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Passmed Flashcards

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1
Q

what should people with STEMI undergoing thrombolysis be given

A

Alteplase and antithrombin (fondaparinux)

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2
Q

what drugs can cause ear ringing

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

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3
Q

first line for acute bronchitis

A

doxycycline

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4
Q

which type of carcinoma is associated with polycythemia

A

renal adenocarcinoma

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5
Q

widening of the mediastinum

A

vascular problems: thoracic aortic aneurysm
lymphoma
retrosternal goitre
teratoma
tumours of the thymus

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6
Q

Ulnar nerve motor innvervation

A

medial two lumbricals
aDductor pollicis
interossei
hypothenar muscles: abductor digiti minimi, flexor digiti minimi
flexor carpi ulnaris

responsible for finger abduction, thumb adduction, and muscle bulk of hypothenar eminence

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7
Q

Ulnar nerve sensory innervation

A

medial 1 1/2 fingers (palmar and dorsal aspects)

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8
Q

Trachea pushed away from white-out CXR

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass

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9
Q

Trachea pulled toward the white-out

A

Pneumonectomy
Complete lung collapse e.g. endobronchial intubation
Pulmonary hypoplasia

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10
Q

most common organism for osteomyelitis

A

stpah aureus most common except in those with sickle-cell disease, where salmonella species dominate

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11
Q

HAP treatment

A

within 5 days: co-amoxiclav or cefuroxime
more than 5 days: piperacillin with tazobactam

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11
Q

Immediate management of acute angle closure glaucoma

A
  • parasympathomimetic eyedrops (pilocarpine)
  • beta blocker eye drops (timolol)
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12
Q

what is required before fundoplication can occur

A
  • oesophageal ph
  • manometry studies
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13
Q

HUS triad

A
  • acute kidney injury
  • microangiopathic haemolytic anaemia
  • thrombocytopenia
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14
Q

Wernike’s encephalopathy

A

chronic alcohol –> thiamine deficiency

  • confusion
  • gait ataxia
  • nystagmus + opthalmoplegia
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15
Q

Kleinfelters vs Kallman

A

Kleinfelters
- small testes
- infertility
- gynaecomastia
- above average height

Kallmans
- anosmia
- NO gynaecomastia

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16
Q

which organism stains with India Ink

A

cryptococcus neoformans

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17
Q

heart failure management

A

1st - ACEi and Beta blocker
2nd - Aldosterone antagonist or ARB or hydralazine and nitrate (especially in people of African or Carribean origin)
3rd - cardiac resynchronisation therapy OR digoxin

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18
Q

aphasia regions and artery supplie

A

Wernike’s - superior temporal gyrus supplied by inferior MCA

broce’s - inferior frontal gyrus supplied by superior MCA

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19
Q

ataxia - where in the cerebellum

A

peripheral ‘ finger-nose ataxia’ - cerebellar hemisphere

gait ataxia - cerebellar vermis

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20
Q

where is th elesion cut-off for autonomic dysreflexia

A

T6 or above

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21
Q

bells palsy

A
  • give oral prednisolone within 72 hours
  • if no sign of improvement in 3 weeks, then urgent referral to ENT
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22
Q

brain absess management

A

surgery
a craniotomy is performed and the abscess cavity debrided
the abscess may reform because the head is closed following abscess drainage.
IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
intracranial pressure management: e.g. dexamethasone

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23
Q

what area of the brain does Huntington’s affect

A

caudate nucelus of the basal ganglia

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24
what area of the brain does Parkinsons suggest
substantia nigra of the basal gangia
25
brown sequard syndrome
- ipsilateral weakness below lesion - ipsilateral loss of proprioception and vibration sensation - contralateral loss of pain and temperature sensation
26
common peroneal nevre lesion
weakness of foot dorsiflexion weakness of foot eversion weakness of extensor hallucis longus sensory loss over the dorsum of the foot and the lower lateral part of the leg wasting of the anterior tibial and peroneal muscles
27
lower motor neuron facial nerve palsy causes
Bell's palsy Ramsay-Hunt syndrome (due to herpes zoster) acoustic neuroma parotid tumours HIV multiple sclerosis* diabetes mellitus
28
4th nerve palsy
vertical diplopia deviate upwards and outwards
29
damage at the wrist - median nerve
paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity) sensory loss to palmar aspect of lateral (radial) 2 ½ fingers
30
damage at the elbow - median nerve
unable to pronate forearm weak wrist flexion ulnar deviation of wrist
31
LOAF muscles of the hand
Lateral 2 lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
32
narcolepsy symptoms
typical onset in teenage years hypersomnolence cataplexy (sudden loss of muscle tone often triggered by emotion) sleep paralysis vivid hallucinations on going to sleep or waking up
33
investigation for genital herpes
NAAT
34
spastic MS treatment
baclofen or gabapentin
35
blood film of hyposplenism
target cells howell-jolly bodies
36
what dementia is associated with MND
frontotemporal dementia
37
chronic schistosoma features
frequency haematuria bladder calcification 'eggshell calcification'
38
chronic schistomoa investigations
asymptomatic - schistosome antibodies preferred symptomatic - urine ot stool microscopy looking for eggs
39
SE - nicorandil
ulceration anywhere in the GI tract
40
reynolds pentad
- fever - RUQ pain - jaundice - hypotension and confusion
41
stable angina - investigations
1st - CT coronary angiography
42
pain relief to use in CKD
mild-moderate: oxycodone severe: bupremorphien or fentanyl
43
electrolyte anomaly most associated with RBC transfusion
hyperkalaemia
44
ITP treatment
1st - oral prednisolone if urgent prcedure required IVIG
45
when is aortic valve replacement considered
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery if symptomatic then valve replacement
46
role of hypoglossal nerve
- motor innervation of the tongue - lesion will cause the tongue to deviate towards the affected side
47
what medication needs to be stopped before a CT scan
metformin
48
serum osmolaitiy equation
2 x(Na) + Urea + glucose
49
visual difference between BCC and SCC
BCC - pale, rolled edges, slow in growth, overlying telangiectasia SCC - usually red, more rapid in growth
50
which anti-TB drug needs visual monitoring
ethambutol
51
PTH in primary hyperparathyroidism vs bony metasteses
pirmary - normal or raised bony metasteses - suppressed
52
indiaction for bariatric surgery
obesity in patients with BMI > 40 kg/m2, or BMI > 35 kg/m2 with comorbidities such as diabetes and hypertension
53
lesion is macula sparing...
occipital cortex
54
when is radiotherapy offered - brest cancer
all women with wide-local excision mastectomy - only if tumor T3-T4 and those with 4 or more positive axillary nodes
55
cellulitis near the nose
co-amoxiclav
56
adverse effects of sulfalezine
oligospermia Stevens-Johnson syndrome pneumonitis / lung fibrosis myelosuppression, Heinz body anaemia, megaloblastic anaemia may colour tears → stained contact lenses
57
DKA when to start potassium and glucose
glucose <14 - infusion of 10% dextrose at 125mls/hr Potassium between 3.5 - 5.5
58
DKA resolution definition
pH >7.3 blodo ketones <0.6 and bicarb >15
59
primary hyperaldosteronism - invesitgations
1st plasma aldosterone/renin ration high -resolution CT if CT normal, adrenal venous sampling can distinguish between adenoma and bilateral hyperplasia
60
cut-offs for impaired glucose tolerance
fasting glucose greater than or equal to 6.1 - 7 OGTT >= 7.8 and <11.1
61
bacterial keratitis causes
staphylococcus aureus contact lenses - psudomonas aeruginosa
62
AAA screenign results
<3 -dishcarge 3 - 4.4 - rescan every 12 months 4.5 - 5.4 - rescan every 3 months 5.5 and above - refer to vascular 2 week wait
63
chromosome anomaly of Turner's
45XO
64
squamous cell carcinoma of the oropharynx - assocation
HPV
65
hodgekins lymphoma - 1 st line
chemotherapy
66
sodium correction complications
hyponatraemia - osmotic demyelination syndrome hypernatraemia - cerebral oedema
67
lateral epicondylitis
wrsit extension elbow supination with extended forearm
68
medial epicondylitis
wrist flexion pronation
69
what is given with isoniazid
pyridoxine prevent peripheral neuropathy
70
eletrolyte anomaly - prolonged diarrhoea
hypokalaemia
71
what medicaiton should all people with CKD be given
statin
72
propofol
anti- emetic properties maintaining sedation on ITU, total IV anaesthesia and daycase surgery
73
sodium thiopentone
used for rapid sequence of induction
74
ketamine
induction of anaesthesia best for those heamodynamically unstable
75
etomidate
no analgesic properties post-op vomititng common
76
medication in STEMI treated with PCI
aspirin 300 mg praugrel/ticagrelor/clopidogrel unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor (tirofiban)
77
medication in STEMi treated with fibrinolysis
aspirin 300mg alteplase + antithrombin follwing procedure give ticagrelor
78
medication in NSTEMI
300 mg aspirin and fondaparinux if no immediate PCI planned low risk - ticagrelor/clopidogrel high risk - ticagrelor/prasugrel - unfractionated heparin
79
medication of preventative oesophagela bleeds
propanolol
80
yellow nail syndrome
yellow nails lymphoedema pleural effusion
81
vaccination in splenectomy
if elective - done 2 weeks prior to operation Hib, meningitis A&C annual influenza vacciantion pneumococcal vaccine every 5 years

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