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Beynon Flashcards

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1
Q

Which type lung cancer is NOT related to smoking

A

Adeoma

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2
Q

Two places ulnar nerve can be damaged?

A

Elbow and the wrist (N.B. the more distal the lesion, the more severe the damage i.e. wrist lesion is more severe)

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3
Q

What does the hand look like when there is an ulnar nerve lesion?

A

‘Claw hand’ (flexion of ring finger and little finger)

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4
Q

What muscles are supplied by the median nerve

A 
Lateral two lumbricals
Obductor pollicis
Abductor pollicisF
lexor pollicis
N.B. LOAF
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5
Q

Give the four main causes of Horner’s syndrome

A
  1. Pancoast tumour
  2. Lateral medullary syndrome
  3. Syringomyelia
  4. Carotid artery dissection
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6
Q

What causes lateral medullary syndrome

A
  1. Occlusion of the PICA

2. Occlusion of the vertebral artery (in 25%)

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7
Q

What are the symptoms of lateral medullary syndrome

A 
Dysarthria
Dysphonia
Dysphagia
Ipsilateral Horner's
Unilateral loss of pain and temperature sensation on one side of the face
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8
Q

Which cranial nerves exit from the pons

A

5, 6, 7, 8

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9
Q

Name the 7 bacteriostatic antibiotics

A 
Trimethoprim
Tetrocycline
Ethambutol
Erythromycin
Clarythromycin
Chloramphenicol
Sufonamides
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10
Q

What T score indicates osteopenia? What about osteoporosis?

A

Osteopenia: -1–2.5
Osteoporosis: <-2.5

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11
Q

What change in which two electrolytes causes prolongation of the QT interval?

A

Hypokalaemia

Hypocalcaemia

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12
Q

What is the normal range for ESR

A

Men: age/2
Women: age+10/2

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13
Q

In what condition is ESR raised while CRP is normal?

A

SLE

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14
Q

What is the normal range for CRP?

A

<10

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15
Q

Where is CRP produced?

A

Liver

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16
Q

What is it’s time to rise? What is it’s half life?

A

4 hours

18 hours

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17
Q

What are the four causes of shock

A

Cardiogenic- failure of the heart to act as an effective pump e.g. ischaemic heart disease
Obstructive: mechanical impediments to forward flow. Obstruction to outflow e.g. PE OR restricted cardiac filling e.g. cardiac tamponade, tension pneumothorax
Hypovolemic/haemorragic
Distributive- abnormalities of peripheral circulation e.g. sepsis, anaphylaxis

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18
Q

Drugs which cause gout

A 
Cyclosporine
Aspirin
Nicotinic acids
Thiazides and theophylline
Loop diuretics and L-DOPA
Ethambutol
Alcohol
Pyrazinamide
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19
Q

Causes of high lactic acid?

A

Type A: tissue hypoxia
Hypoperfusion: LV failure, impaired cardiac output
Hypoxaemia: asphyxiation, respiratory failure, acute anaemia, haemorrhage

Type B: Tissue hypoxia absent
B1: underlying disease e.g. sepsis, chronic kidney disease, liver failure
B2: Drug/toxin mediated: metformin, HIV drugs
B3: errors in metabolism causing acidosis e.g. pyruvate dehydrogenase deficiency

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20
Q

Describe the pharmacokinetics of phenytoin

A

Zero order

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21
Q

What is the major interaction to consider when prescribing phenytoin?

A

It should not be prescribed in conjunction with the OCP (as it is a P450 inducer)

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22
Q

Which antibiotic should not be prescribed with statins?

A

Macrolides- prescription of macrolides and statins increases risk of myopathy

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23
Q

What is the major risk carried by quinolones

A

tendon damage

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24
Q

What is the major complication of use of augmentin?

A

Obstructive jaundice

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25
What is augmentin made up of? Why is it useful against some resistant bacteria?
Amoxicillin+ clavulanic acid | CA prevents beta-lactam resistance
26
What are the most common causative agents of cellulitis?
Streptococcus | Staphylococcus
27
What antibiotic is commonly used to treat cellulitis?
Flucloxacillin
28
Which nerve(s) and/or vessels pass through the wall of the cavernous sinus
3, 4, 5a, 5b
29
Which nerve(s) and/or vessel(s) pass through the cavernous sinus itself?
6 and the carotid artery
30
Causes of small, reactive pupils (unilateral and bilateral)
Unilateral: Horner's Bilateral: Old age, drugs (pilocarpine, opiates)
31
Causes of small, irregular pupils
Argyll Robertson pupil | Uveitis/iritis
32
What is Argyll-Robertson pupil?
Pupil is constricted and unreactive to light but reacts to accommodation. Occurs in neurosyphillis and may be seen in diabetic neuropathy
33
Causes of large pupil
Adie's pupil: dilated pupil which reacts slowly to light and accommodation. Associated with diminished reflexes- often seen in women with impaired knee/ankle jerk and impaired sweating. Caused by damage to post-ganglionic fibres of the parasympathetic innervation of the eye, usually due to viral or bacterial infection CN III lesion- unilateral, unreactive, dilated pupil Mydriatic drugs e.g. anticholinergics- atropine. MDMA
34
Causes of hypothyroidism
``` Autoimmune: Hashimoto's thyroiditis Iodine deficiency Surgical removal of thyroid gland Amioderone Congenital iodine deficiency- cretinism Post-viral thyroiditis ```
35
What are neurological symptoms of hypothyroidism
``` Cerebellar ataxia Proximal myopathy--> Hoffman's syndrome Mental slowing- reversible cause of dementia Slow reactive reflexes Hearing loss Coma ```
36
Which nerve is compressed in carpal tunnel syndrome
Median nerve
37
What is the nerve root of the ulnar nerve?
C8 and T1
38
Is carpal tunnel syndrome more common in men or women? Why?
Women as risk is increased by OCP use and pregnancy
39
What causes achondroplasia?
Defective receptors for fibroblast growth factor (FGF)
40
Describe the bodily proportions of a patient with acondroplasia
Short long bones; normal torso
41
List 7 common signs of an UPPER motor neurone lesion
``` Signs on opposite side to the lesion No fasciculation No muscle wasting Hypertonic- clasp knife/lead pipe (in Parkinson's) Hyper-reflexive Positive Babinski (foot goes upwards) Weakness in arm extensors and leg flexors (i.e. anti-gravity muscles are stronger) Pronator drift ```
42
List 5 common signs of a LOWER motor neurone lesion
``` Signs on same side as the lesion Muscle wasting Reduced tone Fasciculation present Hypo-reflexive ```
43
List common symptoms of Marfan's syndrome
``` Lens dislocation Aortic dissection or dilatation Arachnodactyly (long, spidery fingers) Arm span>height Chest deformity (pectus carinatum/excavatum) Scoliosis Pes planus Ligamentous laxity Dural ectasia (widening or ballooning of the dural sac round the spinal cord) ```
44
What might be indicated by bilateral hilar lymphadenopathy on a CXR?
TB Sarcoids Lymphomametastatic disease
45
Causes of erythema nodosum
Streptococcal infection Sarcoidosis Drugs (OCP, sulfonamides, dapsone)
46
What is indicated by the combination of erythema nodosum and hilar lymphadenopathy?
Sarcoids
47
Signs of a cerebellar lesion
``` Dysdiadokinesia Ataxia Nystagmus Intention tremour Scanning speech- ask the patient to say hippopotamus) Hypotonia ```
48
Which four drugs are used to treat TB? How long is each drug used for?
1. Rifampicin (24 weeks) 2. Isoniazid (24 weeks) 3. Pyrazinamide (8 weeks) 4. Ethambutol (8 weeks)
49
What is the route of excretion of pyrazinamide?
Renal
50
What is the major side-effect of isoniazide?
Peripheral neuropathy
51
What are the major side-effects of pyrazinamide?
hepatitis, arthralgia
52
What is the major side-effect of Ethambutol?
Optic neuritis- colour vision deteriorates first
53
What are the major side-effects of rifampicin?
Increased bilirubin, reduced platelets, inactivation of OCP, orange discolouration of urine and tears
54
What are the causes of apical lung shadowing
``` N.B. Breast B: Berylliosis R: radiation E: Extrinsic allergic alveolitis A: Allergic bronchopulmonary aspergillosis S: Sarcoid T: TB ```
55
What is caused by a lesion in Broca's area?
Expressive dysphasia | Comprehension of spoken and written word is normal but expression is poor with impaired non-fluent speech
56
What is caused by a lesion in Wernicke's area?
Receptive dysphasia | Difficulty understanding spoken and written word but with fluent speech
57
Which cranial nerves arise from the midbrain
3 and 4
58
Which cranial nerves arise from the medulla
9, 10, 11, 12
59
How much oxygen does 1g of fully saturated Hb carry?
1.3ml
60
Malignancies which metastasise to bone Which of these does not cause hypercalcaemia?
``` Thyroid Lung Breast Kidney Prostate (does not cause hypercalcaemia) Sarcoma ```
61
Common causes of optic atrophy
``` Optic neuritis Ischaemia Glaucoma Multiple sclerosis Trauma Congenital causes Toxic causes: methanol; ethambutol; B12 ```
62
Causes of swollen optic disc
Pappiledema Accerated stage hypertension Papillitis Retinal vein thrombosis
63
How do you deferentiate between pappiledema and papillitis
Papilledema- visual accuity is preserved Papillitis= visual acuity drops
64
Which CN do the parasympathetic nerves come from?
3, 7, 9 and 10
65
3 commonest causes of vomitting
Pregnancy Post- operative Alcohol
66
3 rarer causes
Endocrine Uraemia Psychiatic
67
Endocrine causes of vomitting
Addisons's Diabetic ketoacidosis hyper T4 hypo and hyper PTH
68
Common causes of swollen salivary glands
``` Sarcoids Amyloidosis Lymphoma Chronic alcoholism Mumps Bulimia/anorexia ```
69
Glycated HbA1c in diabetes?
>6.5 in old units | >48 in new units
70
Which is the only class of oral anti-glycaemic agent which causes hypoglycaemia?
Sulfonylureas e.g. gliclazide
71
Lesion of which lower motor neurone causes foot drop? What are the nerve roots of this nerve?
Common peroneal nerve (round the head of femur). L4, L5 and S1
72
What muscles are supplied by the L4 nerve root?
Hip abductors and ankle evertors
73
What are the classical presenting symptoms of ankylosing spondylitis?
back pain and early morning stiffness with loss of lumbar lordosis
74
When is chest expansion abnormal?
Thumbs move apart less than 2.5cm
75
Causes of polydypsia and polyuria
1. DM type 1 and 2 2. Psychogenic 3. Diabetes insipidus 4. Hypercalcaemia
76
Normal calcium?
2.12-2.62
77
Causes of hypercalcaemia
1. Cancer metastases 2. Multiple myeloma 3. Sarcoidosis 4. Hyperparathyroidism 5. Drugs: Thiazides
78
How do you calculate the anion gap?
(Na+K) - (Cl+HCO3)
79
Causes of metabolic acidosis with a normal anion gap
Renal tubule acidosis (distal and proximal) Aceto Severe cholera diarrhoea Loss of bicarbonate from a pancreatic fistula Acetazolamide
80
What is the normal anion gap
12-16mmol/L
81
Causes of low Hb with raised MCV
``` B12 deficiency Folic acid deficiency Haemolytic anaemia Aplastic anaemia Sideroblastic anaemia ```
82
Which part of the gut is affected in coeliac disease?
Duodenum | Jejunum

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