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Mixed Qs Flashcards

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1
Q

obstructive uropathy presentation

A

aka renal calculi
*flank pain
*episodes of low volume void +/- high volume void
* potassium wasting –> feeing weak
* if bilateral –> renal dysfunction

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2
Q

mgx of frostbite

A
  • initial –> rapid rewarming in warm bath 37-39oc
    *analgesia and wound care
    *if no improvement –> angiography or technetium 99 to assess for continue ischaemia 2o thrombosis, perfusion
    *thrombolysis in severe life threatening situations within 24hrs
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3
Q

post concussion syndrome presentation

A

*physical: headaches, dizziness, sleep disturbances
*cognitive:- difficulty concentrating, impaired memory
*emotional:- irritability, anxiety, depression
symptoms within a few weeks to months

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4
Q

somatic symptom disorder

A

*excessive preoccupation with >1 medically unexplained somatic symptoms for >6/12
*can affect social life and job

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5
Q

mgx of pts with psychosis

A
  • any 2nd line antipsychotics except for clonazipine which is only given if pt had 2 drugs no response because of SE agranulocytosis
  • if non adherence to PO meds then consider IM
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6
Q

STI screening

A
  • NAAT for gonorrhoea
    *NAAT for chlamydia
    *RPR test for syphillis
    *HIV test
    and for females –> NAAT for trichomonas
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7
Q

approach to post menopausal bleeding

A
  • transvaginal ultrasound
  • endometrium >4mm –> endometrial biopsy
    *endometrial wall <4mm –> observation
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8
Q

postpartum psychosis

A

*medical emergency
*presents within 2/52 of delivery
*symptoms of hallucinations, delusions, disorganised thoughts + mood symptoms
*high risk of suicide and infanticide
*mgx hospitalisation

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9
Q

features of resp failure in asthma

A

*quiet chest, no wheezing
*using accessory muscles of resp
*altered mental status
* no response to treatment
*low ph
*high pCO2
* mgx –> intubation

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10
Q

Sildenafil contraindications and cautions

A

*contraindicated in patients taking nitrates
*careful use in pts taking alpha blockers
*can cause hypotension

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11
Q

compensatory mechanism in decompensated HF

A

activation of the RAAS –> vasoconstriction of afferent ++efferent arterioles. To maintain GFR and perfusion.
*leading to sodium and water retention –> inadvertently worsening the HF

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12
Q

ALS features

A
  • motor signs only
  • affects UMN in corticospinal tract and LMN
  • LMN –>muscle atrophy, fasciculation, UMN –> hyperreflexia, babiniski +ve,
    *bulbar symptoms
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13
Q

anogenital warts are caused by

A

HPV

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14
Q

mgx of caustic ingestion

A

*ABC’s
*remove contaminated clothing, irrigate exposed skin
*CXR if resp symptoms
* OGD within 24hrs

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15
Q

carpal tunnel mgx in pregnancy

A

*wrist splinting
*local glucocorticoid injection if no improvement
*surgery only indicated if severe symptoms i.e motor weakness, thenar atrophy

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16
Q

metastatic brain cancer

A
  • lung is usually 1o location
    *CT :- multiple well circumscribed discrete lesions with surrounding oedema
  • present with headaches, seizures, cognitive change, focal neurological symptoms often without lung symptoms
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17
Q

gambling disorder

A

persistent and recurrent maladaptive gambling behavior that results in impairment or distress

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18
Q

atrophic vaginitis

A

*aka GU syndrome of menopause 2o low oestrogen
* thin vulvar skin + reduced elasticity
*vagina pale, dry, petechiae, fissures
*dyspareunia, dysuria, itching
*minimal vaginal discharge with raised ph >4.5

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19
Q

vulvar lichen sclerosus

A
  • doesn’t affect vagina
    *dyspareunia, vulvar pruritis
    *thin white skin forming plaques –> destruction of vulvar architecture
    Mgx:- topical corticosteroids
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20
Q

Charcot joint disease

A

aka neuropathic arthropathy
*2o impaired pain sensation and joint position due to DM
*repeated damage and destruction to the joint
*XR:- sublimation/dislocation of hind/rear foot, osseous fragmentation, loss of MT head, new bone formation
loss of arch - rocker bottom feet

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21
Q

Multiple Sclerosis CSF findings

A

oligoclonal bands

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22
Q

OCD

A
  • pregnancy and postpartum increase risk
    *obsession and compulsion, time consuming (>1hr spent) causing significant distress or impairment
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23
Q

Sertoli-Leydig cell tumour features

A

*androgen secreting tumor leads to virilisation
*deepening of voice
*male pattern baldness
*increase muscle bulk
*cliteromegaly

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24
Q

Male pt with lower urinary tract symptoms suggest of BPH best first investigation

A

urinalysis –> rule out UTI , hematuria etc

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25
Hypervoluemic hyponatraemia
* Causes:- HF, cirrhosis, kidney disease *dilatation of splanchnic vessels --> low BP *activation of RAAS --> inc ADH --> water and Na retention --> worsening fluid overload * mgx :- diuretic for hypervolaemia and minimizing hypotension no specific treatment for hyponatraemia
26
Infective endocarditis presentation
*fever, myalgia, wt loss, arthralgia *cardiac symptoms :- new murmur, dyspnoea, cough, oedema *immunologic features:- glomerulonephritis *skin manifestation:- osler's nodes (subcutaneous violaceous nodules on finger pads) * anaemia of chronic disease, raised ESR
27
Transverse myelitis
* early flaccid or late spastic paralysis *distinct sensory level +/- autonomic dysfunction *MRI increased T2 signal in cervical spine *1st line mgx --> IV glucocorticoids
28
symptoms specific for dementia
getting lost in familiar surroundings having difficulty with ADL
29
recent memory impairment next steps
take a medication hx to find modifiable causes can be caused by antihistamine
30
portal HTN presentation
hepatosplenomegaly ascites weight gain LL oedema early satiety
31
ovarian cancer with peritoneal disease features
ascites with no portal HTN NO hepatospleenomegaly NO change in wt ( ascites wt gain cancelled by cachexia wt loss)
32
sudden onset headache with isolated cranial nerve palsy
SAH 2o saccular aneurysm
33
hyperosmolar hyperglycemic state
*type II DM *altered mental state +/- neuro deficit *increased osmolality *signs of dehydration *minimal or no ketoacidosis *glucose level >600
34
intracerebral haemorrhage
*evolves over mins to hrs *focal neurological --> raised intracranial pressure signs --> vomiting, bradycardia, headache *decreased consciousness *CT definitive
35
cyanide poisoning
*house fire, sodium nitroprusside, mining *cherry red skin * tachycardia, tachypnoea, headache, confusion * O2 Sats normal *lactic acidosis
36
methemoglobinaemia
*2o dapsone, nitrates, local/general anaesthetics *cyanosis *low O2 sats despite 100% O2 administration
37
large local reaction
*occurs as a result of bee, ant or wasp bite *swelling and erythema >10cm in duration, continuous with the sting *local IgE allergic reaction
38
meningitis in infants
* fever, crying, inconsolable, poor feeding, sleepiness, bulging fontanelle *LP before imaging as open fontanelle reduce the risk of herniation and increased ICP
39
transverse myelitis
spinal demyelination *neuropathic pain with neck movement *motor weakness with UMN signs *sensory level can be associated wit hMS
40
patients autonomy is subject to...
the physicians medical judgment in all cases
41
carbon monoxide poisoning
* occurs > in winter months due to faulty heating * confusion, headache, malaise, dizziness in severe cases --> MI, seizures, coma, death *pts usually feel better when outside in fresh air * diagnosed by co-oximetery of ABG
42
winging of the scapula
long thoracic nerve injury
43
acromioclavicular ligament sprain
*2o fall or direct blow *pain and weakness of shoulder adduction * abduction is not affected
44
suprascapular nerve entrapment/injury
* result of external compression, fall/ direct blow or repetitive shoulder movement * supplies surpaspinatus and infraspinatus * pain and reduced motion on shoulder abduction and ext rotation * passive movements preserved
45
treatment of 1o syphillis
first line --> IM benzathine penicillin G if allergic to penicillin PO doxycycline or IM/IV ceftriaxone
46
major depressive disorder mgx
first line SSRI 2nd line SNRI (venlafaxine), atypical antidepressants (mirtazapine), norepinephrine-dopamine re-uptake inhibitor (bupropion), serotonin modulation (vilazodone) 3rd line TCA (nortriptillyine) and MAOI (phenelzine)
47
contraceptive containdications in pt wit migraine +aura
oestrogen contraceptive
48
mgx of menopause
*severity of vasomotor symptoms *contraindications to oestrogen *if intact uterus --> oestrogen + progesterone pill *if no intact uterus --> oestrogen patches
49
tumor marker for papillary or follicular thyroid cancer
thyroglobulin
50
next step in children with community acquired pneumonia taking abx with no improvement after 48-72hrs
rpt CXR looking for pneumonia related complications
51
adjustment disorder
*emotional or behavioral symptoms in response to an identifiable stressor *3/12 - 6/12
52
proximal AAA pain
can be upper abdominal, flank or back pain Ix of choice CT abdo
53
acute cardiac tamponade
*Beck's triad *CXR cardiac silhouette is normal as amount of fluid only 100-200mls
54
laproscopic abdominal surgery complication
*peritoneal stretching 2o CO2 insuffulation causing bradycardia, AV block or asystole *due to peritoneal stretch receptors sensing increase in intraabdominal pressure increasing vagal tone
55
papillary muscle rupture
*occurs 3-5 days post MI affecting RCA *delayed or absent repercussion increases risk *new systolic murmur in apex *cardiogenic shock *ECHO severe MR
56
PTSD in a child
*nightmares *traumatic themes in play *struggling with emotional regulation *social withdrawl
57
Hgb Barts and HgB H buzzwords
*gamma tetramer --> hgB barts * beta tetramer --> hgB H * chronic haemolytic anaemia, splenomegaly *microcytic anaemia , inc erythrocytes and target cells
58
rashes that involve palms and soles
*secondary syphillis *hand foot and mouth *kawasaki disease *erythema multiforme
59
binge eating disorder
*episodes of binge eating without follow up compensatory methods to lose wt
60
Bulimia Nervosa
*episodes of big eating followed by compensatory methods to lose weight *BMI normal or overweight *tooth enamel thinning, parotid hypertrophy
61
adolescent idiopathic scoliosis
*seen in pts >10yrs old * Cobb angle > 10 *forward bend test --> asymmetric thoracic or lumbar prominence *Xray 1st Ix of choice
62
S4
* diastolic sound -->2o heart not being able to relax * causes:- acute MI, LV concentric hypertrophy, restrict cardiomyopathy
63
live attenuated varicella vaccination in HIV pts
*Do not give if CD4 count <200 *give if CD4 >200 and no hx of vaccination
64
remaining risk after orhciplexy to treat cryptorchidism
*risk of developing germ cell tumor especially if surgery done after age 1
65
psychiatric condition caused by high dose glucorticoirds
medication induced hypomania *can lead to --> hypomania, mania, psychosis, excitement, irritability, restlessness, euphoria, sleep disturbance, depression
66
Chronic immune thrombocytopenic purpura Mgx
*plt count <100,000 for >1 yr *1st line mgx:-> glucorticoids, Anti D immune globulin (if RH+Ve and Coombs test -ve) and immunoglobulins *2nd line:--> splenectomy, tituximab, thrombopoeitin receptor agonist)
67
Acute haemolytic transfusion reaction
*incompatibility of ABO *occurs within mins to 24 hrs *fever, hypotension, flank pain, hemoglobinuria, chills *causes acute renal filature and DIC *Ix:- direct Coombs test, raised LDH and raised indirect bilirubin
68
ovulation discharge
clear, odourless cervical discharge 2o rising oestrogen during follicular phase
69
hyperosmlar hyperketotic state
*seen in type II DM *dehydration, hyperglycemia, total K body deficit despite inc in serum K
70
1o adrenal insufficiency
aka Addison's disease *hyponatraemia, hypotension, hyperkalaemia, *starts with malaise, weakness, fatigue, wt loss *GI symptoms *postural dizziness, syncope
71
Fournier's gangrene
*life threatening necrotising fasciitis affecting the perineal, scrotal and lower abdomen. *rapid onset swelling ,pain, crepitus of affected area, hypotension, fever *surgical emergency requiring emergency debridement before imaging
72
Blunt abdominal trauma + haemodynamically stable
*is peritonitis present? (severe abdominal pain, rigid abdomen) *if yes --> laparotomy *if no --> FAST---> free fluid? If yes --> CT Abdo/Pelvis if inconclusive or no --> serial abdo X-rays
73
blunt abdominal trauma + haemodynamically unstable
is peritonitis present? *if yes ---> laparotomy *if no ---> FAST --> free fluid present? If yes --> laparotomy if no--> consider CTAP after resus/ diagnostic peritoneal lavage
74
schizophrenia
*multiple delusions *disorganised speech and behaviour *negative symptoms *impact on functioning *>6/12
75
clozapine possible complication and monitoring
*risk of developing agranulocytosis *regular bld test for neutropenia
76
Schizotypal personality
*odd beliefs/magical thinking *eccentric behaviour * reduced ability of social intimacy *paranoid ideation may lead to social anxiety and avoidance *no delusions or hallucinations

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