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Passmed Mistakes > Less High Yield Topics > Flashcards

Less High Yield Topics Flashcards

1
Q

Which vessel should TPN be administered through?

A

Central veins as it is strongly phlebitic eg internal jugular, subclavian and femoral

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2
Q

If pt is having planned surgery and needs iron supplementation what do you need to do?

A

If 3m away use oral iron (ferrous sulfate)

If not enough time / not well tolerated give IV Iron (ferric carboxymaltose)

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3
Q

Which drugs can be ototoxic?

A

gentamicin, quinine, furosemide, aspirin and some chemotherapy agent

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4
Q

What does Marcus-Gunn Pupil mean?

A

RAPD

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5
Q

Which men w anaemia need to be referred via 2ww pathway?

A

Men of any age with a Hb below 110g/L should be referred for upper and lower GI endoscopy as a 2ww

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6
Q

Philadelphia chromosome t(9,22) - which haem malignancy?

A

CML

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7
Q

t(15;17) - which haem malignancy?

A

APML

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8
Q

t(8; 14) - which haem malignancy?

A

Burkitts lymphoma

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9
Q

t(14;18) - which haem malignancy?

A

Follicular lymphoma

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10
Q

t(11;14) - which haem malignancy?

A

Mantle cell lymphoma

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11
Q

Subacute unilateral visual loss + eye pain worse on movement - what is dx? initial mx?

A

Optic neuritis - IM corticosteroids + MRI Brain + orbits

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12
Q

Features of otitis media that warrant immediate abx?

A

Symptoms lasting more than 4 days or not improving

Systemically unwell but not requiring admission

Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease

Younger than 2 years with bilateral otitis media

Otitis media with perforation and/or discharge in the canal

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13
Q

What is something that is specific to contact lens wearers that causes red eye? how is the mx of this different to conjunctivitis?

A

Microbial keratitis - requires same day opthal assessment as it can cause visual loss

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14
Q

What is Pompholyx eczema? mx?

A

Subtype percipitated by humidity and high temps -> small blisters on palms and soles + itchy + burning sensation

Cool compress, emollients and topical steroids

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15
Q

What are the features of laryngopharyngeal reflux?

A

Absence of Red flags for laryngeal ca + globus (feeling something is in your throat) + hoarseness

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16
Q

HF pt + 2(+) units of packed red cells - what else needs to be given?

A

Transfusing 2+ units of packed red cells can cause fluid overload hence every other unit stat furosemide should be given

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17
Q

Otitis media w/ effusion (Glue ear) + Downs syndrome / cleft palate - what needs to be done?

A

Refer immediately to ENT as theyre less likely to recover spontaneously -> mx can involve grommet insertion or adenoidectomy

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18
Q

Auer rods on blood film suggests what?

A

APML

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19
Q

Smear cells on blood film suggests what?

A

CLL

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20
Q

Tear drop poikilocytes on blood film suggests what?

A

Myelofibrosis and other BM myelofibrotic disorders

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21
Q

Spherocytes on blood film suggest what?

A

Hereditary spherocytosis / AI haemolytic anaemia

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22
Q

Target cells on blood film suggest what?

A

IDA or hyposplenism

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23
Q

In palliative pts - what causes rattling sound coming from their throat as they breathe in and out? mx?

A

Secretions

Avoid fluid overload, use muscarinic antagonist such as Hyoscine hydrobromide / butylbromide

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24
Q

With which of the blood products is most likely to cause an iatrogenic septicaemia with a Gram-positive organism?

A

Platelets as these are stored at room temp

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25
Q

How is tranexamic acid given in cases of major haemorrhage?

A

IV bolus followed by slow infusion (1g + 1g)

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26
Q

Urticaria not managed only using non-sedating antihistamines such as cetirizine is what?

A

Use a short course of steroids eg 5d oral pred

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27
Q

Pancoast tumour can cause what sx?

A

Horners

Shoulder pain

Upper limb neuro signs

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28
Q

What are the features of multiple myeloma?

A

Ca - hypercalcaemia
Renal - dehydration + increased thirst
Anaemia
B - bleeding due to thrombocytopaenia
Bones - pain + increased risk of fractures
Infection

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29
Q

Ix for Multiple myeloma?

A

Bloods + film (roleaux formation)

Protein electrophoresis

BM aspiration - confirms dx

Imaging - whole body MRI is often used

Urine - shows bence jones proteins (monoclonal IgA/IgG proteins)

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30
Q

What is richters transformation?

A

When CLL converts into NHL and a pt becomes suddenly v ill

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31
Q

Bleeding screen in vWD?

A

Increased bleeding time and APTT but normal platelet count!!

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32
Q

What is the biggest risk associated w blunt ocular trauma?

A

Blunt ocular trauma can lead to hyphema (build up of RBC in eye) -> raised IOP -> glaucoma

Can also cause orbital compartment syndrome (ophthalmic emergency - requires decompression)

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33
Q

sudden onset sensorineural hearing loss - mx?

A

Urgent referral to ENT

MRI to exlcude vestibular schwannoma

High dose oral corticosteroids provided by ENT

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34
Q

What are the indications for urgent ENT referral (w/in 24h)?

A

Sudden onset (over 3 days or less) unilateral or bilateral hearing loss which has occurred within the past 30 days and cannot be explained by external or middle ear causes.

Unilateral hearing loss associated with focal neurology (such as altered sensation or facial droop).

Hearing loss associated with head or neck injury.

Hearing loss associated with severe infection such as necrotising otitis externa or Ramsay Hunt syndrome.

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35
Q

What deficiency can be caused by ileocaecal resection? what tongue sign can this cause?

A

B12 deficiency - glossitis (can also be caused by IDA / folate deficiency however these are absorbed in duodenum + proximal jejunem)

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36
Q

What are some red flag sx of chronic rhinosinusitis that warrant urgent referral to ENT?

A

Unilateral sx

Persisten sx despite compliance w mx for 3m

Epistaxis

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37
Q

What is the threshold for transfusion of red blood cells in pts w/ ACS and w/out? what is their Hb targets following transfusion?

A

ACS - 80g/L
non-ACS 70g/L

Targets = 80-100g/L and 70-90g/L

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38
Q

red eye, photophobia and gritty sensation - suggests what dx? RF?

A

keratitis (inflammation of cornea) - wearing contact lenses is an RF

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39
Q

What is a possible complication of thyroid surgery that can cause parasthesia + cramps and spasms? what can this show on ECGs?

A

Hypocalcaemia secondary to parathyroid gland damage –> Isolate QTc elongation

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40
Q

Photophobia + small irregularly shaped pupil + acute onset = dx? mx?

A

Anterior uveitis - mx w/ steroid + cycloplegic (mydriatic drops)

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41
Q

Fixed dilated pupil + Conjunctival injection + severe pain + haloes around light - possible dx?

A

Acute angle closure glaucoma

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42
Q

What feature in Hodgkins lymphoma is associated w worse prognosis?

A

B sx - Weight loss 10%+ in 6m, Fever 38+ and night sweats

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43
Q

What type of anaemia does methotrexate cause and why?

A

Methotrexate -> folate deficiency hence cause megaloblastic macrocytic anaemia

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44
Q

mx of acne vulgaris?

A

Single topical therapy - retinoids/ benzoyl peroxide

Topical combination therapy - topical retinoid /+ topical abx /+ topical benzoyl peroxide

Oral abx - tetracyclines -> avoid in pregnancy / u12 hence use erythromycin

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45
Q

New onset flashes / floaters - what should you do?

A

Urgent (24h) assessment by opthalmologist - may need to operate to prevent loss of sight in case of retinal detachment

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46
Q

What are the signs of optic neuritis?

A

inflammation of the optic nerve which causes pain on movement, reduced visual acuity, and an RAPD due to reduced response to light of the afferent pathway in the affected eye

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47
Q

What’s the eye like in 3rd nerve palsy? what’s it like in horners?

A

3rd nerve = ptosis + dilated pupil

Horners = ptosis + constricted pupil

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48
Q

Emergency reversal of anticoagulation in pt w/ severe bleed / head injury - what blood product should be used?

A

Prothrombin complex concentrate

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49
Q

Red eye - glaucoma or uveitis?

A

Glaucoma: severe pain, haloes, ‘semi-dilated’ pupil

Uveitis: small, fixed oval pupil, ciliary flush

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50
Q

Rinnes and Webers lateralisation

A

Conductive loss = Rinnes -ve and lateralisation of Webers into the affected ear (CONDUCTS TO THE PLACE WHERE YOU NEED TO GO)

Sensorineural loss = Rinnes +ve (false +ve) + Webers lateralisation to opposite ear

51
Q

CENTOR - likelihood of bact tonsilitis features?

A
  • Temperature >38ºC
  • Tender anterior cervical lymphadenopathy
  • Absence of a cough
  • Exudate present on tonsils
52
Q

What to do about children w squint?

A

Refer to ophthalmology

53
Q

Slow peripheral visual loss + ?normal IOP + increased cup-to-disc ratio - possible dx? results of gonioscopy?

A

Chronic open-angle glaucoma

Gonioscopy is normal as it is open angle hence normal drainage

54
Q

What is malignangt otitis media? who is it found in? mx?

A

Rare subform found in immunocompromised -90% in diabetics

Can progress to temporal bone osteomyelitis hence non-resolving otitis media w/ worsening pain should be urgently referred to ENT for IV abx that covers pseudomonal infections

55
Q

Painful red eye + blueish tingue to sclera +- AI history (eg SLE) -> dx?

A

Scleritis - opthal emergency that requires urgent review -> NSAIDs, glucocorticoids if severe and immunosuppressive if resistant

56
Q

DVT ix - what to do if +ve D dimer but -ve scan?

A

Stop anticoagulation + repeat scan in 1w

57
Q

What are the common causes of bacterial otitis media?

A

MHS - Moraxella catarrhalis, Haemophilus influenzae and Strep pneumo

58
Q

What eye sign can raised ICP cause? how can this present in fundoscopy?

A

Can cause papilloedema

venous engorgement: usually the first sign
loss of venous pulsation: although many normal patients do not have normal pulsation
blurring of the optic disc margin
elevation of optic disc loss of the optic cup
Paton’s lines: concentric/radial retinal lines cascading from the optic disc

59
Q

Features of quinsy? Mx of quinsy?

A

Features include:
severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

Patients need urgent review by an ENT specialist. Management
needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence - w/in 6w

60
Q

Antibody in Cold and warm AIHA?

A

Cold = IgM - Cold in moscow
Warm = IgG - Warm in Greece

61
Q

Does olanzapine increase VTE risk?

A

YES

62
Q

Central scotoma suggests what condition? what are other signs?

A

Optic neuritis - decreased visual acuity, decreased colour vision + RAPD

63
Q

When transfusing RBC what time frame is it over?

A

90-120 mins if no-urgent

STAT if urgent

64
Q

Night blindness + tunnel vision - what dx?

A

Retinitis pigmentosa

65
Q

What is Ramsay hunt syndrome? Mx?

A

Reactivation of VZV in geniculate nucleus of CN VII

Features = auriclar pain (1st), facial nerve palsy, vesicular rash and vertigo + tinnitus

Mx = Oral aciclovir, corticosteroids + eye protection - lube + close it at night

66
Q

Primary care - child w/ rapidly worsening eczema not controlled by normal meds = what dx and mx?

A

Suspicious of eczema herpeticum - same-day referral to paeds for IV aciclovir

67
Q

Which type of abx are used in mx of acne vulgaris?

A

Tetracyclines - 3m at least and onlside topical retinoid / benozyl peroxide to prevent abx resistance

68
Q

Mx of B-thalassaemia major?

A

Repeated transfusions -> iron overload hence iron chelation therapy is important

69
Q

Alpha-thalassaemia presentations

A

Major - death in utero / shortly after birth - no HbA hence HbBarts is made

Trait - Asymptomatic - deletion of 1/2 a-globin gene

70
Q

Beta-thalassaemia presentations

A

Major - Both b-globin chains faulty hence severe anaemia hence rise of other forms of Hb eg HbA2 and HbF

Minor - only one b-globin gene faulty hence assumptomatic w/ mild anaemia

71
Q

In a pt w/ long history of ear discharge - what is the most important part of tympanic membrane to visualise on otoscopy?

A

Attic - if theres crusting / ear wax obstructing it this means it is cholesteatoma until proven otherwise

72
Q

BPPV - what move is to diagnose, what move is to treat?

A

Diagnose - Dix-Halpike

Treat - Epley

73
Q

What features in acne roseaca requires prompt referral to specialists?

A

Red inflamed eyes + eyelids - suggests ocular involvement and requires mx to prevent corneal scarring

74
Q

Mirror shape nuclei upon biopsy?

A

Reed-sternberg cells -> Diagnostic of Hodgkins Lymphoma

75
Q

Mx of children w new onset purpura in primary care?

A

Children with new-onset purpura should be referred immediately for investigations to exclude ALL and meningococcal disease

76
Q

What are poor prognostic factors for Hodgkins Lymphoma?

A

The presence of B symptoms (night sweats, weight loss and fever)

Male gender

Being aged >45 years old at diagnosis

High WCC, low Hb, high ESR or low blood albumin

77
Q

Mx of Polycythaemia vera (JAK2)?

A

Aspirin - reduce throbotic events

Venesection - keep Hb in normal range

Chemo
- Hydroxyurea - slight increased risk of leukaemia
- phosphorus-32 therapy

5-15% will progress to myelofibrosis or acute lukeaemia (increased risk w chemo)

78
Q

What meds should be used to help palliative pts who are having pain and breathlessness?

A

Opioids

Morphine - renally excreted hence not used in renal failure

Oxycodone - liver metabolised so not ideal in liver failure

79
Q

Drugs that cause erythema multiforme?

A

penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine

80
Q

How should Anti-phospholipid syndrome be mx in pregnancy?

A

Aspirin + enoxaparin

81
Q

What medication should be used for long term mx of psoriasis?

A

Vit D analogues eg topical calcipotriol

82
Q

What are the majority of sudden onset sensorneural hearing loss caused by?

A

Idiopathic

refer to ENT for MRI - exclude vest schwan then they’ll give high dose oral corticosteroids

83
Q

Blood tests in Haemophillia A and B?

A

Prolonged APTT

Normal PT, bleeding time and thrombin time

A - Impaired Factor VIIIc activity (lack of VIII)
B - Normal Factor VIIIc activity (lack of IX)

84
Q

Hereditary spherocytosis

+ abdo pain and poorly = ??
+ abdo pain but not that poorly = ??

A

+ abdo pain and poorly = splenic rupture
+ abdo pain but not that poorly = chronic haemolysis -> gallstones

85
Q

How do the following drugs work?
Dabigatran
Rivaroxaban / Apixaban
Heparin
Warfarin

A

Dabigatran - Direct thrombin inhibitor
Rivaroxaban / Apixaban - direct factor xa inhibitor
Heparin - activates antithrombin III
Warfarin - inhibits factor II, VII, IX and X

86
Q

What is the main Ig found in breast milk?

A

IgA - its the first protection they get

(IgA is found in secretions)

87
Q

What are the different classes of haemorrhagic shock?

A

Class I - 750ml (15%) loss - normal BP, HR, RR

Class II - 750-1500ml loss - normal BP, RR (20-30), HR >100

Class III = 1500-2000ml loss - Drop in BP, HR >120, confusion

Class IV - 2000+ ml loss - Drop in BP, V high resp rate, tired

88
Q

Mx of spasticity in MS?

A

Baclofen and gabapentin 1st line

Physio is important

89
Q

Which drugs should be stopped in a C diff infection?

A

Anti-motility and anti-peristaltic -> predispose to toxic megacolon by slowing down clearance of C diff toxin

90
Q

Blood results in neuroleptic malignant syndrome?

A

Raised CK and Raied WCC

91
Q

AF after stroke mx?

A

Warfarin or factor Xa inhibitor (apixaban etc) - start the anticoagulation 2w after event

92
Q

What are the features of urethral stricture?

A

Decreased urinary stream

Incomplete bladder emptying

93
Q

What is the most common cause of osteomyelitis in sickle cell pts?

A

Salmonella

94
Q

When AF is caused by reversible cause / co-existent HF present - how to mx?

A

Rhythm control is 1st line

95
Q

What is the 1st line mx of acromegaly?

A

Transphenoidal surgery

96
Q

For rosacea w/ predominant sx of flushing - what is the mx?

A

Brimonidine gel

97
Q

Mx of anterior uveitis?

A

steroid + cycloplegic (mydriatic) drops

98
Q

How can you distinguish between episcleritis and scleritis?

A

The presence of pain distinguishes scleritis from episcleritis

99
Q

How to treat chronic plaque psoriasis?

A

topical POTENT corticosteroids (BETAMETHASONE) + vit d analogue

100
Q

Isolated rise in GGT in the context of a macrocytic anaemia suggests ………. as the cause

A

alcohol excess

101
Q

An itchy rash affecting the face and scalp distribution is commonly caused by ……

A

seborrhoeic dermatitis

102
Q

Drusen formation on fundoscopy = what dx?

A

Dry macular degeneration

103
Q

What can topical corticosteroids cause in patients w dark skin?

A

Patchy depigmentation

104
Q

colour vision loss (red desaturation), unilateral acute vision changes and painful eye movements is highly suggestive of …………

A

optic neuritis

105
Q

Which drugs can trigger haemolysis in G6PD deficiency?

A

sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis

106
Q

What does Anisocoria worse in bright light imply?

A

Implies a problem with the dilated pupil

107
Q

What prep is required for colonoscopy?

A

Laxatives the day before the examination

108
Q

What are some triggers for migraine?

A

CHOCOLATE:
chocolate,
hangovers,
orgasms,
cheese/caffeine,
oral contraceptives,
lie-ins, alcohol,
travel,
exercise

109
Q

What dementia is associated w MND?

A

FTD

110
Q

Facial rash plus lymphadenopathy think

A

sarcoidosis

111
Q

What does conductive hearing loss + tinnitus + +ve family hx? what can percipitate this in genetically predisposed?

A

Otosclerosis

Pregnancy

112
Q

Where is a common site for epistaxis to originate from?

A

Littles area in the anterior nasal septum as its the confluence of 4 arteries (Kiesselbach’s plexus)

113
Q

What can be used to reduce discomfort of painful mouth at end of life?

A

Benzydamine hydrochloride mouthwash or spray

114
Q

RFs for retinal detachment?

A

DM

Myopia

Age

Previous surgery for cataracts - accelerates posterior vitreous detachment

eye trauma

115
Q

What are some things that can cause vitreous haemorrhage?

A

diabetes, bleeding disorders, anticoagulants

116
Q

What eye condition causes bilateral grittiness? mx?

A

Bilateral blepharitis

mx = hot compress 2x day + mechanical removal of debris +- artifical tears if dry eye / impaired tear film

117
Q

Which glaucoma is associated w/ hypermetropia and which is associated w/ myopia?

A

Acute angle closure = hypermetropia (long sightedness +2etc)

Primary open-angle glaucoma = myopia (short sightedness)

118
Q

Mx of otitis externa?

A

Topical abx +- topical steroid for 1-2w

If poor response to topical abx -> refer to ENT

119
Q

What is double sickening as seen in sinusitis?

A

Secondary bacterial illness following initial viral sinusitis

120
Q

What med can exacerbate plaque psoriasis?

A

Propanolol

121
Q

What can be given to pts w/ nasal polyps?

A

Topical corticosteroids - shrink polyp size in about 80%

122
Q

How long a brak in between courses of topical cortciosteroids for mx of psoriasis?

A

4w

123
Q

Bone profile in MM w/out mets?

A

High ca

normal / high po4-

normal ALP

124
Q

Fever, abdominal pain, hypotension during a blood transfusion →????

A

Fever, abdominal pain, hypotension during a blood transfusion → acute haemolytic reaction

Passmed Mistakes (9 decks)

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