Intensive Revision Period Flashcards by Miranda King

What does the DEXA score relate to?

Compares the bone density compared to that of a healthy young adult

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Key differences between psoriatic and rheumatoid arthritis

Psoriatic arthritis = results in DIP swelling, dactylitis

Both have a pattern of inflammatory arthritis

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What is Scheurmann’s Disease?

Usually seen in pubertal females

See abnormal ossification of the thoracic vertebrae

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Sudeck’s Atrophy =

= complex regional pain syndrome

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Sulphasalazine can result in… (males)

= oligospermia

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If on long term steroids need…

Need bisphosphonates e.g. alendronic acid

Make sure that they are not calcium or vitamin D deficient

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What does the Weber classification relate to?

Used to assess ankle fractures

Relates to the syndesmosis (made of anterior and posterior inferior tibiofibular ligament)

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Sunburst appearance =

= osteosarcoma

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Blood test changes associated with Lupus (4)

Flare VS Infection

Haemolytic anaemia 
Leucopaenia 
Lymphopaenia 
Thrombocytopaenia 
ESR = raised in a flare 
CRP = raised in an infection

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Difference in blood tests:

Primary vs Secondary Hyperparathryoidism

= calcium

Will be high in primary, low in secondary (appropriate response to hypocalcaemia)

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Difference in blood tests:

Osteomalacia VS Paget’s

= calcium
Both will have high ALP and may present with pain
Calcium will be normal in osteomalacia and raised in Paget’s disease

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Epidural abscess VS discitis

Discitis pain will be a prominent feature

In an abscess there may not be focal pain

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Behcet’s Disease =

= a vasculitis, classically see oral and genital ulcers and uveitis
May also see a polyarteritis, arterial thrombosis or DVT

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PCI - deciding on anti-platelets

= dual antiplatelets e.g. aspirin + another agent
Aspirin + Prasugrel/Ticagrelor = if not on anti-coagulants
Aspirin + Clopidogrel = on anti-coagulants

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What is osteochondritis dissecans?

= loss of blood supply to part of bone, part of bone breaks off and causes pain and locking symptoms

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How long are people with shingles infectious for?

Until the vesicles have crusted

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What formulation is the chicken pox vaccine in?

2 doses

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What is the pathophysiology of seborrhoeic dermatitis?

It is a reaction to malassezia (type of fungus)

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Features of hereditary haemorrhagic telangiectasia (4)

Epistaxis
Telangiectases
Visceral lesions
Family history

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Investigation of suspected contact dermatitis

Patch testing

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PUVA

Uses
Risk

Used in management of psoriasis

Associated with SSC

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Prescribing courses of topical steroids in psoriasis

Need to have a gap of 4 weeks between courses

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Dot haemorrhages diagnostic of

Diabetic retinopathy

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Which cells in the body rely on glycolysis?

Erythrocytes

They don’t have any mitochondria

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What causes erysipelas?

Strep pyogenes

Association of thrombophelbitis migrans | What is it?

Pancreatic cancer | = Trosseau syndrome: phelbitis with a thrombus

Unusual presentation of hyperglycaemic hyperosmolar state

Focal neurology

Lateral medullary vs Weber's Syndrome

Lateral medullary = sensory Contralateral sensory loss body Ipsilateral sensory loss face Weber's = motor Contralateral hemiplegia Ipsilateral CN III palsy

CMV eye disease in HIV

Use ganciclovir | Wait to start HAART until they have recovered - may cause a deterioration

Lichen planus VS sclerosus

``` Planus = purple Sclerosus = white, itchy, vulva ```

Definition of orthostatic hypotension

Drop of 20 SBP after three minutes of standing

Fluconazole and warfarin

= p450 inhibitor | Greater availability of warfarin, INR increases

Previous fracture + discharging sinus

Consider osteomyelitis

1y hyperaldosteronism VS renal cell tumour

``` 1y = high aldosterone and low renin RCC = high aldosterone and high renin ```

ECG signs in digoxin toxicity (3)

T wave inversion ST depression Short QT

Widespread T wave inversion on ECG...

Think non-cardiac cause e.g. head injury

Indication for stopping a statin

Liver enzymes 3x the upper limit of normal | Below that, keep them on the statin and monitor

Add in management for hypertension but potassium is high

Avoid spirinolactone | Use alpha or beta blocker instead

What is cortical blindess?

= blindness without an ophthalmological cause | e.g. occipital lesion

What is reverse cholesterol transport?

Transport of cholesterol from peripheral tissues to the liver Done by HDL - need HDL to process cholesterol

Ascending cholangitis VS acute cholecystitis

``` Cholecystitis = normal bilirubin Cholangitis = abnormal bilirubin, may be jaundiced ```

Management of acute sinusitis

Pain management Symptoms for 2 weeks = intranasal steroid Symptoms for 4 weeks or severe = phenoxymethylpenicillin

Causes of gradual visual loss (4)

ARMD Cataract Diabetic retinopathy Open angle glaucoma

Risks of Plasma Exchange (2)

Bleeding (lose clotting factors) | Hypocalcaemia

What is a Jacksonian Seizure?

= type of simple partial seizure | Usually starts in the mouth and the spreads to that side of the body

Management of orbital fracture

Delay surgical repair | Allows oedema and diplopia to improve

Investigation of recurrent UTIs

1. Urinary USS | 2. Flexible cystoscopy

Management of alcoholic hepatitis

Steroids

Infection in kids associated with lymphocytosis

Whooping cough

Proximal myopathy | - Associated gait

Waddling gait = can be associated with osteomalacia

Investigation of acute limb ischaemia

Doppler of pulses | Then want to determine whether is a thrombus or embolus

Investigation of Oesophageal Rupture

CT contrast

Investigation of suspected cervical spine #

CT neck

Proctitis + Lymphadenopathy

Lymphogranuloma venerum

Management of acute gout in CKD 4

Use steroids | NSAIDs contra-indicated

Confirmation of rotator cuff tendinopathy

Don't need to investigate, clinical diagnosis | Manage using physiotherapy

Management of 'terminal restlessness'

Midazolam

Where do you see the first changes in Alzheimer's Disease?

Temporal lobe

Epidural VS Spinal Anaesthesia as Post-Operative Pain Management

Epidural can be topped up/titrated, spinal cannot be

Presentation of delirium tremens (4)

Confusion Visual hallucinations Tachycardia Pyrexia

How long do you continue anti-coagulation in DVT?

``` Provoked = 3 months Unprovoked = 6 months ```

Anti-smooth muscle Ab associated with

Autoimmune hepatitis

Acute limb ischaemia + embolus suspected

= embolectomy

Management of Peripheral Arterial Disease (2)

Atorvostatin | Clopidogrel

H. pylori erradication

PPI + Amoxicillin + Clarithromycin OR Metronidazole

Surgical management of anal fissure | Why?

Sphincterotomy | = relaxes the muscle and gives the fissure time to heal

Aortic abnormality associated with Marfan's Syndrom

Dilated aortic root

An oliguric crisis is an example of what?

Acute dystonic reaction

Acute Dystonia Tardive Dyskinesia Akathisia

Acute Dystonia = sustained contraction: use procyclidine Tardive Dyskinesia = involuntary movements: use tetrabenazine Akathisia = severe restlessness: switch anti-psychotic or consider a beta-blocker

What is hemiballismus?

A type of chorea = involves the arms

Management of: - Achalasia - Pyloric stenosis

Achalasia = Heller myotomy | Pyloric stenosis = Ramstedt pyloromyotomy

P mitrale is what?

Suggests left atrial hypertrophy, commonly in response to mitral stenosis

Presentation of biliary atresia (4) | - Management

``` Prolonged neonatal jaundice Hepatosplenomegaly Abnormal growth Cardiac murmurs Management = surgical intervention ```

SNRIs e.g. venlafaxine | Monitoring requirement

Need to check blood pressure

Anal reflex =

S4, 5

Sudden onset headache Pituitary tumour Visual field defect Hypotension

Pituitary apoplexy | = haemorrhage or infarction of the pituitary

How does CN VII cause hyperacusis?

Get paralysis of the stapedius muscle

Management of HIV +VE and suspected LATENT TB

Isoniazid for 9 months

ST elevation classification =

Chest leads = 2mm | Limb leads = 1mm

PR Interval =

Start of the P wave to the start of the QRS complex

Cause of haemolytic anaemia + pneumonia + maculopapular rash =

= mycoplasma

Sertoli cell - Responds to - Produces

``` Responds = FSH Produces = sperm ```

Leydig cell - Responds to - Produces

``` Responds = LH Produces = testosterone ```

Difference between moderate and severe asthma

RR < or > 25 | HR < or >110bpm

Most common cause of infective exacerbation of COPD

H. influenzae

Initial investigation of Cushing's

24 urinary free cortisol

NSTEMI + Unstable

Immediate PCI

Investigation | Unprovoked DVT + No symptoms

Still consider CT abdomen and pelvis

Ferritin high + screening for haemochromatosis

Need a transferrin | Will be elevated

Management of superficial thrombophlebitis + no DVT

NSAIDs for pain management

1st line management of SVC due to tumour

Dexamethasone to reduce swelling

Most common cause of leg cellulitis

Strep pyogenes

Bronchitis - Presentation? - How do you decide about antibiotics?

Presentation = cough, rhinorrhoea, wheeze, sore throat Cough may or may not be productive Use the CRP to decide whether to prescribe antibiotics - Can offer either delayed prescription or immediate depending on level

What is used to reverse NOACs?

Andexanet alfa

What is used to reverse heparin?

Protamine

Ejection systolic murmur LOUDER on inspiration

= pulmonary stenosis | Remember during inspiration the venous return increases

Which bisphosphonate is only available IV?

Zoledronate

What does cricoid pressure do when intubating?

Compresses and seals off the oesophagus, prevents the passage of gastric contents into the airway

Painful eye and loss of visual acuity =

= ophthalmology assessment

Pressure of CSF in bacterial meningitis

= high pressure

Diffuse VS Limited Systemic Sclerosis

``` Diffuse = anti-Scl-70 antibodies, includes the chest and upper arms Limited = anti-centromere, doesn't involve the chest and upper arms ```

Difference between CML and CLL

CML is more likely to be symptomatic, CLL is likely to be an asymptomatic finding

Test that can be helpful in determining whether early labour

fFN | = foetal fibronectin

Management of mycoplasma pneumonia

Erythromycin

Keratoconjunctivitis sicca =

Sjogrens

Intensive Revision Period Flashcards

(105 cards)