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passmed corrections april part 2 Flashcards

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1
Q

neck of femur fractures vs disolcation of hip presentation

A

NOF shortened and externally rotated
Posterior dislocation- 90% of hip dislocations. shortened, adducted, and internally rotated.
Anterior dislocation- abducted and externally rotated. No leg shortening.

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2
Q

antiphospholipid syndrome managemnt

A

low dose aspirin as primary thromboprophylaxis
plus low molec hep if preg
warfarin target inr 2-3 if secondary proph
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4

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3
Q

most common site of AAA

A

infrarenal segment of the aorta

palpable pulsatile mass in the mid-abdomen, and back pain

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4
Q

treatment of hyperkalaemia and when to treat

A

over 6.5 or ecg changes

IV calcium gluconate to stabilise myocardium and Iv insulin dextrose infusion to shift potassium from extracellular to intracellular space

Removal of potassium from the body- calcium resonium (orally or enema) enemas are more effective than oral as potassium is secreted by the rectum,
loop diuretics

dialysis if persistent hyperkalaemia and aki

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5
Q

what warrants a 2 week wait referral for haematuria

A

45 or over
AND
unexplained visible haematuria without UTI, or
visible haematuria that persists or recurs after successful treatment of UTI

Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised WCC

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6
Q

Extra-renal features of ADPKD include:

A

Hepatic cysts which manifest as hepatomegaly
Diverticulosis
Intracranial aneurysms
Ovarian cysts
Mitral valve dysfunction
Aortic dissection

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7
Q

indications for dialysis

A

confusion
uraemia
refractory hyperkalaemia
refractory fluid overload
pulmonary oedema refractory hypertension
metabolic acidosis

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8
Q

CKD stages

A

1 >90, some sign of kidney damage
2 60-90 , some sign of kidney damage
3a 45-59, moderate reduction in kidney function
3b 30-44, a moderate reduction in kidney function
4 15-29, severe reduction in kidney function
5 < 15, established kidney failure - dialysis or a kidney transplant may be needed

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9
Q

treatment for rosacea

A

rosacea with predominant flushing but limited telangiectasia- brimonidine gel
first-line topical preparation for rosacea with mild-to-moderate papules and/or pustules- ivermectin gel

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10
Q

SSRI interactions drugs

A

NSAIDs: ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin-consider mirtazapine
aspirin- ppi
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

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11
Q

lumbar puncture findings for GBS

A

increased protein, normal WCC. diagnostic
if also do nerve conduction studies - decreased motor nerve conduction velocity (due to demyelination), prolonged distal motor latency, increased F wave latency

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12
Q

perthes managment

A

To keep the femoral head within the acetabulum: cast, braces
If less than 6 years: observation
Older: surgical management with moderate results
Operate on severe deformities

catterall staging 1-4

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13
Q

scale for open fractures called

A

gustilo and anderson- 1- 3b

<1cm 1

> 1cm 3
abc lebvel of soft tissue affects

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14
Q

how to diagnose hepatocellular carcinoma

A

ct/mri
alphafeto protein
no biopsy as can seed
serial ct and aFP in times of doubt

stage with liver MRI and chest, abdomen and pelvic CT scan.

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15
Q

what level does the spinal cord lesion occur if autonomic hyporeflexia occurs

A

at or above T6. above level of splanchnic nerve

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16
Q

risk of lactic acidosis in metformin reduced by

A

risk is high with renal impairment so dose should be reviewed in patients an eGFR<45 ml/min and stopped in patients with an eGFR<30 ml/min

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17
Q

symptoms of anticholinergic overdose / toxicity

A

agitation, tachycardia, hyperthermia, mydriasis (dilated pupils), dry mouth, and urinary retention

(work on muscarinic cholinergic recpertors)

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18
Q

Cushing’s triad

A

describes the physiological response to raised ICP

bradycardia, hypertension- widened pulse pressure, irregular respirations

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19
Q

subdural haematoma chronic vs acute on ct

A

hyperdense- acute- 48 hours of injury
subacute- days to weeks post-injury
hypodense- chronic- over weeks to months

crescenteric

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20
Q

cytomegalovirus congenital features

A

low birth weight
microcephaly
seizures
a petechial rash hepatosplenomegaly jaundice

hearing loss, vision impairment and learning disability later as complication. some have no symptoms but just complications

most common congenital infection in the UK.

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21
Q

features of congenital rubella syndrome

A

Cataracts, PDA (patent ductus arteriosus), “blueberry muffin” rash

sensorineural deafness, eye abnormalities (e.g. retinopathy and cataracts)

also seizures, Low birth weight, microcephaly

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22
Q

what kind of anaemia caused by methrotrexate

A

Methotrexate therapy may result in a megaloblastic macrocytic anaemia secondary to folate deficiency

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23
Q

how to diagnose latent tb

A

positive tuberculin skin test or Interferon-Gamma Release Assay (IGRA) combined with a normal chest x-ray.
Mantoux test - <5mm then neg, >=5mm positive

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24
Q

tb management

A

RIPE 2 months
RI 4 months

latent- RI with pyroxidine (vitB6) for 3 months or I with pyroxidine for 6 months

meningineal - treat for 12 months plus steroids

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25
rifampicin adverse effects
orange secretions hepatitis flu-like symptoms potent liver enzyme inducer
26
isonazid adverse effects
peripheral neuropathy: prevent with pyridoxine (Vitamin B6) hepatitis, agranulocytosis liver enzyme inhibitor
27
pyrazinamide adverse effects
hyperuricaemia causing gout arthralgia, myalgia hepatitis
28
ethambutol adverse effcets
optic neuritis: check visual acuity before and during treatment
29
4 cs for c dif
clindamycin cephalosporins co-amoxiclav ciprofloxacin/fluoroquinolones
30
treatment of cellulitis
flucloxacilli oral clarithromycin, erythromycin (in pregnancy) or doxycycline if penicillin allergy
31
maintenance fluid
25-30 ml/kg/day of water approximately 1 mmol/kg/day of potassium, sodium and chloride approximately 50-100 g/day of glucose to limit starvation ketosis
32
Gingival hyperplasia causes
phenytoin, ciclosporin, calcium channel blockers and AML, scurvy
33
drugs that may cause urinary retention
NOT A Drop: Urinary retention NSAIDs/OPIOIDs / Tetracyclines / Anti-ACh / Disopyramide
34
ototoxic drugs
Aminoglycoside antibiotics (e.g., gentamicin) Loop diuretics (e.g., furosemide) Platinum-based chemotherapeutics (e.g., cisplatin) High-dose salicylates
35
opthalmic complication of temporal arteritis
anterior ischaemic optic neuropathy -swollen pale disc and blurred margins -diplopia -sudden loss of vision, amaurosis fugax, 'curtain coming down
36
investigation for diagmnosis of UC
colonoscopy + biopsy is generally done for diagnosis however in patients with severe colitis colonoscopy should be avoided due to the risk of perforation - a flexible sigmoidoscopy is preferred
37
treatment for PMS
mild- lifestyle advice moderate -new-generation combined oral contraceptive pill (COCP) eg Yasminµ (drospirenone 3 mg and ethinylestradiol 0.030 mg) severe - (SSRI) continuously or just during the luteal phase (for example days 15-28 of the menstrual cycle, depending on its length)
38
SIADH - drug causes:
carbamazepine, sulfonylureas, SSRIs, tricyclics
39
Ciclosporin side-effects
everything is increased - fluid, BP, K+, hair, gums, glucose immunosuppressant which decreases clonal proliferation of T cells by reducing IL-2 release for: following organ transplantation rheumatoid arthritis psoriasis ulcerative colitis pure red cell aplasia
40
iron study profile in haemochromatosis
↑ Transferrin saturation, ↑ serum ferritin, ↓ total iron binding capacity autosomal recessive disorder characterised by dysregulated iron absorption and metabolism, leading to excessive tissue deposition. hfe mutation transferrin saturation most useful marker ferritin should also be measured but is not usually abnormal in the early stages of iron accumulation
41
non falciparum malaria treatmentn
1- chloroquine (if no resistance suspected). 2- Follow with primaquine for 14 days to eliminate liver hypnozoites and prevent relapse. Note: Test for G6PD deficiency before giving primaquine to avoid haemolysis. If chloroquine resistance suspected: Use an artemisinin-based combination therapy (ACT) instead of chloroquine, then follow with primaquine as above. VOM Plasmodium vivax Plasmodium ovale Plasmodium malariae
42
falciparum malaria treatment
Artemisinin-based combination therapy (ACT), e.g., artemether-lumefantrine or artesunate-amodiaquine. Severe - IV artesunate until patient can tolerate oral medication, then complete with ACT. No primaquine needed: P. falciparum does not form hypnozoites, so no radical cure required. Alternative if ACT unavailable: Quinine plus doxycycline or clindamycin for 7 days.
43
criteria for acute asthma attack discharge
PEFR >75% of expected have had their inhaler technique checked and recorded stable on discharge medications for at least 12-24 hours
44
digoxin toxicity precipitating factors
hypokalaemia increasing age renal failure MI hypothermia hypothyroidism amiodarone quinidine verapamil diltiazem spironolactone ciclosporin Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
45
digoxin toxicity management
Digibind correct arrhythmias monitor potassium
46
sarcoidosis signs
SOB erythema nodosum bilateral hilar lymphadenopathy on CXR, elevated serum ACE and calcium uveitis swinging fever parotid enlargement, Lofgren's syndrome- bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia Heerfordt's syndrome (uveoparotid fever)- parotid enlargement, fever and uveitis secondary to sarcoidosis
47
what is indapamide
thiazde like diuretic
48
postpartum contraception time frames
POP- anytime - preferred in breastfeeding COCP- should not be used in the first 21 days after day 21 additional contraception should be used for the first 7 days. not great for breastfeeding first 6months ish IUD and IUS- up to 48 hours after or 4 weeks after Lactational amenorrhoea method (LAM) 98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum inter pregnancy period less than 12 months risky
49
incubation periods of gastroenteritis bugs
1-6 hrs: Staphylococcus aureus (v), Bacillus cereus(v)* 12-48 hrs: Salmonella(d), Escherichia coli (d) 48-72 hrs: Shigella (d), Campylobacter (d and fluish) > 7 days: Giardiasis(d), Amoebiasis (d)
50
aromatase inhibtors
anastrozole letrozole indicated for ERpos breast cancer in post menopasual side effects osteoporosis NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors hot flushes arthralgia, myalgia insomnia
51
work our serum osmolality
(2 x Na+) + Glucose + Urea.
52
managemnet of c dif
oral vanc oral fidaxomine oral vanc, +- IV metro oral vanc and IV metro in severe recurrent within 12 weeks of symptom resolution: oral fidaxomicin after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
53
laxatives to use
first-line laxative: bulk-forming laxative first-line, such as ispaghula second-line: osmotic laxative, such as a macrogol
54
peutz jeugers syndrome wtf
autosmimal dom assoc with gi cancer responsible gene encodes serine threonine kinase LKB1 or STK11 hamartomatous polyps in the gastronintestinal tract (mainly small bowel) small bowel obstruction often due to intussusception gi bleeding pigmented lesions on lips, oral mucosa, face, palms and soles Management conservative unless complications develop
55
bloods for lung cancer show
raised platelets
56
Arnold-Chiari malformation what is
downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum. Malformations may be congenital or acquired through traum
57
gonorrheaa treatemt
for patients with gonorrhoea, a combination of oral cefixime + oral azithromycin is used if the patient refuses IM ceftriaxone
58
antibodies for limited cutaneous systemic sclerosis
Limited (central) systemic sclerosis = anti-centromere antibodies Mere' means not very much, and so does 'limited' subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia ANA positive in 90% RF positive in 30%
59
antibodies associated with diffuse cutaneous systemic sclerosis
anti-scl-70
60
what stains with India ink on CSF
Cryptococcus neoformans cryptococcus most common fungal infection of CNS
61
most common causes of focal neurological lesions in HIV patients
Toxoplasmosis Lymphoma toxo- multiple lesions, Thallium SPECT negative lymphoma- single, Thallium SPECT positive
62
Jarisch-Herxheimer reaction
is sometimes seen following treatment of syphilis (IM penicillin) fever, rash, tachycardia after the first dose of antibiotic in contrast to anaphylaxis, there is no wheeze or hypotension due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment no treatment is needed other than antipyretics if required
63
dexamethasone suppression test results in cushings
In Cushing's disease, cortisol is not suppressed by low-dose dexamethasone but is suppressed by high-dose dexamethasone adrenal adenoma cortsiol not suppressed by dex at all cus its independent of ACTH
64
burns fluid replacement
first 24hrs = SA% x weight x 4ml. The 24hr fluid requirement for burns is given as 50% over 8hrs followed by 50% over 16hrs
65
nerve damage in carotid endarterectomy
The hypoglossal nerve may be damaged during a carotid endarterectomy as ipsilateral tongue deviation on the protrusion.
66
acute interstitial nepjrtis signs
fever, rash, arthralgia eosinophilia mild renal impairment hypertension caused by drugs: the most common cause, particularly antibiotics penicillin rifampicin NSAIDs allopurinol furosemide systemic disease: SLE, sarcoidosis, and Sjogren's syndrome infection: Hanta virus , staphylococci
67
causes of raised prolactin
the p's pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism phenothiazines, metocloPramide, domPeridone, haloPeridol very rare: SSRIs, opioids
68
causes of haemolysis in g6pd def
anti-malarials: primaquine ciprofloxacin sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas
69
signs of basal skull fracture
Periorbital ecchymosis (raccoon eyes) CSF rhinorrhoea haemotympanum mastoid process bruising (battle's sign).
70
myocarditis vs pericarditis
Myocarditis - ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness pericarditis- no left ventricular dsyfunction, troponin is less likely to be raised and there is classically global concave ST elevation, rather than the focal ecg changes
71
biliary atresia features
jaundice high conjugated bilirubin, growth and feeding disturbance, and hepatomegaly with raised liver transaminases (GGT most raised)
72
thyphoid fever features
within 3 weeks of travel pea green diarrhoea rrelative bradycardia abdo pain malaise headache fever dry cough epistaxis constipation blood culture bone marrow aspiration salmonella group
73
salicylate overdose leads to what on an ABG
mixed respiratory alkalosis and metabolic acidosis.
74
ankylosing spondylitis signs on xray
sacroiliitis: subchondral erosions, sclerosis squaring of lumbar vertebrae 'bamboo spine' (late & uncommon) syndesmophytes chest x-ray: apical fibrosis
75
Painful third nerve palsy =
posterior communicating artery aneurysm
76
A raised pCO2 > 6.0 kPa in asthma indicates
indicates near-fatal acute asthma
77
what cause of Pneumonia is associated with cold sores
caused by Streptococcus pneumoniae, reactives herpes simplex most common cause of comm aquired
78
what are splenectomy patients. more susceptible to
Strep. pneumoniae, Haemophilus influenzae and Neisseria meningitidis encapsulated organisms usually given vaccines against to protect prohpylactic penicillin V
79
exudative pleural effusion signs
high LDH (over two-thirds the upper limit of normal serum LDH) pleural fluid-to-serum LDH ratio > 0.6 pleural fluid protein level > 30 g/L
80
treatment of renal stones
renal stones watchful waiting if < 5mm and asymptomatic 5-10mm shockwave lithotripsy 10-20 mm shockwave lithotripsy OR ureteroscopy > 20 mm percutaneous nephrolithotomy Uretic stones < 10mm shockwave lithotripsy +/- alpha blockers 10-20 mm ureteroscopy Ureteric obstruction due to stones together with infection is a surgical emergency
81
hypocalcaemia features
- perioral paraesthesia, cramps, tetany and convulsions depression, cataracts ECG: prolonged QT interval Trousseau's sign Chvostek's sign side effect of phenytoin use btw
82
features of hyperkalaemia
muscle weakness or cardiac arrhythmias
83
features of Hypokalaemia i
often asymptomatic, but severe hypokalaemia (<2.5mmol/L) may be associated with ascending muscle weakness and cardiac arrhythmias including torsades de pointes
84
features of hyponatreamia
nausea and vomiting, headache and confusion
85
causes of large bowel obstruction
tumour most common diverticular disease volvulus
86
management of beta blocker overdose
if bradycardic then atropine in resistant cases glucagon may be used
87
management of heparin overdose
Protamine sulphate
88
apgar score
0-3 is very low score between 4-6 is moderate low between 7 - 10 means the baby is in a good state assessed at 1, and 5 minutes. If the score is low then it is again repeated at 10 minutes.
89
whats tested in antenatal screening for downs
↑ HCG, ↓ PAPP-A, thickened nuchal translucency If a woman has a 'higher chance' results she will be offered a second screening test (NIPT) or a diagnostic test (e.g. amniocentesis or chorionic villus sampling (CVS) nipt best quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
90
managing ankle fratcure
most important first step when managing patients who present with ankle fractures is reduction of the fracture. weber staging ABC depending on involvement of syndesmosis young- open reduction old- conservatibe management
91
managament of impetigo
hydrogen peroxide 1% cream if systemically unwell- topical antibiotics eg fusidic acid topical mupirocin if MRSA or resistance oral flucloxacillin or oral erythromycin (pen all) if extensive
92
tetrad of HSP
non-thrombocytopenic palpable purpura arthritis or arthralgia, abdominal pain renal disease.
93
what to monitor for heperin and LMWH
APTT for heparin factor Xa for LMWH

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