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Year 4 > General Medicine > Flashcards

General Medicine Flashcards

1
Q

Pleural Decompression

A

Second intercostal space

Mid clavicular line

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2
Q

Insulin Delivery in DKA

A

= fixed rate IV insulin at 0.1 units/kg/hour

e.g. 60kg = 6 units/hour

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3
Q

Difference between aortic sclerosis VS stenosis on auscultation

A

Sclerosis has no radiation of murmur to carotids and a normal ECG

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4
Q

U waves

A

= small deflection after T wave

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5
Q

U waves are a sign of

A

Hypokalaemia

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6
Q

Complication in fluid resuscitation in DKA (kids)

A

Cerebral oedema

Can result in seizures

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7
Q

BiPAP =

A

Non-invasive ventilation

Considered in unresponsive acidosis in COPD

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8
Q

Lung cancer associated with hypercalcaemia

A

Squamous lung cell carcinoma

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9
Q

MAP needed to maintain cerebral perfusion

A

65 mmHg

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10
Q

Treatment of PCP

  • Normal
  • Allergic
A
  1. Co-trimoxazole

2. Atovaquone

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11
Q

Differential for SVC syndrome

A

Lymphoma until proven otherwise

Testicular cancer also considered

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12
Q

Management of HHS

A

Calculate osmolality to monitor treatment response
Use IV saline 0.9%
Use low dose insulin (0.05 units/kg/hour) if BM not responding to IV fluids

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13
Q

Difference between acute and chronic respiratory acidosis

A

Look at bicarbonate
Normal = acute respiratory acidosis
High = chronic respiratory acidosis

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14
Q

Oxygen and ABG

A

If someone is on oxygen you would expect pO2 to be 10 less than % of oxygen
e.g. 60% oxygen, pO2 = 50

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15
Q

Which view enlarges the heart?

A

AP (beams front > back)

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16
Q

Cause of dextrocardia

A

Primary ciliary dyskinesia

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17
Q

Cause of air in the mediastinum

A

Oesophageal rupture

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18
Q

Causes of ‘globe’ heart on CXR

A

Dilated cardiomyopathy

Cardiac tamponade/pericardial effusion

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19
Q

Appearance of CXR

Post-Pneumonectomy

A

Fluid accumulates to fill the space

See a total whiteout

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20
Q

Big 3 in Chest Pain

A

ACS
Aortic - dissection, aneurysm
Pulmonary Embolism

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21
Q

Broad QRS in V1

A 
Up = RBBB
Down = LBBB
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22
Q

Biochemical presentation of rhabdomyolysis

A

Raised CK

AKI

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23
Q

Normal electrolyte maintenance

A

1mmol/kg of potassium, sodium and chloride

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24
Q

Hormones released by anterior pituitary

A 
FSH
LH
TSH
ACTH
Prolactin
Growth Hormone
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25
Q

Hormones released by posterior pituitary

A

Oxytocin

ADH

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26
Q

Mineralocorticoids are…

A

Aldosterone

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27
Q

Glucocorticoids are…

A

Cortisol

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28
Q

Management of Grave’s Eye Disease

A

Oral steroids

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29
Q

Assessment of iodine uptake

A

Technetium scanning

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30
Q

Conception advice for radioactive iodine

A

Can’t conceive for 6 months afterwards

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31
Q

Presentation of Thyroid Storm (5)

Association

A 
High temperatures (++) 
Tachycardia 
Congestive Heart Failure 
Extreme Anxiety 
Seizures 
Association: under-treated or undiagnosed hyperthyroidism
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32
Q

Management of Thyroid Storm (3)

A

B blockers
PTU
Hydrocortisone
- Can give iodine to saturate the gland

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33
Q

Sheehan’s Syndrome

A

= infarction of the pituitary due to a drop in blood pressure
Often used in the context of PPH

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34
Q

Myxoedema Coma =

A

= decompensated hypothyroidism

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35
Q

Treating hyperthyroidism in pregnancy

A

PTU is best

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36
Q

Imaging of small bowel

A

Capsule endoscopy

MRI of small bowel

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37
Q

Consideration in acute GI bleed

A

IV PPI e.g. omeprazole

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38
Q

Consideration in acute GI bleed (liver stigmata)

A

Terlipressin

AGM - prevent spontaneous bacterial peritonitis

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39
Q

Ion required for PTH release or action

A

Magnesium

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40
Q

Medications causing hypercalcaemia

Association

A

Lithium, vitamin D, thiazides

Association: short QT syndrome

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41
Q

Management of Hypercalcaemia

A

Fluids

Bisphosphonates - especially in hypercalcaemia associated with malignancy

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42
Q

Biggest risk factor for AF

A

Hypertension

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43
Q

Rate Limiting Drugs (AF)

A

Bisoprolol
Verapamil
Diltiazem
Digoxin

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44
Q

Rhythm Limiting Drugs (AF)

A

Fleccanide

Amiodarone

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45
Q

Orthostatic Hypotension

Classification

A 
Primary = Parkinson's, MS 
Secondary = Diabetes
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46
Q

Features of Epileptic Seizure

A 
Tongue Biting 
Jerking 
Posturing
Post-Ictal Confusion 
Deja Vu
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47
Q

Bad Features of Palpitations (4)

A

Prolonged
Associated with chest pain
Exertional palpitations
FH/high risk of structural heart disease

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48
Q

Screening tool for Heart Failure

A

BNP

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49
Q

Management of Heart Failure

A 
Sit up 
Oxygen 
IV Furosemide
Morphine 
Consider IV GTN and role of CPAP
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50
Q

Difference between CAP and LRTI

A

CAP can only be confirmed on CXR

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51
Q

Steroid dose in infective exacerbation of COPD

A

30mg oral prednisolone

52
Q

Complication of ipratropium

A

Acute angle glaucoma

53
Q

Warfarin reversal in intracerebral haemorrhage

A

Stop warfarin
IV Vitamin K
PCC - prothrombin concentrate complex

54
Q

Target INR in Atrial Fibrillation

A

2.5

55
Q

Target INR in VTE

A

2.5

56
Q

Target INR in VTE whilst on anti-coagulation

A

3.5

57
Q

Target INR in Mechanical Aortic Valve

A

3

58
Q

Medical Management in TIA

A

Antiplatelets (Aspirin + Clopidogrel)
Statin
Anti-Hypertensives

59
Q

Supply of:

  • AV node
  • Apex
A

AV node = posterior interventricular artery

Apex = anterior interventricular artery

60
Q

S/E of adenosine (2)

A

Chest tightness

Bronchospasm

61
Q

S/E of sotalol

A

Torsades de Pointes

62
Q

Papillary muscle rupture in MI can result in what?

A

Acute mitral regurgitation

63
Q

Pain in Diabetic Neuropathy

A

Amitriptyline or Duloxetine

64
Q

Management of Post-Partum Thyroiditis

A

Propranolol

Not PTU or carbimazole

65
Q

Diuretic in Chronic Heart Failure

A

Use spironolactone

Consider furosemide where ejection fraction is preserved or in acute decompensations

66
Q

Medication given before PCI

  • Normal
  • Already on anti-coagluation
A

Prasugrel

On A-C = clopidogrel

67
Q

Verapamil

  • Heart Rhythm C-I
  • Other Drug C-I
A

Heart Rhythm = ventricular tachycardia

Drug = don’t use with B-blocker, increased risk of heart block

68
Q

Requirement for Cardioversion in AF

A

Need to within 48 hours of symptoms OR anti-coagulated for at least three weeks

69
Q

Reversing respiratory depression as a result of magnesium sulphate

A

Calcium gluconate

70
Q

Management of Hypophosphataemia

  • Mild/Moderate
  • Severe
A

Mild/Moderate (0.32-0.8) = oral replacement

Severe (<0.32) = IV infusion

71
Q

Anti-coagulation in Anti-Phospholipid Syndrome

A

Use warfarin

72
Q

Management of pericarditis

A

NSAIDs

e.g. naproxen or colchicine

73
Q

Liver enzymes suggesting alcoholic liver disease

A

AST > ALT

74
Q

Why do we need to dialyse slowly?

A

Disequilibrium Syndrome

= can get cerebral oedema if correct too soon or quickly

75
Q

Management of Glomerulonephritis (AB +VE) (3)

A
  1. Plasma exchange = dump the antibodies
  2. IV Methylprednisolone then PO Prednisolone
  3. Often followed by pulses of Cyclophosphamide
76
Q

Medications needed when on Cyclophosphamide and Prednisolone (3)

A

Co-trimoxazole = PCP protection
Alfacalcidol and Calcichew = bone protection
Lansoprazole = GI bleeding

77
Q

Causes of normal anion gap acidosis (3)

A

Diarrhoea
High out put Ileostomy
Tubular Acidosis

78
Q

Causes of raised anion gap acidosis

A 
M - methanol 
U - uraemia 
D - diabetic ketoacidosis 
P - paraldehyde 
I - iron or isonazid 
L - lactic acidosis 
E - ethylene glycol 
S - salicylates e.g. aspirin
79
Q

Anion Gap Calculation

A

Na+ - (Cl- + HCO3-)

In raised gap, looking at either increased sodium or reduced bicarbonate

80
Q

Types of Lactic Acidosis

- Type seen with Metformin

A 
A = overproduction of lactate e.g. shock 
B = normal production, problem with metabolism

In metformin get a type B lactic acidosis

81
Q

Three ECG Changes associated with Hyperkalaemia

A

Prolonged PR interval
Absent P waves
Tall tented T waves

82
Q

Immunosuppression given in Renal Transplant (3)

A

Prednisolone
MMF - anti-proliferative
Tacrolimus

83
Q

Sick day rules with steroids and renal transplant

A

Need to double prednisolone dose

84
Q

Prophylaxis of CMV in Renal Transplant

A

Valganciclovir

85
Q

Presentation of CMV (5)

A 
Mouth ulcers 
Retinitis
Leukopaenia 
Diarrhoea 
Meningitis
86
Q

BV Virus =

A

Found in uroepithelial tissue, can track up to the glomerular tissue and cause a glomerulonephropathy
Signs = raise in creatinine is all you will see

87
Q

Threshold for Urgent Treatment of Hypercalcaemia

A

> 3.5

= use fluids +/- bisphosphonates (strongest evidence in hypercalcaemia caused by malignancy)

88
Q

Management of severe hypernatraemia (>170)

A

Use 5% glucose, unless volume depleted then use 0.9% saline

89
Q

Rate of correction of hypernatraemia

A

No greater than 10mmol/24 hours

90
Q

Rate of correction of hypokalaemia

A

No greater than 10mmol/hour

91
Q

Low Sodium

- Next step and causes

A

Plasma osmolality
High = think about urea and glucose
e.g. hyperglycaemia, urea

Normal = alternative/weird causes
e.g. paraproteinaemias, hyperlipidaemia

Low = consider the urine sodium and urine osmolality
If there is a hyponatraemia, then the kidneys SHOULD be conserving sodium
= urine osmolality low
Also need to consider the fluid status

92
Q

Presentation of Iron Toxicity (5)

  • Natural course of Iron Toxicity
  • Management
A 
Vomiting 
Diarrhoea
Abdominal Distension 
Bowel Perforation 
Liver Failure

Course = gets initially better before a deterioration (iron absorbed into the mitochondria), then see a metabolic acidosis and hypoglycaemia

Management = parenteral desferrioxamine

93
Q

GLP1 analogues name
VS
DPP4 inhibitors name

A

GLP-1 = tides
e.g. exanatide

DPP-4 = gliptins
e.g. sitagliptin

94
Q

Coeliac Disease + Symptoms of Malignancy

A

Enteropathy associated T cell lymphoma

95
Q

Phosphate and PTH

A

PTH promotes the excretion of phosphate via the kidneys

96
Q

Artery supplying the AV node

A

Right coronary artery

via the posterior interventricular artery

97
Q

Indication for dialysis in AKI

A

If pulmonary oedema (amongst other things)

98
Q

2nd Line Management for Angina

A

B blocker + Dihydropyridine CCB

e.g. nifedipine, amlodipine

99
Q

Dihydropyridine CCB =

A

Nifedipine

Amlodipine

100
Q

Associations with Thiazolidinediones (3)

A

Increased fracture risk
Associated with bladder cancer
Weight gain

101
Q

Mechanism of VTE in Nephrotic Syndrome

A

Loss of antithrombin III + others through the glomerular basement membrane in nephrotic syndrome

102
Q

Presentation of Haemochromatosis

- Mechanism

A

Hypogonadism

= excess iron deposition in pituitary cells reduces the secretion of FSH and LH

103
Q

IgA Nephropathy also called…

A

Berger’s Disease

104
Q

Test for Bacterial Overgrowth

A

= H breath test

Treat with tetracyclines

105
Q

H breath test positive =

A

= bacterial overgrowth

106
Q

Discrete lesion seen on endoscopy

Haematemesis but no concerning features =

A

= gastrointestinal stromal tumour

107
Q

Daily glucose requirements

A

50-100g per day

Doesn’t matter how much they weigh

108
Q

Cause of peritonitis in peritoneal dialysis

A

Staph epidermidis

109
Q

Measure of adequacy of dialysis

A

Urea

110
Q

SIADH Presentation (4)

A

Small volumes of urine
Altered mental status
Seizure
Coma

111
Q

Association of Zollinger-Ellison Syndrome

A

MEN 1

112
Q

What is Trosseau Syndrome?

A

Thrombosis in strange places

Can be a paraneoplastic syndrome

113
Q

Consequence of chronic atrophic gastritis

A

Megaloblastic anaemia

Pernicious anaemia

114
Q

Association with H. pylori

A

Primary gastric lymphoma = MALT

115
Q

How does CKD cause osteomalacia?

A

The high phosphate in CKD draws calcium out of bones
Vitamin D deficiency due to CKD
= osteomalacia

116
Q

Pathogen seen in bronchiectasis

Association

A

Pseudomonas

Can be seen in autoimmune conditions e.g. rheumatoid arthritis, ulcerative colitis

117
Q

Management of minimal change disease

A

Oral steroids

118
Q

Acute interstitial nephritis

Finding

A

Eosinophils

119
Q

How does calcium resonium work?

A

Removes potassium from the body

VS insulin - drives the potassium into the cells

120
Q

What would make someone unsuitable for peritoneal dialysis?

A

Previous abdominal surgery or conditions e.g. IBD

121
Q

Management of nephrogenic diabetes insipidus

A

Use a thiazide diuretic

122
Q

Urea and creatinine in dehydration

A

See a greater increase in the urea vs creatinine (proportionally)

123
Q

Association of Theophylline

A

Can cause cardiac arrhythmias

Has a narrow therapeutic window

124
Q

Diagnosis of Diabetes

  • Random blood glucose
  • Fasting blood glucose
A 
Random = >11.1
Fasting = >7
125
Q

Murmur heard in Dressler’s Syndrome

A

Pericardial rub

= heard loudest on leaning forward

126
Q

Management of Starvation Ketoacidosis (Alcoholic)

A
  1. Thiamine
  2. IV dextrose
    Need to give thiamine first as glucose can result in Wernicke’s encephalopathy

Year 4 (27 decks)

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