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Mixed practice review 2 Flashcards

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1
Q

NSTEMI DAPT:
If not high bleeding risk
If high bleeding risk

A

ASPIRIN plus
Ticagrelor
Clopidogrel

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2
Q

Ankylosing spondylitis
Features
‘A’ features

A

Reduced lateral flexion, reduced forward flexion, reduced chest expansion

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis Amyloidosis
AV node block

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3
Q

Skin disorders associated with malignancy

1) Acanthosis nigricans

2) Acquired ichthyosis

3) Hypertrichosis lanuginosa

4) Dermatomyositis

5) Erythema gyratum repens

6) Migratory thrombophlebitis

7) Tylosis

A

1) Gastric cancer = acanthosis nigricans

2) Lymphoma = acquired ichthyosis

3) GI or lung cancer = hypertrichosis lanuginosa

4) Ovarian and lung cancer = dermatomyositis

5) Lung cancer = Erythema Graytum repens

6) pancreatic cancer - migratory thrombophlebitis

7) Oesophageal cancer - tylosis

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4
Q
A
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5
Q

Heart failure:
First line management:
Second line:
Third line:

A

ACEi and Beta Blocker (generally one started at a time)

Aldosterone antagonist

Ivanradine
Sacubitril and Valsartan
Digoxin strongly indicated if patient has AF

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6
Q

Oxford stroke classification: 3 core initial symptoms

A

1) unilateral hemiparesis
2) homonynous hemianopia
3) higher cognitive dysfunction - dysphasia

All 3 for total anterior circulation
2 for partial

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7
Q

Lacunar strokes: one of three of these symptoms

A

1) Unilateral weakness of face and/or leg and/or arm

2) pure sensory stroke

3) ataxic hemiparesis

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8
Q

Posterior circulation stroke
Involves:
Symptoms:

A

Basilar arteries
1) cerebellar or brainstem syndromes
2) loss consciousness
3) isolated homonynous hemianopia

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9
Q

Acute otitis media
Common bugs:

A

Streptococcus pneumoniae, Haemophilus influenzae, moraxella catarrhalis

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10
Q

Prevention of renal stones:
Calcium
Oxalate
Uric acid

A

Calcium: thiazide diuretics increase tubular calcium secretion

Oxalate stones: cholestyramine, pyridoxine

Uric acid: allopurinol, urinary alkalinisation

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11
Q

Key features of PROLIFERATIVE diabetic retinopathy that distinguishes it from non-proliferative

A

Retinal neovascularisation (50% are blind in 5 years)
Maculopathy

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12
Q

Non-proliferative diabetic retinopathy features:

A

Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots

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13
Q

Bed wetting - at which age do you intervene
Management

A

Under 5 years reassurance and advice.

Look for causes
Reward systems
Enuresis alarm
Desmopressin - short term control mostly.

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14
Q

Epididymo-orchitis management
Most commonly caused by:

A

Chlamydia trachomatus and Neisseria gonorrhoea

Management: if STI most likely - organism unknown: IM ceftriaxone single dose plus 100mg Doxycycline PO for 10-14 days

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15
Q

Surfactant deficient lung disease:
Seen in:
Other risk factors:
XR shows:

Management:

A

Premature babies (risk decreases with gestational age)
Male sex, diabetic mothers, C-sections

Ground glass with in distinct heart border

Maternal corticosteroids to induce fetal
lung maturity.
Oxygen
Assisted ventilation (caffeine helps wean)
Exogenous surfactant via ET tube

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16
Q

Anatomical differentiation between inguinal and femoral hernias

Definitions
Incarceration vs strangulation

A

Femoral = inferolateral to the pubic tubercle

Inguinal = superomedial to pubic tubercle

Incarceration = cannot be reduced
Strangulation = likely non-reducible, follows on from incarceration. Causes systemic upset

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17
Q

Causes of increased ferritin WITHOUT iron overload:

A

Inflammation (acute phase reactant)
Alcohol excess
Liver disease
CKD
Malignancy

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18
Q

Increased Ferritin WITH iron overload

A

Hereditary haemochromatosis
Secondary iron overload: repeated transfusions

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19
Q

B symptoms:

A

Weight loss >10% in last 6 months
Fever >38 degrees
Night sweats

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20
Q

CRABBI mnemonic for myeloma

A

Calcium (increased)
Renal (damage which causes thirst and dehydration)
Anaemia
Bleeding (bone marrow crowding = thrombocytopenia)
Bones (may present as pain in the back)
Infection - reduction in normal immunoglobulins -> increased susceptibility to infection

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21
Q

Myeloma investigations findings: Peripheral blood film:
UEs

Bone profile

A

Rouleaux formation

Renal failure

Hypercalcaemia

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22
Q

Electrolyte disturbance in rhabdomyloysis/long lie

A

Hypocalcaemia

Calcium binds to myoglobulin released from damaged muscles causing hypocalcaemia)

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23
Q

ECG features of hypokalaemia

A

U waves
Small/absent T waves
Prolonged QT interval
ST depression
Long QT

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24
Q

Commonest cause of glomerulonephritis worldwide?

How to differentiate this from Post-streptococcal nephropathy?

Treatment:

A

IgA nephropathy

Develops 1-2 WEEKS after strep infection (IgA develops in 1-2 days)

Post-streptococcal has low complement typically

Both involve haematuria and recent URTI

Only if persistent proteinuria - Give ACEi if this does not respond - give immunosuppression with corticosteroids

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25
Hair loss in response to severe stress name:
Telogen effluvium
26
Treatment of choice in capillary haemangioma
Propranolol
27
DVT pathway: Wells score of X means DVT 'likely' Actions on: DVT 'unlikely' score Actions on: If scan us negative but D-dimer is positive:
2 points or more proximal leg ultrasound should be carried out within 4 hours. If US cannot be carried out within 4 hours, D-dimer should be sent and interim anticoagulation commenced. 1 point or less D-dimer -> If positive, proximal leg ultrasound should be arranged within 4 hours Stop interim therapeutic anticoagulation, offer a REPEAT leg vein ultrasound 6 to 8 days later
28
Anti-depressant which is most likely to increase QT interval -> cause torsades du point
Citalopram
29
Treatment of congenital inguinal hernia in paediatrics
congenital inguinal hernias should be REPAIRED promptly once identified More common in babies and boys
30
COCP: Protective against which cancers? Increases risk of which cancers?
Protective: Colorectal, ovarian, endometrial Not-protective: Breast, cervical
31
Breast feeding on anti-epileptics: Which are safe?
Breast feeding is acceptable with nearly ALL AEDs
32
Spider naevi vs talengectasias What are spider naevi common in ?
Spider naevi fill from the centre (think of a spider -> Central body with legs spreading outwards) Talengectasia fill from the edge Liver disease Pregnancy COCP
33
Kallman syndrome gonadotrophins: FSH/LH Testosterone Height Key finding
X-linked recessive LH/FSH low Testosterone low Height: Normal or above avergae (contrary to belief) Lack of smell
34
Effect on pupil with: third nerve palsy Holmes-Adie pupil traumatic iridoplegia phaeochromocytoma congenital Drugs: Atropine, amphetamines, cocaine, TCAs
Mydriasis -> dilated pupil
35
If blood sugar readings still not met on metformin on pregnancy, what should happen and why?
Start insulin -> increasing metformin and waiting to see response will delay necessary control of patients glucose
36
Scabies: How long may itch persist after treatment Treatment:
6 weeks Permethrin is first line Malathion lotion is second line Household contacts should all the treated
37
Psoriasis treatment laddder
Regular emollients may help to reduce scale loss and reduce pruritis 1) Potent topical corticosteroid once daily plus vitamin D analogue applied once daily -> Up to 4 weeks for initial treatment 2) If no improvement in 8 weeks -> Vitamin D analogue twice daily 3) No improvement after 8-12 weeks then offer potent corticosteroid twice daily or COAL TAR applied 1/2 times weekly.
38
Management of Crohn's: Inducing remission Maintaining remission
Glucocorticoids (5-ASAs mesalzine may be used but are less effective) Azathioprine or mercaptopurine (methotrexate is second line or first if TPMT)
39
Live attenuated vaccines: mnemonic and vaccines:
'MY BOO' MMR Yellow fever BCG Oral typhoid Oral polio/rotavirus
40
Vestibular schwannoma: Affected nerves - symptoms
CNV CNVII CNVIII CNV: Absent corneal reflex CNVII: Facial nerve palsy CNVIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
41
Respiratory alkalosis causes:
CHAMPS mnemonic: CNS disease: Stroke, SAH Hypoxia - PE Anxiety Mechanical over ventillation Progesterone, pregnancy Salicylate poisoning Anxiety leading to hyperventilation Pulmonary embolism salicylate poisoning* CNS disorders: stroke, subarachnoid haemorrhage, Encephalitis Altitude Pregnancy *salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis
42
Drug to administer in confirmed SAH: What does it do?
Nimodipine Calcium channel blocker that is specifically indicated for the prevention of cerebral vasospasm following subarachnoid haemorrhage
43
Where does Crohn's most commonly affect:
Terminal ileum
44
Vesicoureteric reflux Initial investigation: Investigation to look for scarring:
Micturating cystourethrogram DMSA
45
Management of whooping cough: Management of whooping cough if child <6 months Is prophylaxis needed?
Azithromycin if within 21 days on on-set Admit to hospital Yes
46
Useful blood test to investigate whether true anaphylaxis has occurred:
Serum tryptase
47
Most common cause of hirsutism: Other causes of hirsutism: Assessment tool for hirsutism:
PCOS Cushing's syndrome congenital adrenal hyperplasia androgen therapy obesity: thought to be due to insulin resistance adrenal tumour androgen secreting ovarian tumour drugs: phenytoin, corticosteroids Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism
48
If on COCP or any hormonal contraception, how long after taking: 1) Levonorgestrel 2) Ulipristal should you wait before re-starting COCP In which common condition is Ulipristal Acetate contraindicated in
1) immediately restart 2) Advised to wait for 5 days Asthma
49
Vit D, Calcium, phosphate, ALP levels in: Osteomalacia - Pagets - Hypoparathyroid - Primary hyperparathyroid -
Osteomalacia- low vit d, low calcium, low phos. High ALP (the bone is trying but has poor supplies) Pagets - Isolated ALP rise (bone is just doing its own thing) Hypoparathyroid- low ca, high phos, normal ALP (ca/phos affected but bones aren't really involved) Primary hyperparathyroid- high ca, low phos, high ALP (the parathyroid is demanding calcium to the blood, so bones have to break down)
50
Phaeochromocytomas presents with triad of what?
headache, palpitations, hyperhidrosis
51
Commonest cause of UTI in Children: Adults:
E.coli E.coli
52
After giving birth, how long are women protected without additional contraception
21 days
53
Shaken baby triad:
Retinal haemorrhages Subdural haemorrhage Encephalopathy
54
How long should antidepressants continue, despite 'resolution' to reduce risk of relapse:
6 months
55
When should OGTT be checked in pregnancy? If prev. GDM ?
16-18 weeks AS soon as possible after booking
56
M/C cause of hypercalcaemia: Causes of hyperparathyroidism? Bloods in primary hyperparathyroidism:
Hyperparathyroidism 85% solitary parathyroid adenoma raised calcium, low phosphate PTH may be raised or (inappropriately, given the raised calcium) normal
57
Blistering skin conditions: Difference between pemphigoid and pemphigus
no mucosal involvement: bullous pemphigoid mucosal involvement: pemphigus vulgaris
58
Excess fluid resus with saline - electrolyte disturbance?
Hyperchloraemic ACIDOSIS
59
Coeliac -> Hyposplenism on blood film:
target cells Howell-Jolly bodies Pappenheimer bodies siderotic granules acanthocytes
60
Iron deficiency anaemia on blood film:
target cells 'pencil' poikilocytes if combined with B12/folate deficiency a 'dimorphic' film occurs with mixed microcytic and macrocytic cells
61
Myelofibrosis on blood film
'tear-drop' poikilocytes
62
Intravascular haemolysis on blood film
schistocytes
63
which finding is an indication that kidney disease is chronic and not acute
Hypocalcaemia
64
Addisons disease investigations: If primary test is unavailable?
Short SYNACTHEN 9am serum cortisol (>500 makes addisons very unlikely) <100 definitely abnormal
65
Tests to confirm Cushing’s syndrome:
Overnight (low dose) dexamethasone suppression test (patients with Cushings do NOT have their morning cortisol spike suppressed 24 hour urinary free cortisol (2 measurements required) Bedtime salivary cortisol (2 measurements required)
66
Cushing’s syndrome: Localisation tests
1) 9am and midnight plasma ACTH (and cortisol) levels -> if acth is suppressed then a non-acth dependent cause is likely such as adrenal adenoma 2) High dose dexamethasone suppression test: 3) CRH stimulation - if pituitary source, then cortisol rises 4) if ectopic then no change in cortisol Petrosal sinus sampling of ACTH may be needed to differentiate between pituitary and ectopic acth secretion.
67
Primary hyperaldosteronism investigations
1) Renin:Aldosterone ratio is first line investigation Following this, a high resolution CT abdomen and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess If this is normal, adrenal venous sampling can differentiate between unilateral a denial and bilateral hyperplasia
68
Acromegaly investigations 1) 2) What levels are used to monitor disease
1) Serum IGF-1 with serial GH measurements 2) OGTT recommended to confirm the diagnosis if IGF-1 levels are raised Also serum IGF-1
69
Gastroenteritis: organism which causes constipation as well as diarrhoea Which other manifestation is associated with this disease:
Typhoid 'rose spots'
70
Dizziness, electric shock sensations and anxiety can occur on the cessation of which widely prescribed medication:
SSRIs (SSRI discontinuation syndrome)
71
Need for contraception after the menopause:
12 months after the last period in women > 50 years 24 months after the last period in women < 50 years
72
UTI in pregnancy: Tx. to be AVOIDED near term:
Nitrofurantoin. First line antibiotic for UTI in pregnancy but is to be avoided near term
73
UTI antibiotic to avoid in FIRST TRIMESTER of pregnancy
Trimethoprim (teratogenic)
74
Osteomalacia -> Calcium: Phosphate: PTH: ALP:
Calcium: decreased Phosphate: decreased PTH: increased ALP: increased
75
Primary hyperparathyroidism -> Calcium: Phosphate: PTH: ALP:
Calcium: high Phosphate: low PTH: high ALP: high
76
Chronic kidney disease (→ secondary hyperparathyroidism) Calcium: Phosphate: PTH: ALP:
Calcium: low Phosphate: high PTH: high ALP: high
77
Paget's disease -> Calcium: Phosphate: PTH: ALP:
Calcium: normal Phosphate: normal PTH: normal ALP: increased
78
Anti-diabetes drug if not tolerating metformin and QRISK > 10% or established CV disease
Add/start SGLT2 inhibitory monotherapy
79
Most common causative organism of infective endocarditis: Previous most common bug:
Staph aureus Strep viridans -> think dental procedure
80
What constitutes severe UC:
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
81
Commonest ocular manifestation of SLE
Keratoconjunctivitis sicca - dry eyes
82
Common condition in which meconium ileus is common. When does meconium ileus present:
Cystic fibrosis Typically in first 24-48 hours of life with abdominal distension and bilious vomiting
83
When does necrotising enterocolitis present? How does it present?
typically in second week of life Dilated bowel loops on AXR, pneumatosis and portal venous air
84
AXR shows double bubble sign, contrast study may confirm -> presents in first few hours of life
Duodenal atresia
85
When does Malrotation with volvulus present
Usually 3-7 days after birth volvulus with compromised circulation may result in peritoneal signs and haemodynamic instability
86
What should be offered post-WLE in breast cancer
Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds
87
Breast cancer screening: When is this offered What does it consist of
women between the ages of 50-70 years Mammogram every 3 years
88
Define fibroadenosis (fibrocystic disease, benign mammary dysplasia)
Most common in middle-aged women 'Lumpy' breasts which may be painful. Symptoms may worsen prior to menstruation
89
Common in women under the age of 30 years Often described as 'breast mice' due as they are discrete, non-tender, highly mobile lumps
fibroadenoma
90
All patients with PVD should be on which 2 drugs
Statin and clopidogrel
91
What is Asherman's syndrome
Asherman's syndrome is a rare condition that occurs when scar tissue forms in the uterus or cervix. Causes secondary amenorrhoea. Commonly after an intra-uterine/cervical procedure
92
What is Sheehan's syndrome?
Sheehan syndrome is a rare condition that occurs when the PITUITARY gland is damaged during childbirth due to severe blood loss Sheehan syndrome describes hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock.
93
1) Where is Broca's area 2) Where is Wernicke's area
1) Frontal lobe - assoc with difficulty in speech PRODUCTION 2) temporal lobe - assoc. with impaired comprehension of speech but intact production
94
Four phases of subacute (De Quervains thyroiditis) What is seen on scintigraphy
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR phase 2 (1-3 weeks): euthyroid phase 3 (weeks - months): hypothyroidism phase 4: thyroid structure and function goes back to normal Globally reduced uptake of contrast Seen m/c post/during viral illness
95
Group B streptococcus in pregnancy antibiotics: when given?
Antibiotics at time of diagnosis AND INTRAPARTUM antibiotics
96
Which blood dyscrasia does antiphospholipid syndrome cause
Antiphospholipid syndrome: (paradoxically) prolonged APTT + low platelets
97
Next line of treatment for lung abscess failing to respond to antibiotics?
Percutaneous drainage
98
Glucose requirement for patients NBM per day in g
50-100g regardless of body mass
99
If patient has stage 1 hypertension, is less than 80 years-old and has QRISK <10, do they need antihypertensives?
No
100
Electrolyte disturbance seen in sarcoidosis:
Hypercalcaemia
101

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