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April Flashcards

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1
Q

Differentials for patient presenting as Manic

A 
Hypomania
Bipolar Affective disorder
Anxiety Spectrum Disorder
Anorexia nervosa
Hyperthyroidism
Phaeochromocytoma
Drug induced psychosis from illicit substance
Cerebral infection/tumour/autoimmune encephalitis
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2
Q

Which mood stabilisers are teratogenic?

A

Valproate

Carbamazepine

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3
Q

When does NICE recommend long term lithium treatment?

A

A manic episode involving significant risk and adverse consequences

Bipolar Type 1 disorder with 2 or more acute episodes

Bipolar Type 2 disorder with significant functional impairment or risk

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4
Q

First Rank Symptoms

A 
ABCD
A- Auditory hallucinations
B- thought Broadcasting
C- Controlled thought (delusions of control)
D- Delusional perception
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5
Q

Typical antipsychotics

A

Haloperidol

Chlorpromazine

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6
Q

Atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine

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7
Q

Consequences of hyperprolactinaemia

A 
Galactorrhea.
Menstrual irregularities.
Sexual dysfunction.
Osteoporosis.
Increased risk breast cancer.
Serum Prolactin levels should be checked if any pt reports such symptoms.
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8
Q

Vitamin C deficiency signs

A

gingivitis, loose teeth
poor wound healing
bleeding from gums, haematuria, epistaxis
general malaise

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9
Q

What type of bilirubinaemia is caused by Gilbert’s

A

UNCONJUGATED HYPERBILIRUBINAEMIA

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10
Q

Which drugs causing drug-induced liver disease give a hepatocellular picture?

A 
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
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11
Q

Which drugs causing drug-induced liver disease give a cholestatic picture?

A

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

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12
Q

Which drugs causing drug-induced liver disease can lead to liver cirrhosis?

A

methotrexate
methyldopa
amiodarone

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13
Q

What intervention is used to control variceal bleeding?

A

Sengstaken Blakemore tube

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14
Q

Which index is used to identify a severe flare of Ulcerative colitis?

A

TRUELOVE AND Witt’s

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15
Q

what is the criteria in the truelove and witt’s index to identify a severe flare of UC?

A

Temperature greater than 37.8°C
Heart rate greater than 90 beats per minute
Anaemia (Hb less than 105g/ L)
Erythrocyte sedimentation rate greater than 30 mm/hour

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16
Q

Treatment for life-threatening C difficile

A

Oral vancomycin

IV metronidazole

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17
Q

What is spontaneous bacterial peritonitis?

A

form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.

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18
Q

Which organism is most likely to be isolated from paracentesis in spontaneous bacterial peritonitis?

A

E COLI

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19
Q

Management for spontaneous bacterial peritonitis

A

IV Cefotaxime

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20
Q

what time frame indicates pathological neontal jaundice?

A

Less than 24 hours

2-14 days usually physiological

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21
Q

Common presenting age of pyloric stenosus

A

2-8 weeks

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22
Q

First line investigation of pyloric stenosis

A

USS

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23
Q

Features of pyloric stenosus

A

Projectile, non-bilious vomiting
Hungry after feed
Dehydrated
Weight loss

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24
Q

Signs of pyloric stenosis

A

Visible gastric peristalsis after test feed

Palpable olive-like pyloric mass

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25
FTT, mouth ulcers occurring after weaning. What is the likely diagnosis?
Coeliac disease
26
WHAT INVESTIGATIONS ARE NEEDED IN A CHILD with suspected coeliac?
TOTAL IGA AND IGA TISSUE TRANSGLUTAMINASE ANITBODIES
27
Strawberry tongue is a sign of what condition?
BOTH Kawasaki and Scarlet fever
28
Major complication of CROHNS and UC and what investigation is useful?
Toxic megacolon | Abdominal X ray
29
Early signs of haemochromatosis
Fatigue Arthralgia Erectile dysfunction
30
Consequence of long-term PPI use
``` Hypomagnasemia - leads to muscle aches Can also cause hyponatraemia Osteoporosis Microscopic colitis Increased C difficile infections ```
31
What system is used to classify the severity of end stage liver disease (cirrhosis)
Child Pugh
32
What criteria are listed to classify severity of liver disease in Child Pugh Score?
``` Bilirubin Prothrombin time Ascites Encephalopathy Albumin ```
33
What is the double duct sign and what condition is it found in?
CT - dilation of common bile duct and dilated pancreatic duct Pancreatic or ampulla vater cancer
34
Name a complication of Wilson's disease
Psychosis
35
What prophylactic medication is required after an episode of spontaneous bacterial peritonitis?
Antibiotics - ciprofloxacin
36
Tool for scoring malnutrition
MUST
37
Tool to estimate risk of pressure sore
Waterlow
38
Which part of the colon is most affected by ischaemic colitis?
Splenic flexure
39
Abdominal pain, diarrhoea and multiple gastroduodenal ulcers can indicate which syndrome?
Zollinger-Ellison Ulcers caused by excess gastrin
40
How are symptoms of zollinger-ellison syndrome controlled?
PPI high dose
41
What sign may accompany other symptoms of Zollinger Ellison syndrome in 1/3 of patients?
Hyperparathyroidism - due to MEN 1
42
Presentations of MEN 1
parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia pituitary (70%) pancreas (50%, e.g. Insulinoma, gastrinoma) also: adrenal and thyroid
43
Diagnostic tests for Zollinger Ellison
fasting gastrin levels: the single best screen test | secretin stimulation test
44
Management of alcoholic ketoacidosis
Thiamine and saline
45
Hepatomegaly with firm, smooth, tender and pulsatile liver edge is a consequence of which condition
Right heart failure
46
Which medications should be held during treatment of c diff?
Antiperistaltic, antimotility eg opioids | Also any other antibiotic treatment
47
What is the first line treatment of Mature Onset Diabetes of Young (MODY)?
Sulfonylurea
48
What is the mode of inheritance of Mature Onset Diabetes of Young?
Autosomal dominant
49
What is the first positive sign of diabetic nephropathy?
Proteinuria
50
What is the first line treatment of diabetic neuropathy?
ACE-i
51
When would ACE-i be withheld in diabetic patients?
If in AKI
52
Which bug is found in neuropathic diabetic ulcers?
Pseudomonas
53
Antibodies are directed towards ? in Hashimoto's thyroiditis?
TPO | Low t3 and t4
54
What characterises primary adrenal insufficiency?
Skin tanning
55
High cortisol =
Cushing's syndrome
56
Low dose dexamethasone test is used to confirm
Cushing's sybndrome
57
Response to high dose dexamethasone tests indicates what cause of ACTH excess
Pituitary tumour
58
No response to high dose dexamethasone tests indicates which cause of ACTH excess
Ectopic
59
Management of adrenal crisis
Urgent corticosteroids (hydrocortisone) and fluids
60
Why in adrenal crisis will there be a raised WCC?
In response to long-term steroids
61
Reversal of warfarin in context of major bleed
Withhold IV vitamin K Prothrombin complex
62
Typical presenting features of ALS (MND)
Upper Motor neuron sign in lower limb (increased tone) | Lower motor neuron sign in Upper limb (absent bicep reflex)
63
Treatment of Steven Johnsons Syndrome
IV fluids
64
Diagnosis of Steven Johnsons
Macropapular purplish target lesions Medications - carbomiazipine, sodium valproate, lamotrigine Covering no more than 10% of body
65
Tingling, decreased sensation,. Repeated episode of sprained ankles, high stepping gait
Charcot Marie Tooth
66
Treatment of giant cell arthritis
High dose prednisolone or methylprednisolone if visual disturbance
67
Findings on temporal artery biopsy in Giant Cell Arteritis
Skip lesions
68
Acute seizure management
Rectal diazepam Oral midazolam IV lorazepam at 5 minute intervals IV Phenytoin
69
Long term seizure management
Sodium valproate Carbamazepine Lamotrigine Ethosuxamide
70
Inheritance of neurofibromatosis
Autosomal dominant
71
NF1 vs NF2
Cafe au lait Iris hamartoma scoliosis Phaeochromocytoma Bilateral Vestibular schwannoma
72
Pathopneumonic sign of MS on CT
Dawson's finger | - periventricular collections
73
What is becks triad?
Muffled heart sounds Raised JVP Hypotension
74
What condition is indicated when patient presents with Beck's triad?
Cardiac tamponade
75
What are waves on ECG associated with?
Hypothermia
76
What is the most common ECG finding in pulmonary embolism?
Sinus tachycardia
77
Management of cardiac tamponade
Urgent pericardiocentesis
78
ECG finding in cardiac tamponade
Electrical alternans

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