Less High Yield Topics Flashcards
(124 cards)
1
Q
Which vessel should TPN be administered through?
A
Central veins as it is strongly phlebitic eg internal jugular, subclavian and femoral
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)
3
Q
Which drugs can be ototoxic?
A
gentamicin, quinine, furosemide, aspirin and some chemotherapy agent
4
Q
What does Marcus-Gunn Pupil mean?
A
RAPD
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
6
Q
Philadelphia chromosome t(9,22) - which haem malignancy?
A
CML
7
Q
t(15;17) - which haem malignancy?
A
APML
8
Q
t(8; 14) - which haem malignancy?
A
Burkitts lymphoma
9
Q
t(14;18) - which haem malignancy?
A
Follicular lymphoma
10
Q
t(11;14) - which haem malignancy?
A
Mantle cell lymphoma
11
Q
Subacute unilateral visual loss + eye pain worse on movement - what is dx? initial mx?
A
Optic neuritis - IM corticosteroids + MRI Brain + orbits
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
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
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
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
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
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
18
Q
Auer rods on blood film suggests what?
A
APML
19
Q
Smear cells on blood film suggests what?
A
CLL
20
Q
Tear drop poikilocytes on blood film suggests what?
A
Myelofibrosis and other BM myelofibrotic disorders
21
Q
Spherocytes on blood film suggest what?
A
Hereditary spherocytosis / AI haemolytic anaemia
22
Q
Target cells on blood film suggest what?
A
IDA or hyposplenism
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
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
25
How is tranexamic acid given in cases of major haemorrhage?
IV bolus followed by slow infusion (1g + 1g)
26
Urticaria not managed only using non-sedating antihistamines such as cetirizine is what?
Use a short course of steroids eg 5d oral pred
27
Pancoast tumour can cause what sx?
Horners
Shoulder pain
Upper limb neuro signs
28
What are the features of multiple myeloma?
Ca - hypercalcaemia
Renal - dehydration + increased thirst
Anaemia
B - bleeding due to thrombocytopaenia
Bones - pain + increased risk of fractures
Infection
29
Ix for Multiple myeloma?
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)
30
What is richters transformation?
When CLL converts into NHL and a pt becomes suddenly v ill
31
Bleeding screen in vWD?
Increased bleeding time and APTT but normal platelet count!!
32
What is the biggest risk associated w blunt ocular trauma?
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)
33
sudden onset sensorineural hearing loss - mx?
Urgent referral to ENT
MRI to exlcude vestibular schwannoma
High dose oral corticosteroids provided by ENT
34
What are the indications for urgent ENT referral (w/in 24h)?
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.
35
What deficiency can be caused by ileocaecal resection? what tongue sign can this cause?
B12 deficiency - glossitis (can also be caused by IDA / folate deficiency however these are absorbed in duodenum + proximal jejunem)
36
What are some red flag sx of chronic rhinosinusitis that warrant urgent referral to ENT?
Unilateral sx
Persisten sx despite compliance w mx for 3m
Epistaxis
37
What is the threshold for transfusion of red blood cells in pts w/ ACS and w/out? what is their Hb targets following transfusion?
ACS - 80g/L
non-ACS 70g/L
Targets = 80-100g/L and 70-90g/L
38
red eye, photophobia and gritty sensation - suggests what dx? RF?
keratitis (inflammation of cornea) - wearing contact lenses is an RF
39
What is a possible complication of thyroid surgery that can cause parasthesia + cramps and spasms? what can this show on ECGs?
Hypocalcaemia secondary to parathyroid gland damage --> Isolate QTc elongation
40
Photophobia + small irregularly shaped pupil + acute onset = dx? mx?
Anterior uveitis - mx w/ steroid + cycloplegic (mydriatic drops)
41
Fixed dilated pupil + Conjunctival injection + severe pain + haloes around light - possible dx?
Acute angle closure glaucoma
42
What feature in Hodgkins lymphoma is associated w worse prognosis?
B sx - Weight loss 10%+ in 6m, Fever 38+ and night sweats
43
What type of anaemia does methotrexate cause and why?
Methotrexate -> folate deficiency hence cause megaloblastic macrocytic anaemia
44
mx of acne vulgaris?
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
45
New onset flashes / floaters - what should you do?
Urgent (24h) assessment by opthalmologist - may need to operate to prevent loss of sight in case of retinal detachment
46
What are the signs of optic neuritis?
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
47
What's the eye like in 3rd nerve palsy? what's it like in horners?
3rd nerve = ptosis + dilated pupil
Horners = ptosis + constricted pupil
48
Emergency reversal of anticoagulation in pt w/ severe bleed / head injury - what blood product should be used?
Prothrombin complex concentrate
49
Red eye - glaucoma or uveitis?
Glaucoma: severe pain, haloes, 'semi-dilated' pupil
Uveitis: small, fixed oval pupil, ciliary flush
50
Rinnes and Webers lateralisation
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
CENTOR - likelihood of bact tonsilitis features?
* Temperature >38ºC
* Tender anterior cervical lymphadenopathy
* Absence of a cough
* Exudate present on tonsils
52
What to do about children w squint?
Refer to ophthalmology
53
Slow peripheral visual loss + ?normal IOP + increased cup-to-disc ratio - possible dx? results of gonioscopy?
Chronic open-angle glaucoma
Gonioscopy is normal as it is open angle hence normal drainage
54
What is malignangt otitis media? who is it found in? mx?
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
Painful red eye + blueish tingue to sclera +- AI history (eg SLE) -> dx?
Scleritis - opthal emergency that requires urgent review -> NSAIDs, glucocorticoids if severe and immunosuppressive if resistant
56
DVT ix - what to do if +ve D dimer but -ve scan?
Stop anticoagulation + repeat scan in 1w
57
What are the common causes of bacterial otitis media?
MHS - Moraxella catarrhalis, Haemophilus influenzae and Strep pneumo
58
What eye sign can raised ICP cause? how can this present in fundoscopy?
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
Features of quinsy? Mx of quinsy?
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
Antibody in Cold and warm AIHA?
Cold = IgM - Cold in moscow
Warm = IgG - Warm in Greece
61
Does olanzapine increase VTE risk?
YES
62
Central scotoma suggests what condition? what are other signs?
Optic neuritis - decreased visual acuity, decreased colour vision + RAPD
63
When transfusing RBC what time frame is it over?
90-120 mins if no-urgent
STAT if urgent
64
Night blindness + tunnel vision - what dx?
Retinitis pigmentosa
65
What is Ramsay hunt syndrome? Mx?
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
Primary care - child w/ rapidly worsening eczema not controlled by normal meds = what dx and mx?
Suspicious of eczema herpeticum - same-day referral to paeds for IV aciclovir
67
Which type of abx are used in mx of acne vulgaris?
Tetracyclines - 3m at least and onlside topical retinoid / benozyl peroxide to prevent abx resistance
68
Mx of B-thalassaemia major?
Repeated transfusions -> iron overload hence iron chelation therapy is important
69
Alpha-thalassaemia presentations
Major - death in utero / shortly after birth - no HbA hence HbBarts is made
Trait - Asymptomatic - deletion of 1/2 a-globin gene
70
Beta-thalassaemia presentations
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
In a pt w/ long history of ear discharge - what is the most important part of tympanic membrane to visualise on otoscopy?
Attic - if theres crusting / ear wax obstructing it this means it is cholesteatoma until proven otherwise
72
BPPV - what move is to diagnose, what move is to treat?
Diagnose - Dix-Halpike
Treat - Epley
73
What features in acne roseaca requires prompt referral to specialists?
Red inflamed eyes + eyelids - suggests ocular involvement and requires mx to prevent corneal scarring
74
Mirror shape nuclei upon biopsy?
Reed-sternberg cells -> Diagnostic of Hodgkins Lymphoma
75
Mx of children w new onset purpura in primary care?
Children with new-onset purpura should be referred immediately for investigations to exclude ALL and meningococcal disease
76
What are poor prognostic factors for Hodgkins Lymphoma?
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
Mx of Polycythaemia vera (JAK2)?
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
What meds should be used to help palliative pts who are having pain and breathlessness?
Opioids
Morphine - renally excreted hence not used in renal failure
Oxycodone - liver metabolised so not ideal in liver failure
79
Drugs that cause erythema multiforme?
penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
80
How should Anti-phospholipid syndrome be mx in pregnancy?
Aspirin + enoxaparin
81
What medication should be used for long term mx of psoriasis?
Vit D analogues eg topical calcipotriol
82
What are the majority of sudden onset sensorneural hearing loss caused by?
Idiopathic
refer to ENT for MRI - exclude vest schwan then they'll give high dose oral corticosteroids
83
Blood tests in Haemophillia A and B?
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
Hereditary spherocytosis
+ abdo pain and poorly = ??
+ abdo pain but not that poorly = ??
+ abdo pain and poorly = splenic rupture
+ abdo pain but not that poorly = chronic haemolysis -> gallstones
85
How do the following drugs work?
Dabigatran
Rivaroxaban / Apixaban
Heparin
Warfarin
Dabigatran - Direct thrombin inhibitor
Rivaroxaban / Apixaban - direct factor xa inhibitor
Heparin - activates antithrombin III
Warfarin - inhibits factor II, VII, IX and X
86
What is the main Ig found in breast milk?
IgA - its the first protection they get
(IgA is found in secretions)
87
What are the different classes of haemorrhagic shock?
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
Mx of spasticity in MS?
Baclofen and gabapentin 1st line
Physio is important
89
Which drugs should be stopped in a C diff infection?
Anti-motility and anti-peristaltic -> predispose to toxic megacolon by slowing down clearance of C diff toxin
90
Blood results in neuroleptic malignant syndrome?
Raised CK and Raied WCC
91
AF after stroke mx?
Warfarin or factor Xa inhibitor (apixaban etc) - start the anticoagulation 2w after event
92
What are the features of urethral stricture?
Decreased urinary stream
Incomplete bladder emptying
93
What is the most common cause of osteomyelitis in sickle cell pts?
Salmonella
94
When AF is caused by reversible cause / co-existent HF present - how to mx?
Rhythm control is 1st line
95
What is the 1st line mx of acromegaly?
Transphenoidal surgery
96
For rosacea w/ predominant sx of flushing - what is the mx?
Brimonidine gel
97
Mx of anterior uveitis?
steroid + cycloplegic (mydriatic) drops
98
How can you distinguish between episcleritis and scleritis?
The presence of pain distinguishes scleritis from episcleritis
99
How to treat chronic plaque psoriasis?
topical POTENT corticosteroids (BETAMETHASONE) + vit d analogue
100
Isolated rise in GGT in the context of a macrocytic anaemia suggests .......... as the cause
alcohol excess
101
An itchy rash affecting the face and scalp distribution is commonly caused by ......
seborrhoeic dermatitis
102
Drusen formation on fundoscopy = what dx?
Dry macular degeneration
103
What can topical corticosteroids cause in patients w dark skin?
Patchy depigmentation
104
colour vision loss (red desaturation), unilateral acute vision changes and painful eye movements is highly suggestive of ............
optic neuritis
105
Which drugs can trigger haemolysis in G6PD deficiency?
sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis
106
What does Anisocoria worse in bright light imply?
Implies a problem with the dilated pupil
107
What prep is required for colonoscopy?
Laxatives the day before the examination
108
What are some triggers for migraine?
CHOCOLATE:
chocolate,
hangovers,
orgasms,
cheese/caffeine,
oral contraceptives,
lie-ins, alcohol,
travel,
exercise
109
What dementia is associated w MND?
FTD
110
Facial rash plus lymphadenopathy think
sarcoidosis
111
What does conductive hearing loss + tinnitus + +ve family hx? what can percipitate this in genetically predisposed?
Otosclerosis
Pregnancy
112
Where is a common site for epistaxis to originate from?
Littles area in the anterior nasal septum as its the confluence of 4 arteries (Kiesselbach's plexus)
113
What can be used to reduce discomfort of painful mouth at end of life?
Benzydamine hydrochloride mouthwash or spray
114
RFs for retinal detachment?
DM
Myopia
Age
Previous surgery for cataracts - accelerates posterior vitreous detachment
eye trauma
115
What are some things that can cause vitreous haemorrhage?
diabetes, bleeding disorders, anticoagulants
116
What eye condition causes bilateral grittiness? mx?
Bilateral blepharitis
mx = hot compress 2x day + mechanical removal of debris +- artifical tears if dry eye / impaired tear film
117
Which glaucoma is associated w/ hypermetropia and which is associated w/ myopia?
Acute angle closure = hypermetropia (long sightedness +2etc)
Primary open-angle glaucoma = myopia (short sightedness)
118
Mx of otitis externa?
Topical abx +- topical steroid for 1-2w
If poor response to topical abx -> refer to ENT
119
What is double sickening as seen in sinusitis?
Secondary bacterial illness following initial viral sinusitis
120
What med can exacerbate plaque psoriasis?
Propanolol
121
What can be given to pts w/ nasal polyps?
Topical corticosteroids - shrink polyp size in about 80%
122
How long a brak in between courses of topical cortciosteroids for mx of psoriasis?
4w
123
Bone profile in MM w/out mets?
High ca
normal / high po4-
normal ALP
124
Fever, abdominal pain, hypotension during a blood transfusion →????
Fever, abdominal pain, hypotension during a blood transfusion → acute haemolytic reaction
