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Medicine Flashcards

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1
Q

What electrolyte imbalance comes from excess vomiting?

A

Hypochloraemic hypokalaemic metabolic alkalosis

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2
Q

Define ADHD

A

A persistent pattern of inattention and/or hyperactivity that interferes with functioning or development
Present before age 12
In 2 or more settings

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3
Q

What can cause gingival hyperplasia?

A

Ciclosporin
Phenytoin
Calcium channel blockers
AML

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4
Q

What are the hallmarks of asthma?

A

Variable
Intermittent
Worse at night
Provoked by triggers

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5
Q

What are the short term effects of steroids?

A 
Gastritis 
Hypokalaemia 
Psychosis 
Delayed wound healing
Fluid and sodium retention 
Insomnia 
Amenorrhoea
Acne
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6
Q

What are the long term effects of steroids?

A 
Osteoporosis 
Weight gain 
Immunosuppression 
Hypertension 
Hyperglycaemia 
Thin skin 
Easy bruising 
Myopathy
Cataracts
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7
Q

What do we use to keep the ductus arteriosus open?

A

Prostaglandin E

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8
Q

What are the 4 areas of developmental assessment?

A

Gross motor
Speech and language
Social, personal and emotional
Vision and fine motor

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9
Q

Name some correctable causes of delayed development

A

Undernutrition
Iron deficiency anaemia
Social isolation
Hypothyroidism

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10
Q

What bacteria is strongly associated with GBS?

A

Campylobacter

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11
Q

What disease can cause pain with alcohol consumption?

A

Hodgkin’s lymphoma

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12
Q

Name some migraine triggers

A 
Chocolate 
Hangovers
Orgasms 
Cheese/caffeine
Oral contraceptives
Lie-ins
Alcohol 
Travel 
Exercise
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13
Q

What is the preferred DOAC for patients with impaired renal function?

A

Apixaban

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14
Q

What is the acute management of Ménière’s disease?

A

Prochlorperazine

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15
Q

What is the preventative management of Ménière’s disease?

A

Betahistine

Vestibular rehab exercises

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16
Q

What are the risk factors for neural tube defects?

A

family history
Folate deficiency/anti folate drugs
AEDs eg. Valproate/carbamazepine

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17
Q

B12 deficiency can cause complications of …

A

Peripheral neuropathy

Subacute combined degeneration of the spinal cord

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18
Q

Define Todd’s paresis

A

Weakness of convulsive limbs for several hours post seizure

Stroke mimic

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19
Q

Causes of delayed walking

A 
Normal variant - bottom shuffler, familial, commando crawler
CP
Congenital myopathy 
Spinal cord lesion - spina bifida
GDD
DDH
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20
Q

Causes of delayed speech

A 
Normal familial variant 
Hearing loss
Autism spectrum 
GDD
Psychosocial deprivation
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21
Q

Lifestyle advice for a child with constipation

A 
Fluids
Exercise
Fruit and veg - make into smoothie if wont eat
Smaller seat for toilet
Give them enough time to go 
Don’t criticise for soiling
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22
Q

Which laxatives do we use in children?

A

Osmotic first line

Movicol or laxido

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23
Q

Name some stroke chameleons

A

Dizziness - POCS
Monoparesis - focal cortical stroke
Acute confusion - focal cortical stroke
Acute memory disturbance - bilateral thalamic strokes
Limb shaking TIAs - can appear like focal seizures

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24
Q

Name some stroke mimics

A 
Todd’s paresis 
Migraine esp with aura/hemiplegia 
Sepsis
Syncope
SoL
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25
What is seen in background diabetic retinopathy?
Microaneurysms | Dot and blot haemorrhages
26
What would you see on pre-proliferative retinopathy?
Cotton wool spots
27
What would you see on proliferative retinopathy?
New vessel formation
28
What defines maculopathy in diabetic retinopathy?
Presence of exudates +/- oedema at the macula
29
What is the mx of diabetic retinopathy?
Pan retinal photocoagulation
30
Hypertensive retinopathy stages and what you would see?
Grade 1 - subtle changes, generalised arteriolar narrowing Grade 2 - areas of focal narrowing - AV nipping Grade 3 - haemorrhages, hard exudates, cotton wool spots Grade 4 - optic disc swelling
31
RCHOP chemo includes
``` Rituximab Cyclophosphamide Doxorubicin Vincristine prednisolone ```
32
ABVD chemo includes
Adriamycin Bleomycin Vinblastine Dacarbazine
33
Endometrial cancer staging
1. Limited to myometrium 2. Cervical spread 3. Uterine serosa, ovaries, vagina 4. Bladder/bowel involvement, distant mets
34
Ix needed for ?endometrial ca
Endometrial biopsy - pipelle Hysteroscopy TV US
35
Ovarian Ca staging
1. Limited to ovary/ovaries 2. Spread to pelvic organs 3. Spread to rest of peritoneal cavity 4. Distant mets
36
Cervical cancer staging
1. Confined to cervix 2. Beyond cervix 3. Pelvic spread 4. Distant spread
37
Cervical screening
25-49 every 3 years | 50-65 every 5 years
38
Clomiphene complications
Multiparity Ovarian hyperstimulation Enlarged ovarian cysts Inhibits lactation
39
Hearing test for newborn screening
OAE | Otoacoustic emissions
40
Causes of airway obstruction
``` FB/tumour Allergy Resp infection - epiglottitis/abscess Trauma Altered consciousness ```
41
GCS sections are out of what numbers?
E 4 V 5 M 6
42
Common causes of low GCS
``` Drugs/alcohol Medications Epilepsy Hypoglycaemia Stroke/haemorrhage Hypoxia Meningitis Hypo/hyperthermia ```
43
Everybody with heart failure need these drugs...
ACEi | Beta blocker
44
What kind of pacemaker is useful in HF?
Biventricular (CRT) | Keeps the ventricles pumping in time to preserve ejection fraction
45
Why can chronic furosemide therapy become less effective?
Leads to compensatory hypertrophy of DCT Na reabsorbed +++ DCT Therefore loop diuretic not as effective But thiazides will work well
46
Why do we need to be cautious with nitrate in inferior MI?
More likely to have a RV infarction If BP drops too much then preload drops Will massively decrease cardiac output
47
How long is dual antiplatelet needed for post MI?
1 year
48
NICE recommends prednisolone for how long in IECOPD?
5 days 30mg
49
Commonest causes of aortic stenosis
Age related calcification | Bicuspid aortic valve
50
How does adenosine work?
Blocks AVN
51
What is SVT with aberrancy?
Tachycardia from the atria LBBB doesn’t conduct well LBB picture on ECG
52
What are the beats only seen in VT?
Fusion and capture
53
What is electrical alternans?
Tall short tall short QRS Heart moving in fluid so closer and further away from electrode Cardiac tamponade
54
How do we tell the difference between AVRT and AVNRT?
Have to see the resting ECG AVNRT - normal resting ECG AVRT - abnormal resting ECG
55
What is the steroid ladder?
Hydrocortisone Eumovate Betnovate Dermovate
56
What artery supplies the lateral brain?
Middle cerebral artery
57
Which artery supplies the medial brain?
Anterior cerebral
58
Treatment of raised ICP
``` A-E resus as needed Treat any seizures Elevate head of bed Hyperventilate to decrease CO2 Mannitol Dexamethasone Restrict fluids Monitor closely - neuro obs ICP monitoring ```
59
Why and when do we stop ACE/ARB before surgery?
24 hours before | Can be associated with severe hypotension after anaesthesia induction
60
Common SEs of sulfonylurea (gliclazide)
Weight gain | Hypoglycaemia
61
Which diabetic medication should not be used in HF?
Pioglitazone
62
SGLT2 inhibitor SEs eg. Empagliflozin
Hypoglycaemia | Urinary tract infections
63
Which leads are positive and negative in RAD?
``` Positive = II, III, aVF Negative = I, aVL ```
64
Which leads are positive and negative in LAD?
``` Positive = aVL, I Negative = II, III, aVF ```
65
Causes of RAD
RVH PE COPD
66
Causes of LAD
LBBB LVH Inferior MI Left anterior fascicular block
67
What are the 4 types of eye drops used for glaucoma?
Prostaglandin analogue Beta blocker Alpha 2 agonist Carbonic anhydrase inhibitor
68
Give examples of eye drops to dilate pupils
Atropine | Tropicamide
69
Give an example of a pupil constricting eye drop
Pilocarpine
70
Which nerves supply taste to the tongue?
Facial n - anterior 2/3 | Glossopharyngeal- posterior 1/3
71
Which nerves provide normal sensation to the tongue?
Anterior 2/3 = V3 mandibular branch trigeminal | Posterior 1/3 = glossopharyngeal
72
Normal pCO2 categories the asthma attack as ...
Life threatening
73
Raised pCO2 classifies the asthma attack as..
Near fatal
74
Stepwise drugs of adult asthma mx
``` SABA ICS low dose LABA Increase dose ICS LTRA/LAMA ```
75
Paediatric asthma mx
SABA and paediatric dose ICS (or LTRA if <5 years) LABA/LTRA Increase dose ICS Consider LTRA trial
76
Features of MSA
Parkinsonism Cerebellar sx ANS dysfunction
77
3 components of West Syndrome
Infantile spasms Hypsarrhythmia General learning disability
78
Best mx OCD
Exposure and response prevention therapy
79
First rank sx schizophrenia
``` Auditory hallucinations Thought insertion, broadcast, removal Delusion perception Somatic passivity External control of emotions Lac of insight ```
80
Mnemonic for mania sx
``` DIG FAST Distractibility Irresponsibility Grandiose delusion Flight of ideas Activity increase Sleep deficit Talkative ```
81
What artery supplies Broca’s and Wernicke’s?
Middle cerebral artery | Usually L
82
Causes of vit D deficiency
``` Lack of sunlight Nutritional deficiency GI malabsorption Liver disease Drugs ```
83
Signs of rickets
``` Bowed legs Knock knees Seizures/tetany Wrist swelling Deformed skull Impaired growth ```
84
Describe ABO incompatibility in a newborn
Maternal and Fetal blood types (ABO) differ Maternal IgG antibodies pass through placenta - recognise fetal RBCs as foreign - haemolysis Can occur in first pregnancy and does not become more severe
85
Describe rhesus disease of newborn
Begins with rhesus positive Fetus in rhesus negative mother Some fetal RBCs cross into maternal circulation - antibodies made in mother Rarely a problem in first exposure Subsequent pregnancies - rhesus positive Fetus, large amount maternal antibodies produced - cross placenta - haemolysis
86
When is anti-D given in pregnancy?
Rhesus negative women 28 weeks 34 weeks And any sensitising event eg. Abortion, miscarriage, amnio
87
Straw coloured ascites indicates ...
Cirrhosis
88
Bloody ascites indicates ...
Malignancy
89
Cloudy ascites indicates ...
Infection
90
Which diuretic is best for ascites?
Spironolactone
91
Signs of portal hypertension
``` Ascites Caput medusa Dilated superficial veins Stigmata of chronic liver disease Haemorrhoids ```
92
Causes of CN III palsy
Compression - aneurysm (posterior communicating artery), tumour Diabetes Vasculitis
93
Signs of CN III palsy
Down and out eye position Dilated pupil Ptosis
94
Causes of INO
MS Wernicke’s Cerebrovascular disease
95
Signs of Horner’s
One side of face Miosis Ptosis anhydrosis
96
Sx of CN VI palsy
Horizontal Diplopia
97
Sx of CN IV palsy
Looking down causes Diplopia
98
What forms the vegetations in infective endocarditis?
Organisms and fibrin deposits
99
Commonest source of infection for endocarditis
Mouth after a dental procedure or tooth abscess
100
Resp failure is oxygen paO2 less than ..
8 kPa
101
Venturi devices deliver what percentages of oxygen
``` 24% 28% 35% 40% 60% ```
102
CXR signs of bronchiectasis
Ring shadows “tram lines”
103
Important ix in ?sarcoidosis
Calcium ACE High res CT
104
Causes of pancytopenia
``` Sepsis Vit B12 or folate deficiency Myelodysplasia Acute leukaemia BM failure - drugs, myelofibrosis ```
105
Newborn blood spot test looks for ...
Sickle cell Hypothyroidism CF Inherited metabolic disorders eg homocystinuria, PKU
106
What are the types of cerebral palsy?
Spastic Dyskinetic/athetoid Ataxic Mixed
107
Which of MMR viruses does the rash usually start behind the ears?
Rubella
108
Give some causes of ARDS
``` Pneumonia Smoke Aspiration Sepsis Acute pancreatitis Burns ```
109
What are the phases of ARDS?
Exudative Proliferative Fibrotic
110
Give some NM causes of dysphagia
Stroke Achalasia Diffuse spasm Myasthenia gravis
111
Give some causes of unilateral oedema
Lymphatic obstruction Venous obstruction (DVT) Cellulitis Localised immobility eg. Hemiparesis
112
What are the features of a benign murmur?
Systolic Normal ECG/CXR No cardiac signs or symptoms
113
What causes a benign murmur?
Fever Anaemia Pregnancy Thyrotoxicosis
114
What is the commonest malignancy in the HIV patient?
Lymphoma
115
What foreign infections have a short incubation period?
Dengue Enteric infections Legionella
116
Which foreign infections have a long incubation period?
``` Malaria Viral hepatitis Schistosomiasis HIV seroconversion Amoebic liver abscess ```
117
Fresh water exposes people to what infections?
Schistosomiasis | Leptospirosis
118
Differentials for a tremor other than Parkinson’s
``` Benign essential tremor Thyrotoxicosis Anxiety Cerebellar disease Wilson’s disease ```
119
Describe the movements of chorea
Continuous Facial grimacing Teeth grinding Often worse with walking
120
What can cause chorea other than Huntington’s?
Drugs - LDOPA and antipsychotics SLE Pregnancy Thyrotoxicosis
121
What are the risk factors for pre-eclampsia?
``` Family hx Patient hx Primigravida Multiple pregnancy Pre existing HTN or diabetes Extremes of age ```
122
What are the complications of twins?
``` Twin to twin transfusion Malpresentation Polyhydramnios Conjoined twins Low birth weight IUGR ```
123
Give causes of recurrent miscarriages
``` PCOS APS SLE Protein C and S deficiency Hypothyroidism Uterine malformation Fibroids ```
124
Causes of premature labour
``` Extremes of maternal age Heavy stressful work Smoking/substance misuse Cervical incompetence PROM Maternal febrile illness Uterine anomalies ```
125
What causes a third heart sound?
Left ventricular failure
126
NYHA HF classification
I no SoB II on strenuous exercise III moderate effort IV at rest
127
Triad of Sx with aortic stenosis
Exertional: Dyspnoea Angina Dizzy/syncope
128
Investigations for subfertility
``` Early follicular phase LH, FSH, oestradiol Mid luteal phase progesterone TSH, prolactin, testosterone TV US Semen analysis ```
129
Define carcinoma in situ
Malignancy continued with the basement membrane
130
Why is lobular breast ca harder to detect with screening?
Is not associated with microcalfications
131
What is the most important prognostic factor in breast ca?
LN involvement
132
What scoring system can we use for prognosis in breast ca?
Nottingham prognostic index
133
Give some causes of retinal vein occlusion
Hypertension Hyperviscosity Diabetes Sarcoidosis
134
Give some causes of vitreous haemorrhage
Proliferative retinopathy Warfarin Vitreous/retinal detachment Trauma
135
What is Ro?
The average number of cases of infection that one case generates
136
What are the antigen presenting cells?
Dendritic cells Macrophages B cells
137
What type of abx in vancomycin?
Glycopeptide - inhibits cell wall synthesis
138
What kinds of abx act on protein synthesis?
Tetracyclines Aminoglycoside Macrolides
139
Wenckebach HB is which type of HB?
Mobitz I
140
What test is used currently for COVID 19?
Reverse transcription PCR
141
What are the signs of HF on a CXR?
``` Alveolar shadowing Kerley B lines Cardiomegaly Upper lobe diversion Effusion ```
142
What are the myeloproliferative disorders?
CML Myelofibrosis Polycythaemia Vera Essential thrombocytosis
143
Polycythaemia is associated with what mutation?
JAK 2
144
What is the management of polycythaemia vera?
Venesection Hydroxyurea Aspirin - prophylaxis of the complications
145
What are the FBC findings in myelodyplasia?
Macro anaemia Leukopenia Thrombocytopenia
146
What causes raised anion gap metabolic acidosis?
Renal parenchymal disease Ingestion of acid Lactic acidosis DKA
147
Acute interstitial nephritis usually occurs as the result of ...
Drugs
148
Define amaurosis fugax
Embolus from carotid artery travelling to ophthalmic branch causing unilateral blindness lasting a few minutes
149
What is the pattern of disease seen in subacute combined degeneration of cord?
Peripheral neuropathy Dorsal column loss Corticospinal damage
150
What Ix should we do for suspected Wilson’s disease?
``` Ceruloplasmic (decreased) Copper serum (decreased) ```
151
What is the typical diagnostic Ix for PSC?
MRCP
152
In terms of preserving neurological function, what is the BEST mx for cord compression?
Radiotherapy
153
Where would the earliest changes of Alzheimer’s be detected on MRI?
Temporal lobe
154
What is the first line management of prolactinomas?
Dopamine agonist | Eg. Cabergoline
155
Can you talk metformin on the morning of a surgery?
Yes
156
What is the commonest endocrine cause of HTN?
Conn’s syndrome - primary aldosteronism
157
What is the first line anti hypertensive for an Afro-Caribbean person?
Calcium channel blocker
158
Describe a performance score of 2
Up and about >50% of waking hours
159
Describe a performance score of 5
Dead
160
Describe a performance score of 1
Restricted in strenuous activity
161
Why might ferritin be raised even in an iron deficiency anaemia?
Ferritin is an acute phase protein so may be raised
162
BRCA 2 is implicated in breast cancer and ...
Prostate cancer
163
Give an example of LHRH agonist
Goserelin
164
Give an example of an anti androgen
Flutamide
165
Auer rods are seen in ...
AML
166
Smudge cells are seen in ...
CLL
167
A rouleaux of red cells in the BM aspirate is seen in ...
Myeloma
168
What is rasburicase?
A synthetic uricase | Breaks down urate esp in TLS
169
What is denosumab?
RANKL inhibitor to prevent progression to mature osteoclasts to prevent excess Ca release
170
How much improvement does there need to be to confirm bronchodilator reversibility?
12%
171
What kind of anaemia occurs with malaria?
Haemolytic | Macrocytic - due to reticulocytosis because of haemolysis
172
Which infection has a relative bradycardia?
Enteric fevers - typhoid and paratyphoid
173
What are rose spots indicative of?
Enteric fever - typhoid and paratyphoid
174
What is the abx choice for typhoid?
Ciprofloxacin or azithromycin
175
Which abx for TB causes peripheral neuropathy?
Isoniazid

Finals Revision (6 decks)

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