia in those with G6PD deficiency

47
Q

features of G6PD deficiency

A 
Features
neonatal jaundice is often seen
intravascular haemolysis
gallstones are common
splenomegaly may be present
Heinz bodies on blood films. Bite and blister cells may also be seen
48
Q

clues which point towards a diagnosis of motor neuron disease

A

fasciculations
the absence of sensory signs/symptoms*
the mixture of lower motor neuron and upper motor neuron signs
wasting of the small hand muscles/tibialis anterior is common

49
Q

Ciclosporin side-effects

A

everything is increased - fluid, BP, K+, hair, gums, glucose

50
Q

view demyelinating lesions

A

MRI with contrast should be used to view demyelinating lesions

51
Q

spasticity in MS

A

Baclofen and gabapentin

52
Q

left homonymous hemianopia

A

visual field defect to the left, i.e. Lesion of right optic tract

53
Q

homonymous quadrantanopias

A

PITS (Parietal-Inferior, Temporal-Superior)

54
Q

incongruous defects

A

optic tract lesion; congruous defects = optic radiation lesion or occipital cortex

55
Q

NICE advise that, as PSA levels may be increased, testing should not be done within at least:

A 
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
56
Q

Turner’s syndrome murmur

A

is associated with an ejection systolic murmur due to bicuspid aortic valve

57
Q

Cerebellar hemisphere

A

finger-nose ataxia

58
Q

Basal ganglia

A

Hypokinetic (e.g. Parkinsonism) or hyperkinetic (e.g. Huntington’s)

59
Q

Parietal lobe

A

sensory symptoms, dyslexia, dysgraphia

60
Q

Frontal lobe

A

motor symptoms, expressive aphasia, disinhibition

61
Q

Cerebellar vermis lesions

A

gait ataxia

62
Q

feature of optic neuritis

A

central scotoma

63
Q

Prostate cancer - more common in

A

afro-carribean population

64
Q

cause of aplastic crisis

A

parvovirus

65
Q

required by patients with beta-thalassaemia major

A

Lifelong blood transfusions

66
Q

most common presentation of neonatal sepsis

A

Grunting and other signs of respiratory distress

67
Q

Loss of corneal reflex

A

think acoustic neuroma

68
Q

Osteoporosis is commonly associated with _____ blood test values (e.g. _____ ALP, ____ calcium, _____ phosphate, ____ PTH)

A

Osteoporosis is commonly associated with normal blood test values (e.g. normal ALP, normal calcium, normal phosphate, normal PTH)

69
Q

contraindicated with any form of cardiovascular disease

A

diclofenac

70
Q

criteria for liver transplantation

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

71
Q

Complications of Transurethral Resection: TURP

A

T ur syndrome
U rethral stricture/UTI
R etrograde ejaculation
P erforation of the prostate

72
Q

A _______ should be requested in those with multiple episodes of loss of consciousness with quick recovery times

A

24 hr ECG

73
Q

Severe asthma RR

A

> 25/min

74
Q

eGFR variables

A

CAGE - Creatinine, Age, Gender, Ethnicity

75
Q

Once an ischaemic stroke is confirmed the patient should be given …..

A

aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term.

A statin should also be offered if the patient is not already on statin therapy.

76
Q

how to know if chest drain is in pleural cavity

A

Rises in inspiration, falls in expiration

77
Q

late sign of cauda equina

A

urinary incontinence

78
Q

who gets leptospirosis

A

sewage workers, farmers, vets or people who work in an abattoir
however, on an international level, leptospirosis is far more common in the tropics so should be considered in the returning traveller

79
Q

features of leptospirosis

A

the early phase is due to bacteraemia and lasts around a week
>may be mild or subclinical
>fever
>flu-like symptoms
>subconjunctival suffusion (redness)/haemorrhage

second immune phase may lead to more severe disease (Weil’s disease)
>acute kidney injury (seen in 50% of patients)
>hepatitis: jaundice, hepatomegaly
>aseptic meningitis

80
Q

investigation of leptospirosis

A
  • serology: antibodies to Leptospira develop after about 7 days
  • PCR
  • culture
    > growth may take several weeks so limits usefulness in diagnosis
    -blood and CSF samples are generally positive for the first 10 days
    -urine cultures become positive during the second week of illness
81
Q

management of leptospirosis

A

high-dose benzylpenicillin or doxycycline

82
Q

irregular broad complex tachycardia

A

senior help

83
Q

IV adenosine needs to be infused via ….

A

IV adenosine needs to be infused via a large-calibre vein or central route

Finals Revision (29 decks)

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