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RW FY1 > Misc. > Flashcards

Misc. Flashcards

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1
Q

Stress incontinence - Tx?

A

(1) Pelvic floor exercises
(2) Duloxetine
(3) Colposuspension
(4) Intramural bulking agents
(5) nerve stimulation

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2
Q

Urge incontinence - Tx?

A

(1) Bladder re-training
(2) Anti-muscarinics
- Oxybutynin (IR)
- Tolterodine
- Solifenacin
- Darifenacin
(3) - If frail/elderly –> Mirabegron (B3-agonist)
(4) Botox into bladder
(5) Nerve stimulation

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3
Q

High QRISK 2 score. Started on Atorvastatin 20mg ON. 3 month follow up target?

A

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%

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4
Q

Ethylene glycol overdose - Tx?

A
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5
Q

Bisoprolol overdose - Tx?

A

(1) IV Atropine
(2) IV Glucagon

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6
Q

DHx Warfarin. Started new TB drug. Now raised INR.

What drug?

A

Isoniazid

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7
Q

DHx Warfarin. Started new TB drug. Now decreased INR.

What drug?

A

Rifampicin

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8
Q

Which organelle does catabolism of long chain fatty acids?

A

Peroxisome

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9
Q

Dermatitis herpetiformis

Which HLA?

A

HLA-DR3

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10
Q

TCA overdose - Tx?

A

IV Bicarbonate

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11
Q

Conversion ratios

S/C morphine –> PO Morphine

PO Oxycodone –> PO Morphine

PO Codeine –> PO Morphine

PO Tramadol –> PO Morphine

A
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12
Q

Which opioid in renal impairment can you use

A
  • If eGFR 30-60
    • Oxycodone
  • If eGFR < 30
    • Buprenorphine patch
    • Fentanyl parch
    • Alfentanil (under specialist advice)
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13
Q

Bony metastases pain - Tx?

A

Tx: NSIADs

+/- Opiates

+/- Bisphosphonates (pain improves within 4 weeks)

+/- Radiotherapy (pain improves within 6 weeks)

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14
Q

How to titrate morphine

A

Starting dose

  • PO Morphine sulphate 5mg every 4 hours (30mg/day)
    • PRN Oromoprh IR 5mg for breakthrough pain

Up-titrating if pain is not > 90% relieved

  • Method 1
    • Increase dose by 30-50%
  • Method 2
    • Calculate total daily dose (including PRN doses)
    • Divide into 2x 12 hourly doses as BD modified release
  • Calculate new PRN dose (1/6 total daily dose)
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15
Q

Breakthrough pain

Tx?

A

Immediate release morphine sulphate (e.g. Oromorph)

Dose = 1/6 TOTAL daily dose

PRN every 4-6 hours

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16
Q

Palliative medications

Agitation + Anxiety

Agitation + Delirium

SOB

Secretions

Diffuse oral pain

Hiccups

A

Agitation + Anxiety –> Midazolam

Angitation + Delirium –> Haloperidol or Levomepromazine or Chlorpormazine

SOB –> Morphine

Secretions –> Hyoscine butylbromide or Glycopyrronium bromide

Diffuse oral pain –> Benzydamine mouthwash

Hiccups –> Chlorpromazine

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17
Q

Alcohol abstinence maintainence therapy

A
  • Disulfiram (unpleasant symptoms after drinking)
    • MOA: Inhibits acetaldehyde dehydrogenase –> ↑ acetaldehyde –> ↑ N&V, mimics flush reaction
  • Acamprosate (↓ cravings)
    • MOA: unknown –> ↑ GABA –> ↓ craving
    • ↓ pleasurable effects of alcohol
  • Naltrexone
    • MOA: µ-opiate receptor antagonist –> ↑ GABA –> ↓ DA
    • ↓ pleasurable effects of alcohol
    • Can safely drink
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18
Q

Aspirin overdose - Tx

A

IV sodium bicarbonate

If within 12 hours –> Oral activated charcoal

+/- Haemodialysis

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19
Q

Aspirin overdose - ABG

A

Mixed respiratory alkalosis + metabolic acidosis

hyperventilation –> respiratory alkalosis

salicylate –> metabolic acidosis

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20
Q

CO poisoning - Tx

A

Hyperbaric oxygen

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21
Q

“Brick-red skin”

Smell of “bitter almonds”

Headache

Confusion

Ataxia

Diagnosis? MOA? Tx?

A

Cyanide poisoning

Cyanide inhibits Cytochrome C

Tx: IV Hydroxocobalamin

or Combination of Amyl nitrite (inhaled) + IV Sodium nitrite + IV Sodium thiosulfate

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22
Q

Basophilic stippling

Abdominal pain

Confusion

Diagnosis? Treatment?

A

Lead poisoning

Tx: Dimercaprol

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23
Q

Benzodiazepine overdose - Tx

A

Flumazenil

S/E: Seizures

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24
Q

Methanol overdose & Ethylene glycol vose

Tx?

A

Fomepizole

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25
Heparin overdose - Tx
**Protamine sulphate**
26
Iron overdose - Tx
**Desferrioxamine**
27
Lithium overdose - Tx
**IV 0.9% saline** **Haemodialysis**
28
Local anaesthetic toxicity Tx?
**IV Lipid Emulsion 20%**
29
**Aflatoxin** **Aniline** Risk factors for what cancer
**Aflatoxin** -\> alpha fetoprotein -\> **liver cancer** **Aniline** -\> urine -\> **bladder cancer**
30
**Bladder cancer** **Most common type** **Most common type** associated **with Schistosomiasis**
Bladder cancer * **Transitional cell carcinoma** (90%) * **Squamous cell carcinoma** - associated with Schistosomiasis * **Adenocarcinoma** (rare)
31
Once lung cancer is diagnosed, what Ix to assess suitability for surgical resection
**PET scan**: to look for extent of primary tumour and any mets
32
Small cell + Squamous cell lung cancer Paraneoplastic syndromes
33
Tx for neutropenic sepsis
Tazocin + Gentamicin
34
VIPoma presentation
Most arise from Pancreas **WDHA syndrome** * WD = **Watery diarrhoea** * H = **Hypokalaemia** * A = **achlorhydia** (absence of hydrochloric acid secretion)
35
**Factors affecting PSA levels**
36
Medical Tx for prostate cancer
GnRH agonist (**Goserelin**) + Anti-androgen (**Cryproterone acetate**) * co-presecribed to prevent initial increase Testosterone
37
**Thyroid cancer** Most common types Most aggressive type Most slow growing Associated with MEN2A/2B Associated with Hashimoto's thyroiditis
Thyroid cancer ## Footnote Most common types --**\> Papillary** Most aggressive type --**\> Anaplastic** Slow growing **--\> Follicular** Associated with MEN2A/2B --\> **Medullary** (Parafollicular C cells) Associated with Hashimoto's thyroiditis --**\> MALT lymphoma**
38
**Unilateral sensorineural hearing los** **Tinnitus** **Facial palsy** **Absent corneal reflex** Diagnosis? Associations? Most common location
**Acoutstic neuroma = vestibular schwannoma** Associated with **NF2** Most commonly located at the **cerebellopontine angle**
39
**BPPV** **Dix-Hallpike vs Epley**
****_D_**ix-Hallpike** manoeuvre is ****_d_**iagnostic** **Epley manoeuvre** is for **treatment**
40
**Recurrent vertigo** **Caused by movement** Diagnosis?
BPPV
41
**Episodic vertigo** **Sensorineural hearing loss** **Tinnitus** **Sensation of fullness (in affected ear)** Horizontal nystagmus Diagnosis
**Meniere's disease**
42
**_Recent viral illness_** **_Vertigo (room spinning)_** **Horizontal nystagmus** **+ve head impulse** **Normal hearing** **_Single episode_** DDx from BPPV and Vestibular migraine which require recurrent episodes for diagnosis
**Vestibular neuritis** ## Footnote Single episode --\> DDx from BPPV and Vestibular migraine which require recurrent episodes for diagnosis
43
**Recent URTI** **Sensorineural hearing loss** **Vertigo** Diagnosis?
**Labyrinthitis**
44
45
**Von Hippel Lindau** aetiology presentation
Von Hippel Lindau **Autosomal dominant** mutation in VHL gene * Café au lait macules * Haemangiomas * CNS haemangiomas --\> **subarachnoid haemorrhage** * Retinal haemangiomas --\> **Vitreous haemorrhage** **[often 1st sign]**
46
**Alports syndrome** Aetiology Presentation
**Alports syndrome** **X linked dominant** * Triad * **Haematuria** --\> Renal failure * **Sensorineural deafness** * **Ocular pathology** * Lens dislocation * Retinitis pigmentosa * Renal biospy: "**baseket weave appearance**" of GBM
47
**Achondroplasia** Aetiology Features
**Achondroplasia** **Autosomal dominant** mutation in **FGFR3 gene** * **Short stature** * **Long bone shortening** * **Trident hands** * **Flat nasal bridge with frontal bossing** * **Narrow foramen magnum**
48
Bartter vs Gitelman vs Liddle syndrome
**Bartter** (Barffer = Furosemide = Loop diuretic) * Defect in Na-K-Cl co-transporter in LoH (similar to Furosemide) * **Hypokalaemia + Normotension** **Gitelman** (GiTelman = Thiazide = Na Cl in DCT) * Defect in NaCl co-transporter in DCT (similar to Thiazides) * **Hypokalaemia + Normotension** **Liddle** (Liddle Conn / Little Kong) * Defect in Na channels in DCT --\> increase Na absorption (similar to Conn's) * **Hypokalaemia** + **Hypertension**
49
**Pseudomembranes on the tonsils** Diagnosis?
Diphtheria
50
**HIV and opportunistic infections**
51
HHV 1-8
52
**Itchy, maculopapular rash** **Classicaly AFTER administration of Amoxicillin or Cephalosporin** Diagnosis? Cause? Investigations?
**Infectious mononucleosis** **EBV** Monospot test for Heterophile antibodies Anti-EBV antibodies Atypical lymphocytosis
53
HPV types and causes
**Genital warts --\> HPV 6 / HPV 11** **Cervical cancer --\> HPV 16 / HPV 18**
54
**Patches of hypopigmented skin + sensory loss** Diagnosis? Cause?
**Leprosy** *Mycobacterium leprae*
55
**Painful genital ulcer** **Ragged undermined border** **Painful inguinal lymphadenopathy** Diagnosis?
**Chancroid** Haemophilus ducreyi
56
**MSM** (Anal sex) **Painless genital ulcer** **Balanitis / Proctitis / Cervicitis** **Painful inguinal lympadenopathy** Diagnosis? Cause?
**Lymphogranuloma venerum (LGV)** *Chlamydia*
57
**Diarrhoea** **Weight loss, Arthralgia, Lymphadenopathy** **Ophthalmoplegia** **Jejunal biopsy shows Macrophages with Periodic acid schiff granlues** Diagnosis? Cause?
**Whipple's disease** T*ropheryma whippelii*
58
Tx for schistosomiasis
**Praziquantel**
59
Quadrantanopia
Tip: PITS (Parietal-Inferior, Temporal-Superior) for Pie in the Sky **Superior quadrantanopia ==\> Lesion of Temporal lobe** **Inferior quadrantanopia ==\> Lesion of Parietal lobe**
60
Homonymous hemianopia with macular sparing Lesion?
**Occipital cortex**
61
**Gradual reduce visual acuity** **Glare + Halos** **Loss of red reflex** Diagnosis
Cataract
62
**Acute onset, painful red eye** **Haloes** **Fixed dilated pupil** Diagnosis?
Closed angle glaucoma
63
**Asymptomatic** **Peripheral visual field loss / Tunnel vision** **Scotoma** Diagnosis?
Open angle glaucoma
64
**Diabetic** **Sudden, painless visual loss** **New floaters** **Blood on retina** Diagnosis?
Vitreous haemorrhage
65
Drusen
Dry AMD
66
Choroidal neovascularisation
Wet AMD
67
Painless deterioration of central vision
AMD
68
**Sudden onset, painless vision loss** **Pale retina** **Cherry red spot** Diagnosis? Causes?
**Central retinal arterial occlusion** Caused by Embolism or Giant Cell Arteritis
69
**Sudden onset, painless loss of vision** **Retinal haemorrhages** Diagnosis?
**Central retinal vein occlusion**
70
**Floaters + Flashing lights** **Normal vision** Diagnosis?
Posterior vitreous detachment
71
**Floaters + Flashing lights** **Visual field loss** Diagnosis?
Retinal detachment
72
**Vertical diplopia** **Patients head tilted to _contralateral_ side** Diagnosis? Cause?
**4th nerve palsy** **Trauma**
73
**Horizontal diplopia** Diagnosis? Cause?
**6th nerve palsy** Raised ICP
74
**Horizontal diplopia** **Failure of adduction (ipsilateral)** **Abducting nystagmus (contralateral)** Diagnosis? Lesion? Cause?
**Internuclear ophthalmoplegia (INO)** Lesion in medial longitudinal fasciculus (midbrain/pons) Caused by MS
75
Causes of red eye
76
**Holmes-Adie pupil** Features
**Holmes-Adie pupil** * Reecent infection --\> damage to parasympathetic to eye * **Dilated pupil** * **Slowly reactive to light** * Once constricted, it remains abnormally small for a long period of time * +/- **Absent knee or ankle jerks**
77
**Marcus Gunn pupil**
**Marcus Gunn pupil = RAPD** * **MS** * Ischaemic optic disease * Glaucoma
78
Hutchinson's pupil
**Hutchinson's pupil** Compression of CN III by SOL * **Unilaterally dilated pupil** * **Unresponsive to light** *In contrast, Holmes-Adie is dilated + slowly constricts to light*
79
**Argyll-Robertson pupil** Features? Cause?
**Argyll-Robertson pupil** Neurosyphilis = "prostitute's pupil" --\> "accommodates but doesn't react" * Bilaterally, small pupils * Do NOT react to bright light * Normal accommodation

RW FY1 (15 decks)

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