Gen Med Flashcards
(246 cards)
1
Q
T2DM Diagnostic Criteria
- HbA1c
- Fasting blood glucose
A
HbA1c > 6.5 (48mmol)
Fasting glucose > 7
2
Q
Where is B12 absorbed?
A
Ileum
3
Q
Where is folate absorbed?
A
Duodenum & Jejunum
4
Q
Reference ranges for Anaemia
A
FBC <130 in men, <120 in women AND children 12-14
MCV <80 = Microcytosis (iron deficiency more likely)
MCV >100 = Macrocytic
Ferratin - correlates to total body iron stores. Low ferritin suggests low iron except in pregnant people (2nd&3rd trimester)
Serum ferritin <30 = iron deficiency
however it is an inflammatory marker so can be raised despite iron deficiency in acute or chronic inflammation.
5
Q
Term that describes velocity dependent increased tone?
A
Spasticity
6
Q
Term that describes increased tone not dependent on velocity?
A
Rigidity
7
Q
what visual disturbance is likely to be reported in acromegaly?
A
Pituitary adenoma –> Impinges on optic chasm causing bitemporal hemianopia
8
Q
Symptoms of Horners syndrome
A
ptosis - drooping eyelid
miosis - constricted pupil
anhrdrosis - can’t sweat
ON IPSILATERAL SIDE
9
Q
Biochemistry suggestive of AKI?
A
Increase in serum creatinine >26.4
or increase >50%
or reduced urine output
within 48 hour period and after fluid resuscitation
10
Q
Indications for acute dialysis
A
Acidosis Electrolytes (raised K+) Intoxication (Salicylic acid, Lithium, isopropanol, magnesium laxative, ethylene glycol)
Overload (fluid)
Uraemia complications
11
Q
Muddy brown casts
A
acute tubular necrosis
12
Q
H.Pylori eradication?
A
PPI + Amox + Clarithromycin
PPI + Met + clarithromycin if PA
13
Q
What is smoking protective for?
A
UC
14
Q
pseudopolyp & crypt abscess
A
UC
15
Q
Cobblestoning & skip lesions
A
Crohns
16
Q
Radio-lucent stones
A
urate + xanthine stones
17
Q
Radio-dense stones
A
Cystine stones
18
Q
Does raised urea favour upper GI or lower GI pathology?
A
Upper
19
Q
Major inspiratory muscles
A
Diaphragm (C3,4,5) and external intercostals
20
Q
Accessory muscles of inspiration
A
SCM, scalene’s,pectoral
21
Q
Muscles of ACTIVE expiration
A
Abdominals and internal intercostals
22
Q
Side effect of isoniazid
A
Drug induced lupus
23
Q
Side effect of ethambutol
A
Optic neuritis
24
Q
Side effects of rifampicin
A
Hepatitis
Orange secretions
Flu like symptoms
25
When is methyldopa contraindicated
Depression
26
What is hairy leukoplakia associated with?
EBV
27
Rotterdam criteria
Oligo/amenorhoea
Hyperandrogenism
Polycystic ovaries (TVUS)
2 required for diagnosis of PCOS
28
Drug management of peripheral arterial disease
Atorvastatin
| Clopidogrel
29
What is treatment with pyrazinamide associated with?
Gout
30
ECG changes in PE
S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III - 'S1Q3T3'
RBBB
RAD
Sinus tachy
31
Commonest cause of ascending cholangitis?
E.coli
32
Differentiating between seizures/pseudoseizures
Prolactin raised after genuine seizure
33
What causes Scarlet fever?
GAS
34
Are statins contraindicated in pregnancy
yes
35
Side effects of nitrates
Hypotension
Headaches
Tachycardia
36
Drug that reduced INR?
Pheonobarbital
37
What should be prescribed with goserelin and why?
Anti androgen for first 2 weeks
| prevents flare of symptoms
38
Peripheral Arterial Disease management
QUIT SMOKING
Exercise training - claudication
Atorvastatin 80mg
Clopidogrel 75mg
39
BP targets > 80 y/o
Clinic 150/90 mmHg
| ABPM 145/85 mmHg
40
Cutaneous signs in dermatomyositis?
Gottrons papules, shawl sign, heliotrope rash
41
Lab findings for polymyositis/dermatomyositis
Raised CK
| Anti Jo-1
42
Definitive investigation and treatment of poly/dermatomyosisis
Muscle biopsy = definitive investigation
| Prednisolone 40mg plus MTX or AZT
43
Which drugs exacerbate psoriasis?
Propanolol
44
What is secreted from zone glomerulosa of adrenal?
Mineralocorticoids
45
What is secreted from zone fascicularis of adrenal?
Glucocorticoids
46
What is secreted from zone reticularis of adrenals?
Androgens
47
What is secreted from the adrenal medulla?
Adrenaline and noradrenaline
48
Function of mineralocorticoid?
Increase BP by retaining fluid
49
Example of mineralocorticoid?
And antimineralocorticoid?
Fludrocortisone
Sprironolactone and eplerenone
50
Inheritance of MODY
AD
51
Early diastolic murmur post endocarditis - worse when making a fist and collapsing pulse
Aortic regurgitation
52
On HRT but needing contraception - period control
Progestogen only methods
53
COCP increases risk of ..... and .... cancer but is protective against ... and .... cancer
Increased risk of breast & cervical
| Decreased risk of endometrial & ovarian
54
Inverted t waves =
Ischaemia
e.g. inverted t waves and no raised trop then angina
55
Management of heart block
1. 500micrograms atropine up until 3mg
2. Transcutaneous pacing
3. Adrenaline
56
1st line treatment for prolactinoma?
cabergoline
57
What tumours is MEN2 associated with?
Medullary thyroid
Parathyroid
Phaeochromocytoma
58
What drug is contraindicated in VT?
Verapamil
59
What differentiates diffuse and limited systemic sclerosis?
Trunk only affected in diffuse
Antibodies:
Limited = anti centromere antibody
Difffuse = anti scl-70
60
Treatment for raynauds?
CCB/iloprost
61
Warfarin his teratogenic.
| True or false?
True
LMWH instead
62
Risk factors for gout
Genetics, diet high in red meat, alcohol and seafood
63
Acid build up in gout
Uric acid
64
Pseudogout =
Calcium pyrophosphate
65
Knee jerk nerves
L2-4
66
Malignancy + raised CK?
Polymyositis
67
Hypertension in systemic sclerosis with renal complications?
ACEi
68
How long is antibiotic therapy in septic arthritis?
4-6 weeks
69
Hoffman's test
suggests ms
70
cannot close his left eye or wrinkle the left side of his forehead
Left CN VII LMN
71
CN VII lower face =
Contralateral
72
Location & function of brocas area
Inferior frontal gyrus
| Motor function of speech
73
Location and function of wernickes area
Superior temporal gyrus
| Comprehension and planning of speech - cannot understand
74
Murphys sign
Pain on palpation of right subcostal area on expiration after deep inspiration due to inflamed gallbladder coming into contact with body wall
Diagnosis = acute cholecystitis
75
Anticoagulant of choice in AKI
Warfarin
76
Contraindication to triptans
CVD
77
RA, splenomegaly and low WCC
Feltys syndrome
78
Shortened, adducted and internally rotated leg.
| What's the diagnosis and which nerve is most at risk of damage?
Posterior hip dislocation
| Sciatic nerve
79
Pneumothorax <2cm
Discharge and review - normally self limiting
80
Biceps reflex nerves
Triceps reflex nerves
Supinator reflex nerves
C5/6
C6/7
C5/6
81
4 most common causes of liver cirrhosis?
Alcohol
NAFLD
Hep B
Hep C
82
Antidote for opioid overdose?
Naloxone
| 100micrograms at a time up to 1200mcg
83
Antidote for benzos?
Activated charcoal if within 1 hour
| Flumazenil (caution)
84
Antidote for MDMA/cocaine (uppers)
None - slow them down with benzos
85
Pupils in MDMA/cocaine OD?
Dilated
86
Pupils in opiate OD?
Pinpoint
87
Pupils in benzo OD?
Normal/dilated
88
Presentation in anticholinergic OD?
| and examples of common causes?
Everything is dry - Dry skin
| Antihistamines, TCAs
89
Presentation of cholinergic OD (organophosphates/nerve agent)
```
Salivation
Lacrimation
Urination
Diarrhoea
GI
Emesis
```
Manage with atropine
90
Antidote for b-blocker OD?
Glucagon/insulin
91
Antidote for CCB OD?
Ca chloride or Ca gluconate
92
Antidote for iron OD?
Desferrioxamine
93
antidote for digoxin?
Digibind
94
Cholecystitis vx cholangitis
Inflammation of gallbladder vs inflammation of the bile ducts
95
tinkling bowel sounds
obstruction
96
Haustra vs valvular conniventes
Haustra - large bowel - lines do not cross width
| Valvulae conniventes - small bowel - visible lines across entire width
97
3 main causes of bowel obstruction
Adhesions
Hernias
Malignancy
98
Classification of haemorrhoids?
1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, doesn't return on relaxing, but can be pushed back
4th degree: prolapsed permanently
98
Classification of haemorrhoids?
1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, doesn't return on relaxing, but can be pushed back
4th degree: prolapsed permanently
99
What is required for thorough examination of haemorrhoids?
Proctoscopy
100
Differentials for rectal bleeding?
```
Anal fissures
Diverticulosis
Inflammatory bowel disease
Colorectal cancer
Haemorrhoids
```
101
When would you consider admission for thromboses haemorrhoids?
within 72 hours
102
Management of haemorrhoids?
increase fibre and fluid intake
topical therapy - anusol
Non surgical - Rubber band ligation
- Injection sclerotherapy (injection into the haemorrhoid to cause sclerosis and atrophy)
- Infra-red coagulation
- Bipolar diathermy
Surgery - Haemorrhoidal artery ligation
- Haemorrhoidectomy
- Stapled haemorrhoidectomy
103
teardrop RBCs?
Myelofibrosis
104
anticoagulant in PE/DVT
rivaroxiban, apixaban, dabigatran, edoxaban, lmwh
105
What is JAK2 associated with?
Myelofibrosis
106
3 signs of polycythaemia vera?
Ruddy complexion
Splenomegaly
red conjunctiva (plethora)
107
Which type of anaemia occurs in aplastic anaemia?
107
Which type of anaemia occurs in aplastic anaemia?
Normocytic
108
When is irradiated and CMV negative blood required
Intrauterine transfusion
Granulocyte transfusion
Neonates up to 28 days post due date
109
When is irradiated blood required?
Immunocompromised - chemo/radio
Current or previous Hodgkins lymphoma
Bone marrow/stem cell transplants
110
When is prothrombin complex concentrate used?
Emergency reversal of anticoagulant in severe bleeding or suspected intracranial haemorrhage
111
What does cryoprecipitate replace?
Fibrinogen & factor VIII
112
Universal donor for FFP?
AB
113
What is the transfusion threshold for anaemia?
70 or 80 if acute coronary syndrome
114
How long is a unit of RBCs transfused over?
| Non emergency
90-120 minutes
115
Warfarin reversal
Vitamin K - takes 6 hours
FFP - need a lot of fluids
Human prothrombin complex - much quicker (60 mins) but short half life so given with bit k
116
What initial investigations may you perform for suspected myeloma?
What is required for definitive diagnosis?
B – Bence–Jones protein (request urine electrophoresis)
L – Serum‑free Light‑chain assay
I – Serum Immunoglobulins
P – Serum Protein electrophoresis
bone marrow biopsy
117
What is the child-pugh classification used to assess?
Liver cirrhosis
118
ECG features of WPW
short PR interval
| wide QRS complexes with a slurred upstroke - 'delta wave'
119
Causes and symptoms of SVCO?
Lung cancer - medical emergency, lymphoma,
Presentation
- Dyspnoea is the most common symptom
- Swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
- Headache: often worse in the mornings
- Visual disturbance
- Pulseless jugular venous distension
120
Which thyroid cancer secretes calcitonin?
Medullary thyroid cancer
121
What are the 3 types of colon cancer?
Sporadic (95%)
Hereditary non polyposis colorectal cancer (5%)
Familial adenamatous polyposis (<1%)
122
what is the most common hereditary cause of colon cancer?
HNPCC - Lynch syndrome
| Autosomal dominant
123
What is the next most common cancer associated with HNPCC?
endometrial
124
Tumour marker for colorectal cancer?
CEA
125
Most common cause of spontaneous bacterial peritonitis?
E.coli
126
What conditions must you inform the DVLA of?
Epilepsy
Stroke
Mania
insulin dependent diabetes
127
Most common benign tumour of bone?
Osteochondroma
128
Immature bone surrounded by sclerotic halo
Osteoid osteoma
129
What is the most common age for presentation of sarcoma?
50-70
130
patchy sclerosis
AVN
131
Presentation of achondroplasia
Disproportionately short limbs
Prominent forehead
Widened nose
Normal mental status
132
Main features of marfans
```
Autosomal dominant
Pectus excavatum
Long bones - ligament laxity
Aortic aneurysm/dissection/regurgitation
Mitral valve: prolapse/regurgitation
```
133
Beckers muscular dystrophy
Mild version of DMD
Boys can walk in their teens
Survival to 30s
134
Is a positive babinski an UMN or LMN sign?
UMN
135
mildest form of spina bifida
Spina bifida occulta
| - tuft of hair or dimple
136
What is associated with spina bifida?
Hydrocephalus
137
What is the more sever form of spina bifida?
Spina bifida cystica
- meningocele normally no motor impact
- myelomeningocele affects nerves below area
138
What is the most common congenital malformation of the limbs?
Sclerodactyl
| two digits fused
139
When should you suspect primary amenorrhoea?
No period by 13 if no secondary sexual characteristics.
No period by 15 if sexual characteristics present
140
What is required for home O2 therapy to be allowed?
2x pO2 <7.3
141
What drug class is ipatropium?
SAMA
142
Antibiotic in bacterial infective exacerbation of COPD?
Amox
| Doxy or clarithromycin if PA
143
Management of PBC?
Ursodeoxycholic acid is the first-line medication for primary biliary cholangitis
144
Investigation for PSC?
MRCP
145
Metabolic alkalosis + hypokalaemia ?
→ prolonged vomiting
146
How do you diagnose spontaneous bacterioalperitonitis?
Pericentesis
147
Medical cardioversion in AF?
Amiodarone or flecanide
148
Murmur most associated with connective tissue disease (Marfans etc)
Mitral regurgitation
| Pansystolic
149
What is the ligament of Treitz
Junction between upper and Lower GIT
| Duodenal jejunal junctiom
150
Antibody in GPA?
cANCA
151
Antibody in goodpastures?
Anti GBM
| Linear IgG
152
Antibody in microscopic polyangitis?
pANCA
153
Features of nephrotic syndrome?
Proteinuria > 3.5g/24 hours
Peripheral oedema
Hypoalbuminaemia
Hypercholesterolaemia
154
4 infrarenal causes of acute renal failure
1. Acute glomerulonephritis
2. Acute tubular necrosis
3. Acute interstitial nephritis
4. Vascular
155
What is the difference between acute renal failure and AKI?
AKI doesn't require reduced urine output
156
When should a statin be taken?
More effective at night
157
spike wheel on CT
Oncocytoma - benign renal tumour
158
indications for dialysis?
eGFR<7
Urea >40
Resistant hyperkalaemia/acidosis
159
What is required to make a diagnosis of CKD?
Two samples, 90 days apart
160
eGFR = 50
| What stage CKD?
3a (45-59)
161
eGFR 15-29
| What stage CKD?
4
162
eGFR measurement in CKD 5
<15
163
how long should patients be monitored after AKI?
2-3 years as risk of CKD
164
Treatment of hyperkalaemia?
10ml 10% calcium gluconate (stabilises myocardium)
| 10 units insulin + 50ml 50% dextrose (moves K into cellss decreasing serum K)
165
Treatment of chronic hyperkalaemia?
Calcium resonium
166
Why do ACEi/ARBs/NSAIDs cause AKI/CKD?
Renal hypoperfusion
167
What is the most common cause of AKI?
Acute tubular necrosis
168
Triad seen in HUS?
Haemolytic anaemia
Low platelets
AKI
169
How high is CK in rhabdo?
1000s
170
Treatment of rhabdomyolysis?
IV fluids
| Treat hyperkalaemia
171
Side effect of tamsulosin?
HYPOtension
172
Treatment of ascites
Spironolactone
| Aldosterone antagonist
173
ABG in hyperaldosteronism?
Metabolic alkalosis due to increased acid secretion
Low K+
High Na+
174
What is cord prolapse commonly associated with?
Artificial rupture of membranes
175
Commonest type of ovarian cancer?
Serous
176
Fever + Jaundice + RUQ pain
Charcots triad - ascending cholangitis
177
Most common causative organism in pneumonia after influenza?
staph aureus
178
inguinal hernias in children ?
urgent surgery - risk of strangulation
179
Hyper or hypocalcaemia in severe pancreatitis
HYPOCALCAEMIA
- lipase leaks from damaged pancreas and mops up calcium to make soap --> decreased serum calcium
180
Outcome of Na valproate and warfarin?
Na Val is an enzyme inhibitor which Increases warfarin efficacy
181
How is metformin excreted?
Renally
182
What should not be prescribed with methotrexate?
Trimethoprim
| Co-trimoxazole
183
Encephalopathy + jaundice + coagulopathy?
acute liver failure
184
Where to check for pulse on child < 1y/o
Brachial or femoral
185
electrolyte abnormality that would give prolonged QT?
Hypocalcaemia
186
Electrolyte abnormality that would give prolonged PR
Hypermagnesemia
187
Electrolyte abnormality that would give a shorted QT or ST segment?
Hypercalcaemia
188
Contraindictaions to a laryngeal airway?
Not fasted
| Obese
189
Management of reactive arthritis ?
NSAIDs
190
Initial management of spinal cord compression
8mg dexamethasone
191
What can be used if treatment with haloperidol causes dystonia?
Procyclidine should reverse
192
Fluid resus in children?
20ml/kg NaCl over <10mins
193
Management of an acute exacerbation of COPD?
1. 30mg Prednisolone daily
2. Consider antibiotic therapy
Amox/doxy/clarithromycin 1st line
If no response within 2 days then send sputum sample
3. consider co-amox if high risk of treatment failure (prev resistance etc)
194
Treatment of cor pulmonale?
Loop diuretic
| Home oxygen if suitable
195
What is the criteria for LTOT?
pO2 <7.3
| or 7.3-8 with oedema, anaemia, pulmonary hypertension
196
Name some LABAs
Salmeterol
| Formoterol
197
Name a SAMA
Ipatropium
198
Name some LAMAs
Tiotropium
| Glycoperonium
199
Non invasive ventilation in COPD
BiPAP
200
Jelly like stool
Intusussception
201
Management of thyrotoxic storm?
Propanolol
Propylthiouracil
Hydrocortisone
202
Management of phaeochromocytoma
A blocker - phenoxybenzamine
B-blocker after initiated on a-blocker
Adrenalectomy = definitive however medical management 1st reduces risk from surgery
203
what is conn's
primary aldosteronism
204
When should a GLP-1 be added to diabetes management?
If triple therapy unsuitable/ineffective or contraindicated and BMI >35
GLP-1 causes weight loss
205
What is the pathophysiology of metabolic acidosis in DKA?
Increased glucose causes increased urination
Increased urination results in increased electrolyte loss
Electrolyte loss = acidosis
Kaussmaul breathing to reduce CO2 in blood
206
Difference between DKA and hyperglycaemic hyperosmolar syndrome
HHS more likely to be T2DM
Associated with diuretics/fizzy drinks/steroids resulting in hypovolaemia and resultant hyperglycaemia
Less acidotic - ketones not raised
207
How do you calculate insulin dose?
0.3 units/kg
Divide 50% basal and 50% meals
The 50% meals further divided by 2/3
208
What is Addisons disease?
Primary adrenal insufficiency
Decreased aldosterone - decreased Na&H20 retention = decreased BP
Decreased glucocorticoid (cortisol) = weight loss, hyperpigmentation
Decreased androgens
209
Management of primary adrenal insufficiency?
15-25mg Hydrocortison
| 50-200micrograms fludrocortisone
210
Diagnostic test for Cushings?
DST
211
Diagnostic test for acromegaly?
OGTT
| IGF-1
212
Diagnostic test for adrenal insufficiency/addisons?
Short synACTHen
213
Diagnostic test for Conns/aldosteronism?
aldosterone:renin ration
High aldosterone : low renin
214
what's diabetes insidious?
Lack of ADH
= unconcentrated urine
= lots of dilute urine
= hypernatraemia because salt not excreted in urine
215
Causes of nephrogenic diabetes insidious?
Lithium
Kidney disease
Genetic
216
Management of SIADH?
Fluid restriction
| Tolvaptan (ADH receptor blocker) - 6hr sodium required
217
What is the action of PTH?
Increases Ca2+
| Decreases PO4-
218
Which diabetes medication should not be used in heart failure?
Pioglitazone
219
Difference between primary and secondary prevention for lipid modification?
```
Primary = Qrisk>10% = Atrovastatin 20mg
Secondary = known CVD/IHD/PAD = Atorvastatin 80mg
```
220
What type of pain do c-fibres produce?
Dull, difffuse pain
221
What type of pain do a-delta fibres produce?
Fast, sharp, localised pain
222
First line options for neuropathic pain?
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
all 4 can be tried in turn but only 1 at a time
223
Daily requirement of K+, NA+ and H2O?
```
k+ = 1mmol/kg
Na+ = 4-5mmol/kg
H2O = 25-30ml/kg
```
224
T score for osteoporosis?
<-2.5
225
T score for osteopenia?
-1 to -2.4
226
Movement affected by de quervains tenosynovitis?
thumb & wrist abduction
227
DAS 28 <2.6?
Remission
228
DAS 28 >5.1?
Active disease
| Consider biologic if already on MTX
229
Onion skin appearance?
Ewings sarcoma
230
Loss of red reflex?
Retinal detachment
cataracts
retinoblastoma (children)
231
Normal cup:disc ratio?
0.3-0.5
232
cup:disc ratio >0.5
Glaucoma
233
No cup visible (ophthalmoscopy)
| What must you do?
Papilloedema
Examine the other eye - raised iCP?
234
central vision loss
ARMD
| Optic neuritis
235
Painful eye movements, colour destination, RAPD,central scotoma
Optic neuritis
| High dose steroids
236
cycloplegic or mydriatic eye drops?
They will dilate the pupil --> relieves pain
e.g. used in uveitis
237
Management of diabetic retinopathy?
- non proliferative
- proliferative
Non proliferative - good glycemic control and frequency montoring
Proliferative - pan retinal photocoagulation +/- anti VEGF
238
Peripheral vision loss + haloes around lights
| worse at night
Glaucoma
239
How is intraocular pressure measured?
Non contact tonometry (screening)
Goldmann applanation tonometry - gold standard
240
Drug treatment of glaucoma (prostaglandin analogue)
Latanoprost - increases uveoscleral outflow
SE - browning of iris,eyelash growth
Timolol
Carbonic anhydrase
241
Causes of RAPD
Optic neuritis
| retinal. detachment
242
What is papilloedema?
cupping of dic due to raised ICP - always bilateral
243
Long term treatment of SBP?
Antibiotic prophylaxis with ciprofloxacin
244
Signs of lung cancer + gynaecomastia?
Adenocarcinoma
