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Year 4 > General Medicine > Flashcards

General Medicine Flashcards

(126 cards)

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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
Hormones released by posterior pituitary
Oxytocin | ADH
26
Mineralocorticoids are...
Aldosterone
27
Glucocorticoids are...
Cortisol
28
Management of Grave's Eye Disease
Oral steroids
29
Assessment of iodine uptake
Technetium scanning
30
Conception advice for radioactive iodine
Can't conceive for 6 months afterwards
31
Presentation of Thyroid Storm (5) | Association
``` High temperatures (++) Tachycardia Congestive Heart Failure Extreme Anxiety Seizures Association: under-treated or undiagnosed hyperthyroidism ```
32
Management of Thyroid Storm (3)
B blockers PTU Hydrocortisone - Can give iodine to saturate the gland
33
Sheehan's Syndrome
= infarction of the pituitary due to a drop in blood pressure Often used in the context of PPH
34
Myxoedema Coma =
= decompensated hypothyroidism
35
Treating hyperthyroidism in pregnancy
PTU is best
36
Imaging of small bowel
Capsule endoscopy | MRI of small bowel
37
Consideration in acute GI bleed
IV PPI e.g. omeprazole
38
Consideration in acute GI bleed (liver stigmata)
Terlipressin | AGM - prevent spontaneous bacterial peritonitis
39
Ion required for PTH release or action
Magnesium
40
Medications causing hypercalcaemia | Association
Lithium, vitamin D, thiazides | Association: short QT syndrome
41
Management of Hypercalcaemia
Fluids | Bisphosphonates - especially in hypercalcaemia associated with malignancy
42
Biggest risk factor for AF
Hypertension
43
Rate Limiting Drugs (AF)
Bisoprolol Verapamil Diltiazem Digoxin
44
Rhythm Limiting Drugs (AF)
Fleccanide | Amiodarone
45
Orthostatic Hypotension | Classification
``` Primary = Parkinson's, MS Secondary = Diabetes ```
46
Features of Epileptic Seizure
``` Tongue Biting Jerking Posturing Post-Ictal Confusion Deja Vu ```
47
Bad Features of Palpitations (4)
Prolonged Associated with chest pain Exertional palpitations FH/high risk of structural heart disease
48
Screening tool for Heart Failure
BNP
49
Management of Heart Failure
``` Sit up Oxygen IV Furosemide Morphine Consider IV GTN and role of CPAP ```
50
Difference between CAP and LRTI
CAP can only be confirmed on CXR
51
Steroid dose in infective exacerbation of COPD
30mg oral prednisolone
52
Complication of ipratropium
Acute angle glaucoma
53
Warfarin reversal in intracerebral haemorrhage
Stop warfarin IV Vitamin K PCC - prothrombin concentrate complex
54
Target INR in Atrial Fibrillation
2.5
55
Target INR in VTE
2.5
56
Target INR in VTE whilst on anti-coagulation
3.5
57
Target INR in Mechanical Aortic Valve
3
58
Medical Management in TIA
Antiplatelets (Aspirin + Clopidogrel) Statin Anti-Hypertensives
59
Supply of: - AV node - Apex
AV node = posterior interventricular artery | Apex = anterior interventricular artery
60
S/E of adenosine (2)
Chest tightness | Bronchospasm
61
S/E of sotalol
Torsades de Pointes
62
Papillary muscle rupture in MI can result in what?
Acute mitral regurgitation
63
Pain in Diabetic Neuropathy
Amitriptyline or Duloxetine
64
Management of Post-Partum Thyroiditis
Propranolol | Not PTU or carbimazole
65
Diuretic in Chronic Heart Failure
Use spironolactone | Consider furosemide where ejection fraction is preserved or in acute decompensations
66
Medication given before PCI - Normal - Already on anti-coagluation
Prasugrel | On A-C = clopidogrel
67
Verapamil - Heart Rhythm C-I - Other Drug C-I
Heart Rhythm = ventricular tachycardia | Drug = don't use with B-blocker, increased risk of heart block
68
Requirement for Cardioversion in AF
Need to within 48 hours of symptoms OR anti-coagulated for at least three weeks
69
Reversing respiratory depression as a result of magnesium sulphate
Calcium gluconate
70
Management of Hypophosphataemia - Mild/Moderate - Severe
Mild/Moderate (0.32-0.8) = oral replacement | Severe (<0.32) = IV infusion
71
Anti-coagulation in Anti-Phospholipid Syndrome
Use warfarin
72
Management of pericarditis
NSAIDs | e.g. naproxen or colchicine
73
Liver enzymes suggesting alcoholic liver disease
AST > ALT
74
Why do we need to dialyse slowly?
Disequilibrium Syndrome | = can get cerebral oedema if correct too soon or quickly
75
Management of Glomerulonephritis (AB +VE) (3)
1. Plasma exchange = dump the antibodies 2. IV Methylprednisolone then PO Prednisolone 3. Often followed by pulses of Cyclophosphamide
76
Medications needed when on Cyclophosphamide and Prednisolone (3)
Co-trimoxazole = PCP protection Alfacalcidol and Calcichew = bone protection Lansoprazole = GI bleeding
77
Causes of normal anion gap acidosis (3)
Diarrhoea High out put Ileostomy Tubular Acidosis
78
Causes of raised anion gap acidosis
``` 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
Anion Gap Calculation
Na+ - (Cl- + HCO3-) | In raised gap, looking at either increased sodium or reduced bicarbonate
80
Types of Lactic Acidosis | - Type seen with Metformin
``` A = overproduction of lactate e.g. shock B = normal production, problem with metabolism ``` In metformin get a type B lactic acidosis
81
Three ECG Changes associated with Hyperkalaemia
Prolonged PR interval Absent P waves Tall tented T waves
82
Immunosuppression given in Renal Transplant (3)
Prednisolone MMF - anti-proliferative Tacrolimus
83
Sick day rules with steroids and renal transplant
Need to double prednisolone dose
84
Prophylaxis of CMV in Renal Transplant
Valganciclovir
85
Presentation of CMV (5)
``` Mouth ulcers Retinitis Leukopaenia Diarrhoea Meningitis ```
86
BV Virus =
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
Threshold for Urgent Treatment of Hypercalcaemia
>3.5 | = use fluids +/- bisphosphonates (strongest evidence in hypercalcaemia caused by malignancy)
88
Management of severe hypernatraemia (>170)
Use 5% glucose, unless volume depleted then use 0.9% saline
89
Rate of correction of hypernatraemia
No greater than 10mmol/24 hours
90
Rate of correction of hypokalaemia
No greater than 10mmol/hour
91
Low Sodium | - Next step and causes
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
Presentation of Iron Toxicity (5) - Natural course of Iron Toxicity - Management
``` 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
GLP1 analogues name VS DPP4 inhibitors name
GLP-1 = tides e.g. exanatide DPP-4 = gliptins e.g. sitagliptin
94
Coeliac Disease + Symptoms of Malignancy
Enteropathy associated T cell lymphoma
95
Phosphate and PTH
PTH promotes the excretion of phosphate via the kidneys
96
Artery supplying the AV node
Right coronary artery | via the posterior interventricular artery
97
Indication for dialysis in AKI
If pulmonary oedema (amongst other things)
98
2nd Line Management for Angina
B blocker + Dihydropyridine CCB | e.g. nifedipine, amlodipine
99
Dihydropyridine CCB =
Nifedipine | Amlodipine
100
Associations with Thiazolidinediones (3)
Increased fracture risk Associated with bladder cancer Weight gain
101
Mechanism of VTE in Nephrotic Syndrome
Loss of antithrombin III + others through the glomerular basement membrane in nephrotic syndrome
102
Presentation of Haemochromatosis | - Mechanism
Hypogonadism | = excess iron deposition in pituitary cells reduces the secretion of FSH and LH
103
IgA Nephropathy also called...
Berger's Disease
104
Test for Bacterial Overgrowth
= H breath test | Treat with tetracyclines
105
H breath test positive =
= bacterial overgrowth
106
Discrete lesion seen on endoscopy | Haematemesis but no concerning features =
= gastrointestinal stromal tumour
107
Daily glucose requirements
50-100g per day | Doesn't matter how much they weigh
108
Cause of peritonitis in peritoneal dialysis
Staph epidermidis
109
Measure of adequacy of dialysis
Urea
110
SIADH Presentation (4)
Small volumes of urine Altered mental status Seizure Coma
111
Association of Zollinger-Ellison Syndrome
MEN 1
112
What is Trosseau Syndrome?
Thrombosis in strange places | Can be a paraneoplastic syndrome
113
Consequence of chronic atrophic gastritis
Megaloblastic anaemia | Pernicious anaemia
114
Association with H. pylori
Primary gastric lymphoma = MALT
115
How does CKD cause osteomalacia?
The high phosphate in CKD draws calcium out of bones Vitamin D deficiency due to CKD = osteomalacia
116
Pathogen seen in bronchiectasis | Association
Pseudomonas | Can be seen in autoimmune conditions e.g. rheumatoid arthritis, ulcerative colitis
117
Management of minimal change disease
Oral steroids
118
Acute interstitial nephritis | Finding
Eosinophils
119
How does calcium resonium work?
Removes potassium from the body | VS insulin - drives the potassium into the cells
120
What would make someone unsuitable for peritoneal dialysis?
Previous abdominal surgery or conditions e.g. IBD
121
Management of nephrogenic diabetes insipidus
Use a thiazide diuretic
122
Urea and creatinine in dehydration
See a greater increase in the urea vs creatinine (proportionally)
123
Association of Theophylline
Can cause cardiac arrhythmias | Has a narrow therapeutic window
124
Diagnosis of Diabetes - Random blood glucose - Fasting blood glucose
``` Random = >11.1 Fasting = >7 ```
125
Murmur heard in Dressler's Syndrome
Pericardial rub | = heard loudest on leaning forward
126
Management of Starvation Ketoacidosis (Alcoholic)
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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