Medicine Flashcards
(137 cards)
1
Q
What can you do during endoscopy to help stop variceal bleeding?
A
Band ligation
2
Q
What can you do to stop general upper GI bleeding (not varisces)
A
Adrenaline injection
3
Q
What can you use for bleeding prophylaxis after endoscopy
A
Propanolol
4
Q
How can you tell between hepatocellular carcinoma and pancreatic cancer?
A
ALT/AST will be raised in hepatic cancer
Just ALP and GGT in pancreatic cancer
Both can have weight loss, anorexia and jaundice
5
Q
First line management of NAFLD
A
Lose weight
6
Q
Most common cause of NAFLD
A
Obesity
7
Q
What actually IS non-alcoholic fatty liver disease?
A
Fat build up in the liver
Can result in inflammation
Can progress to fibrosis and cirrhosis
8
Q
Which is greater, ALT or AST in NAFLD?
A
ALT > AST
9
Q
Signs of NAFLD
A
Increased liver echogenicity on USS
ALT > AST
Heptomegaly
RF such as obesity
10
Q
Ix for NAFLD
A
Blood tests
Liver USS
ELF liver testing
11
Q
What can induce UC flares?
A
Smoking cessation
Illness
Stress
12
Q
AMA is linked with which disease?
A
PBC
13
Q
AI hepatitis blood results
A
ALT/AST > ALP
AMA negative
14
Q
Features of autoimmune hepatitis
A
Fever
Jaundice
ANA
Inflammation beyond limiting plate on liver biopsy
15
Q
Management of AI hepatitis
A
Steroids or other immunosuppressants
16
Q
When is a transjugular intrahepatic portosystemic shunt performed?
A
Refractory bleeding in oesophageal varices
17
Q
Which 2 veins are joined in a TIPS procedure?
A
Hepatic vein and portal vein
18
Q
Management of acute oesophageal variceal harmorrhage
A
ABC FFP and vit K to correct clotting Terlipressin Prohylactic antibiotics (typically quinolones) ENDOSCOPY! TIPS
19
Q
Prophylaxis of variceal haemorrhage
A
Propranalol
Band ligation
20
Q
1st line management of PBC
A
Ursodeoxycholic acid (slows progression and improves symptoms)
21
Q
Complications of PBC
A
CIRRHOSIS
22
Q
Which antibodies in PBC
A
AMA
23
Q
Sx of PBC
A
Itching
Jaundice
Raised ALP
Clubbing?!
24
Q
In transudative ascites the SAAG is high or low?
A
HIGH ( >11 )
25
Causes of exudative ascites
Infection
| Cancer
26
SAAG in exudative ascites will be >11 or <11?
<11!
27
How might Budd-Chiari syndrome present?
Sudden abdo pain
Ascites
Tender hepatomegaly
28
Risk factors of oesophageal cancer
GORD
Smoking
Achalasia
Alcohol
29
Squamous oesophageal cancer usually occurs in which portion of the oesophagus?
Upper 2/3!
30
Dx of oesophageal cancer
Endoscopy
| Barium swallow
31
Main risks of oesophageal surgery?
```
Bleedings
Anastomotic leaks (can result in mediastinitis = high mortality)
```
32
N B symptoms in CLL suggests?
Richter's transformation
| CLL transforming into large cell lymphoma!
33
1/3 rule of CLL
1/3 bleeding
1/3 infection
1/3 transform
34
Clinical features of ARDS
Multi organ failure
Acute dyspnea
Rising ventilatory pressures
35
Patient is acutely unwell, should you give the flu vaccine?
No, you should wait
36
What is a flail chest injury?
Segment of rib breaks off and becomes detached
37
RF of flail chest injury
Pneumothorax
38
Bloody diarrhoea
Painful abdomen
SNT abdomen
AF
Mesenteric ischaemia
39
Diagnosis of mesenteric ischaemia
Lactate
| CT scan
40
Signs of ischaemic colitis
Transient, less severe than mesenteric ischaemia
| See thumb printing of bowel on abdo xray
41
What is intestinal angina also known as?
Chronic mesenteric ischaemia
42
Triad of chronic mesenteric ischaemia
Severe, long term colicky post prandial abdo pain
Weight loss
ABDOMINAL BRUIT!
43
Why do patients with chronic mesenteric ischaemia get weight loss?
Poor blood supply to the bowel leads to poor absorption
44
Which fissure is across the right lobe and delinieates the UL and ML?
Horizontal fissure
45
What is aphasia
Inability to comprehend or formulate language
46
Major causes of aphasia
CVA
Head trauma
Brain tumours
47
What can infective endocarditis put you are risk of?
CVA because infective emboli can break off and block vessels
48
Name of primary heart tumour
Atrial myxoma
49
Most commonly affected valve in IE
Mitral valve
50
Most common cause of infective endocarditis
S.Aureus in IVDU
51
HIV needlestick protocol
Oral anti-retroviral therapy for 4 weeks
52
Cause of bacterial vaginosis
Overgrowth of gardenerella vaginalis
53
Symptoms of trichomonas
Frothy dischargeand vulvitis, vaiginitis or cervicitis
54
Type of cell seen on microscopy in bacterial vaginosis
Clue cells
55
Signs of bacterial vaginosis
Clue cells on microscopy
Raised (>4.5) pH
Clear, thin, fishy discharge
56
Treatment of bacterial vaginosis
Oral metronidazole
57
Migraine triggers
```
CHOCOLATE
COCP
Hangover
Orgasms
Chocolate
```
58
Really acidotic in a cirrhosis patient =>
Alcoholic ketoacidosis
59
Management of alcoholic ketoacidosis
Infusion of saline and IV thiamine
60
DKA features
Ketonuria
| Hyperglycaemia
61
HHS features
Hyperglycaemia
ABSENCE of ketones
Hypovolaemia
Hyperosmolarity
62
Features of an Addisonian crisis
Hypotension
Hypoglycaemia
N+V
Drowsiness
63
Exacerbating factors of Addison's disease
Infection or steroid withdrawal
64
Above the waist ulcers most likely which type of herpes?
Herpes type 1
65
Below the waist herpes most likely which type?
Herpes type 2
66
Treatment of colicky pain due to mechanical obstruction
Hyoscine butylbromide
67
Drugs for N+V
Cyclizine
Haloperidol
Metoclopramide
68
Antiplatelet treatment for percutaneous coronary intervention
Aspirin
| Ticagrelor
69
Investigation for PSC
MRCP
70
Well's score of 1 and a swollen leg, what should you do?
D-dimer in 4hr
| It's very sensitive for DVT!
71
1st line treatment of VTE?
Rivoroxaban (DOAC)
72
If a DVT is 'likely' 2< what should you do?
Proximal leg vein ultrasound
| If positive -> anticoagulant
73
If proximal leg vein ultrasound is negative, what should you do?
D-dimer
74
What can cause thoracic outlet syndrome?
```
Osseous structure (rib) or soft tissue growth can impair the brachial plexus or arterial system
Either going to get tingling or a pale limb
```
75
Management of Bell's palsy
Prednisolone
| Artificial tears and eye taping
76
Which key drug can increase WCC?
Steroid
Prednisolone
Glucocorticoid
77
Why do steroids increase WCC initially?
Cause demargination of neutrophils from the endovascular lining
78
Signs of idiopathic intracranial hypertension
Chronic, generalised headaches
Visual disturbance
Papilloedema
High opening pressure on LP
79
Biggest modifiable risk factor in idiopatic intracranial hypertension
Weight
80
Delayed puberty and absent sense of smell since birth =>
Kallman's syndrome
81
Hormone levels in Kallman's syndrome
Low/normal FSH
| LOW TESTOSTERONE
82
What is varenicline used for?
Smoking cessation
83
MSM should be offered additional immunisation for ...
Hepatitis A
84
Mid shaft humeral fractures are assocaited with injury to which nerve?
Radial nerve
85
How can you assess the radial nerve?
Extend the wrist
86
Cut off for acute graft rejection
<6mo
87
How might acute graft rejection present?
```
Symptoms of infection
LIF pain
Fever
Rigors
Renal failure
```
88
Best initial management of acute graft rejection
Increase steroid dose
89
What is a typical Addisonian picture?
Low sodium
High potassium
Low BP
90
Symptoms of acute adrenal insufficiency
Delerious and hypotensive after surgery after being on long term corticosteroid therapy
91
Mx of adrenal crisis
Hydrocortisone 100mg IV
| 1L of normal saline over 1hr
92
Cellulitis with haemorrhagic bullae implies
Necrotising fasciitis
93
Most common location of necrotising fasciitis
Perineum
| Fournier's gangrene
94
Mx of necrotising fasciitis
Urgent surgical debridement
| IV antibiotics
95
Iron study levels in haemochromatosis
Raised transferrin saturation, raised ferritin, low TIBC (because left over capacity is reduced)
96
First line Mx of PBC
Ursodeoxycholic acid
97
Complication of PBC
Cirrhosis -> portal hypertension -> ascites -> variceal haemorrhage
98
Mx of itching in PBC
Cholestyramine
99
Which cause of pneumonia is assocaited with erythema multiforme?
Mycoplasma pneumoniae
100
Anaemia and raised bilirubin =>
Haemolysis
101
Mx of mycoplasma pneumoniae?
Doxycycline
102
Mx of hypothyroidism
Levothyroxine
103
Mx of hyperthyroidism
Block and replace
Carbimazole
Levothyroxine
104
Long term steroid use increases risk of...
Fractures
105
Low platelets
Petechial rash
Bleeding
ITP
106
First line treatment of ITP
Oral prednisolone
107
Treatment of localised impetigo
Hydrogen peroxide 1% cream who are systemically well (new first line)
Topical fusidic acid
Shouldn’t be in school because it’s highly contagious
108
What is osteomalacia?
Poor bone mineralisation due to lack of vitamin D
109
Long term steroid use is associated with...
Osteopenia
Osteoporosis (difference = T score remember)
Avascular necrosis
Cushings
110
First line T1DM management
Basal bolus regime = 2 doses of determir
111
How often should HbA1C be monitored in T1DM?
Every 3-6mo
112
What is the target HbA1C?
48mmol
113
Cut off BMI for considering adding metformin to T1DM management?
25
114
Which drug can you give to reduce vasospasm in SAH?
Nimodipine
115
What is the surgical treatment of ruptured berry aneurysm ?
Insertion of a coil by interventional radiologists
116
Complications of SAH (after initial stuff)
Vasospasm
Seizures
Hydrocephalus
Rebleeding
117
What is xanthachromia?
Blood in the CSF, detected 12hr post bleed to confirm SAH
118
What is the medical management of incomplete miscarriage?
Vaginal misoprostol
119
Treatment of leptospirosis
Doxycycline
120
HIV patient, getting clumsy and non-compliant with medication
Leukoencephalopathy
| Usually secondary to JC virus
121
Hyperacute T waves indicate what?
Early myocardial ischaemia
122
Investigations for pumonary oedema
```
Bedside observations
Arterial blood gas
ECG
Troponin if concerned about a new cardiac event
Serum BNP
Chest Xray
```
123
Mx of pulmonary oedema
Take an ABCDE approach
Sit the patient up
Administer oxygen
Ensure IV access
IV Furosemide
Consider non-invasive ventilation such as CPAP if failed medical therapy (usually in an intensive care setting)
Consider further therapies in the intensive care setting such as invasive ventilation and inotropic support if the above fails
124
1st line management of diabetic neuropathy
Pregabalin
125
Management of pericarditis
Naproxen and bed rest
126
Complications of hypomagnesaemia
```
Ventricular arrhythmias - magnesium is an essential cofactor in the cardiac Na/K-ATPase pump.
Weakness
Paresthaesia
Seizures
Coma
Hypocalcaemia - because low magnesium interferes with PTH release.
Hypokalaemia
Chondrocalcinosis
```
127
Causes of unilateral optic disc swelling
Vascular – Diabetes or central retinal vein occlusion
Inflammatory – Uveitis or sarcoidosis
Infective – Herpes, toxoplasmosis or viral
Multiple sclerosis
Lymphoma
128
Features of tetralogy of Fallot
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect
129
What type of drug is octeotride?
Somatostatin analogue
130
Extra-intestinal features of IBD
Dermatological manifestations: erythema nodosum, pyoderma gangrenosum.
Ocular manifestations: anterior uveitis, episcleritis, conjunctivitis.
Musculoskeletal manifestations: clubbing, a non-deforming asymmetrical arthritis, a sacroiliitis.
Hepatobiliary manifestations: primary sclerosing cholangitis (this is much more common in ulcerative colitis than in Crohn's disease).
Other features include AA amyloidosis (secondary to chronic inflammation).
131
Hyperkalaemia ECG changes in order of severity
```
Tall tented T-waves
Flattened P-waves
Prolonged PR interval
Widened QRS complexes
VF/asystole
```
132
Viral causes of gastroenteritis
Rotavirus: most common cause of infantile gastroenteritis
Norovirus: most common cause of viral infectious gastroenteritis in all ages in England and Wales
Adenoviruses: commonly cause infections of the respiratory system but can also cause gastroenteritis, particularly in children.
133
Bacterial causes of gastroenteritis
Staphylococcus aureus: usually found in cooked meats and cream products
Bacillus cereus: mainly found in reheated rice.
Clostridium perfringens: usually found in reheated meat dishes or cooked meats
Campylobacter
E.coli including E.coli 0157 (which can cause haemolytic uraemic syndrome)
Salmonella
Shigella
134
Asymptomatic longstanding AF, first line treatment
Verapamil (rate control)
135
Chads vasc of 1 (1 being for female sex), what do you do?
Nothing
| No need for anticoagulation
136
Splanchnic nerve damage causes
Impotence
| Sexual dysfunction
137
Causes of urinary obstruction Sx
BPH
Prostate cancer
Urethral stricture
