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May Flashcards

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1
Q

Klebsiella penumoniae is what type of bacteria?

A

Gram negative rod

Normal gut flora

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2
Q

Features of klebsiella pneumonia

A 
Adults - alcoholics, diabetics
Red currant jelly sputum
Cavitating upper lobe pneumonia
Common after aspiration
Lung abscess and empyaema
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3
Q

Features of Kartagener’s syndrome

A

Quiet heart sounds
Dextrocardia
Recurring chest infections, sinusitis, bronchiectasis
Subfertility

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4
Q

Differentiate kartagener’s syndrome from Cystic fibrosis

A

Sweat test positive for CF

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5
Q

When does carcinoid syndrome commonly occur?

A

In liver metastases - release of serotonin

Or lung carcinoid

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6
Q

Features of carcinoid syndrome

A 
Flushing
Abdominal discomfort
diarrhoea
bronchospasm
hypotension
Right valvular stenosis
ACTH and GHRH giving Cushings syndrome
Pellagra
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7
Q

Investigations for carcinoid syndrome

A

Urinary 5-HIAA

Plasma chromogranin A y

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8
Q

Management of carcinoid syndrome

A

Octreotide - somatostatin analogue

Cyproheptadine to help diarrhoea

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9
Q

Features of steroid responsiveness

A

Any previous, secure diagnosis of asthma or of atopy
A higher blood eosinophil count
Substantial variation of FEV1 over time (at least 400ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)

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10
Q

Iron study profile for haemochromatosis

A

Raised transferrin saturation
Raised ferritin
Low TIBC

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11
Q

Drugs causing pulmonary fibrosis

A

bleomycin, cyclophosphamide, nitrofurantoin, methotrexate and penicillamine
Amiodarone

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12
Q

Adverse effects of atorvastatin

A

Myopathy

Liver impairment

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13
Q

Adverse effects of trimethoprim

A

Myelosuppression

Neural tube defects

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14
Q

What conditions are treated by hydroxychloroquine?

A

SLE and rheumatoid arthritis

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15
Q

Adverse effects of hydroxychloroquine

A

Visual disturbances

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16
Q

Mechanism of ciclosporin

A

Inhibits calcineurin causing immunosuppression

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17
Q

Adverse effects of ciclosporin

A

Gum hypertrophy
Nephrotoxicity
Hepatotoxicity

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18
Q

Symptoms of pericarditis

A

chest pain: may be pleuritic. Is often relieved by sitting forwards
other symptoms include non-productive cough, dyspnoea and flu-like symptoms
pericardial rub
tachypnoea
tachycardia

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19
Q

Cause of pericarditis

A 
Viral  infection - Coxsackie
Tuberculosis
Uraemia
Trauma
Post MI, Dresslers
Connective tissue disease
Hypothyroid
Malignancy
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20
Q

Risk factor for pericarditis

A

Systemic Lupus erythematosus

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21
Q

Treatment for pericarditis

A

Treat underlying cause
NSAIDs
Colchicine

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22
Q

Diagnosis: cholestatic jaundice raised IgM and positive anti-mitochondrial antibodies

A

Primary Biliary cholangitis

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23
Q

Treatment for primary biliary cholangitis

A

Ursodeoxycholic acid

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24
Q

Adverse effects of thiazide diuretic - bendroflumethiazide

A

hypercalcaemia, as well as hyponatraemia, hypokalaemia and hypomagnesaemia.

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25
Features of hypercalcaemia
``` Stones Bones Groans Thrones Tones Psychiatric Moans ```
26
Causes of Upper Zone Fibrosis
Coal workers’ pneumoconiosis Histiocytosis Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis Radiation Tuberculosis Silicosis (progressive massive fibrosis), sarcoidosis CHARTS
27
Which other structural abnormality is associated with coarctation of the aorta?
Bicuspid aortic valve Systolic murmur - heard under left scapula
28
First line treatment for Allergic Bronchopulmonary Aspergillosis in CF?
Prednisolone | 2nd line - antifungal
29
Term given to multiple large, round, well-circumscribed masses in both lungs seen on Chest X-ray and condition
Cannonball metastases Renal cell carcinoma Can be choriocarcinoma or prostate but less common
30
Diagnosis- painful rash on shins and cough
Sarcoidosis
31
Features of sarcoidosis
acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia insidious: dyspnoea, non-productive cough, malaise, weight loss skin: lupus pernio hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)
32
Which condition is most commonly associated with HOCM and can be demonstrated on ECG?
Wolff Parkinson White
33
Features of autonomic neuropathy
1. Postural hypotension 2. Loss of respiratory arrhythmia 3. Erectile dysfunction
34
Condition associated with autonomic neuropathy
Type 2 diabetes
35
Neuropathy associated with Vitamin B12 deficiency
Sensory neuropathy
36
Neuropathy associated with botulism and lead poisoning
Motor
37
Predisposing factors for sleep apnoea
Obesity Macroglossia - acromegaly, hypothyroidism, amyloidosis large tonsils Marfan's
38
Symptoms and consequence of sleep apnoea
Daytime somnolence Compensated respiratory acidosis Hypertension
39
Assessment of sleep apnoea
Epworth Sleepiness Scale - questionnaire completed by patient +/- partner Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)
40
Diagnostic tests for sleep apnoea
Sleep studies - polysomnography
41
What is measured in sleep studies?
EEG, respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry
42
Management of sleep apnoea
Weight loss | Continuous Positive Airway Pressure
43
Which antibiotics increase risk of tendonitis?
Fluoroquinolones - ciprofloxacin
44
First line treatment for back pain?
NSAIDs - naproxen
45
Features of carpal tunnel
pain/pins and needles in thumb, index, middle finger unusually the symptoms may 'ascend' proximally patient shakes his hand to obtain relief, classically at night
46
What nerve is compressed in carpal tunnel?
Median
47
Causes of carpal tunnel
``` ARMPIT Acromegaly Rheumatoid Arthritis Myxoedema (hypothyroidism) Pregnancy Idiopathic Trauma ```
48
Examination findings in carpal tunnel
Weakness of thumb abduction Wasting of thenar eminence Tinels sign Phalens sign
49
What is tinel's test and how is it interpreted?
Tapping over the wrist causes paraesthesia - positive - carpal tunnel
50
What is Phalen's sign?
Full flexion of wrists - prayer sign - causes symptoms of carpal tunnel
51
Management of carpal tunnel
``` corticosteroid injection wrist splints at night surgical decompression (flexor retinaculum division) ```
52
Which pathogen is associated with malaria and homozygous sickle cell disease?
Non typhi salmonella
53
What event is an anterior shoulder dislocation most commonly associated iwth?
FOOSH | Fall onto Outstretched Hand
54
Most common causative organism of osteomyelitis
Staph aureus
55
Back pain relieved by sitting and leaning forward
Spinal stenosis
56
what tests are required before starting a prescription of amiodarone?
TFT, LFT, U&Es, CXR
57
Next step in adult with episodic wheezing and SOB, normal spirometry
Adults with suspected asthma should have both a FeNO test and spirometry with reversibility
58
Aspiration pneumonia is more common on which sideR
Right
59
Management of recurrent pleural effusion
recurrent aspiration pleurodesis indwelling pleural catheter drug management to alleviate symptoms e.g. opioids to relieve dyspnoea
60
Side effect of PPIs- omeprazole
hyponatraemia
61
Most common presenting group with Primary Biliary Cholangitis
IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
62
Which medication should be avoided in VT?
Verapamil
63
Tests required before commencing treatment with arithromycin
ECG | LFTs`
64
Clear chest and acute onset shortness of breath - diagnosis
Pulmonary embolism

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