Passmed General 2 Flashcards by Evie Wood

What is the typical presentation of Guillain-Barre syndrome?

Ascending, progressive, symmetrical weakness of all the limbs often preceded by an infection. Reduced reflexes,

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What is the pathophysiology of Guillain-Barre syndrome?

immune-mediated demyelination of the PNS

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Where are the majority of ectopic pregnancies?

97% are in the fallopian tubes

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Which location are fibroids that are likely to prevent embryo implantation?

Submucosal

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What medications are used to manage menorrhagia secondary to fibroids?

NSAIDs (mefenamic acid), tranexamic acid, COCP, POP

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What medications can be used to shrink fibroids?

GnRH agonists

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What tests are included in the combined test for Down’s syndrome?

bHCG (raised)
PAPP-A (low)
nuchal translucency (thickened)

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What tests are included in the quadruple test for Down’s, Edwards syndrome and neural tube defects?

alpha-fetoprotein, unconjugated oestriol, HCG, inhibin A

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What tests can be offered after combined screening?

Non-invasive prenatal screening (looks at cell-free fetal DNA)
Amniocentesis and Chorionic villous sampling

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Which part of the pituitary secretes ADH and oxytocin?

Posterior

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What is a glaucoma?

Optic neuropathy associated with raised intraocular pressure

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What is the treatment for primary open-angle glaucoma?

1st Selective laser trabeculopathy, 2nd prostaglandin analogue eye-drops, 3rd BB eye-drops, carbonic anhydrase, sympathomimetic eye-drops

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Which cranial nerve lesion causes a dilated fixed pupil?

CN III

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What does Phenelzine do?

Monoamine oxidase inhibitor

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Name three SSRIs

1st Citalopram and fluoxetine
2nd Sertraline

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What investigations do you do in an acute exacerbation of asthma?

Vital signs
ABG if O2 sats are below 92%

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What ECG change is associated with Wolff-Parkinson-White syndrome?

Short PR interval, wide QRS - with delta wave

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What blood levels can you use to distinguish an upper GI bleed from a lower GI bleed?

High urea in upper GI bleed - due to blood being digested

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What is the immediate management of patients with bradycardia and signs of shock?

500ug atropine - repeated up to 3mg max

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What is the first line management of acute pericarditis?

NSAIDs (Naproxen) and Colchicine

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What are the features of pericarditits?

Chest pain, relieved by sitting forwards, pericardial rub, saddle-shaped ST elevation, PR depression

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What is the first line treatment for painful diabetic neuropathy?

Duloxetine/amitriptyline/gabapentin/pregabalin

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What is the difference in findings of pre-renal and renal AKI?

Pre-renal = low urinary sodium - kidneys hold onto sodium to preserve volume
Renal = high urinary sodium - kidneys cannot retain it

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What is the criteria for malignant hypertension?

BP over 180/120mmHg - send to secondary care immediately

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What are the ECG findings on patients with hypokalaemia?

U waves, small or absent T waves, long PR interval, ST depression, long QT

What is the clinical indication for giving patients with acute bronchitis antibiotics?

CRP level > 100mg/L give Abx immediately CRP level 10-100mg/L offer delayed prescription

What is the typical presentation of acute bronchitis?

Cough that typically starts off dry then becomes productive, usually resolves within 3 weeks.

How can you tell the difference between pneumonia and acute bronchitis?

bronchitis - no focal chest signs other than wheeze pneumonia - dull to percussion, crepitations, bronchial breathing, systemic features

What is the difference between bronchitis and pneumonia?

Pneumonia is an infection of the alveoli, bronchitis affects the larger airways

What are the three stages of AKI?

1: increased creatinine to 1.5-1.9 x the baseline reduced urine output by 0.5 for > 6 hours 2: Increased creatinine to 2-2.9 x the baseline reduced urine output by 0.5 for > 12 hours 3: Increased creatinine to >3 x the baseline reduced urine output by 0.3 for > 24 hours

What are the complications of acute lymphocytic leukaemia?

Anaemia, low IgG leading to infections, autoimmune haemolytic anaemia, transformation to high-grade lymphoma (Richter's transformation)

What is the treatment for necrotising fasciitis?

Surgical debridement, IV abx

What changes are seen in different kidney diseases?

diabetic nephropathy - bilaterally enlarged then bilaterally normal CKD - shrunken kidneys Congenital defect - horseshoe kidney

What is the management of a patient with a wells score for 2 +?

Proximal leg US within 4 hours, interim anti-coagulation

What is the management of a patient with a wells score of 1 point or less with a suspected DVT?

D-dimer within 4hrs with interim anticoagulation

What are the first line anticoagulants used in DVT?

Apixaban or rivaroxaban

How long should people with DVTs have anticoagulation?

3 months if provoked 6 months if unprovoked

Which blood marker is used to assess severity of a C.Diff infection?

Raised white cell count

What is the first line treatment of C.Diff?

Oral Vancomycin for 10 days

What blood gas changes are seen in vomiting?

Metabolic alkalosis - loss of protons, potassium and chloride ions

What is the motor section of the GCS score?

6. obeys commands 5. localises to pain 4. withdraws from pain 3. abnormal flexion to pain 2. extending to pain 1. none

What is the verbal response section of the GCS score?

5. orientated 4. confused 3. words 2. sounds 1. none

What is the eye-opening response for the GCS score?

4. spontaneous 3. to speech 2. to pain 1. none

Can you give a blood transfusion to the child of jehovah's witnesses in a life-threatening situation?

Yes

Which infectious disease presents with koplik spots (small white lesions on buccal mucosa)?

Measles

What is the treatment for stress incontinence?

Pelvic floor exercises, duloxetine (SNRI)

What is the first line treatment of urinary incontinence?

urge incontinence: bladder retraining stress incontinence: pelvic floor muscle training

What are the features of roseola infantum?

high fever: lasting a few days, followed later by a maculopapular rash Nagayama spots: papular enanthem on the uvula and soft palate febrile convulsions occur in around 10-15% diarrhoea and cough are also commonly seen

What is the causative organism of roseola infantum?

Human Herpes Virus 6

What are the features of hypernatremia?

jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma

What is a raised Gamma GT indicative of?

Liver problems, alcohol misuse disorder

What is the first line medication used in stress incontinence?

duloxetine

What is the first-line investigation in reflux nephropathy?

Micturating cystography

What is the treatment for pain in palliative patients with mild-moderate renal failure?

Oxycodone (Fentanyl or buprenorphine for severe renal impairment (<30ml/min))

Give an example of a macrolide antibiotic

axithromycin/clarithromycin

What is the action of metformin?

It increases peripheral insulin sensitivity

What age do men have AAA screening?

What screening tests are offered to women at their booking appointment?

Syphilis, HIV, hep B, sickle cell and thalassaemia

What is the first line antibiotic for tonsillitis?

Phenoxymethypenicillin - 10 day course

How do you treat Ramsey-hunt syndrome?

Oral aciclovir and corticosteroids

What is the treatment for suspected PE with confirmed DVT?

low molecular weight heparin

How does the progesterone only pill interact with antibiotics?

No interactions

What must you give in patients with an SSRI and NSAID?

PPI

What type of pulse is associated with patent ductus arteriosus?

bounding, collapsing pulse

Which medications are used for migraine prevention?

Propanolol Topiramate (not in women of childbearing age or on contraceptives) amitriptyline

What is a common trigger of cluster headaches?

Alcohol

In gestational diabetes with a fasting glucose of <7 what is the first line management?

Diet and exercise for 1-2 weeks

What do you give to a woman exposed to chicken pox for the first time in pregnancy?

Varicella Zoster IgG

What is the mechanism of action of benzodiazepines?

Enhances the effects of GABA

What is otosclerosis?

Adherence of the stapes footplate to the middle ear - bilateral conductive hearing loss with a family history

What is presbyacusis?

bilateral sensorineural hearing loss - age related, gradual onset, affects higher frequencies first

What is open-angle glaucoma?

Most common glaucoma - increased intraocular pressure with visual field loss

What can be used to manage open angle glaucoma?

topical prostaglandins, topical beta-blockers, topical carbonic anhydrase inhibitor, topical alpha agonist (all decrease amount of aqueous humour)

What are the features of acute angle glaucoma?

subacute - episodic halos, impaired vision, eye pain, worse in the dark. fixed dilated pupil, hazy cornea

What is the treatment for acute angle glaucoma?

refer to ophthalmology, drainage

What are the common causes of central vision loss?

B12 deficiency, MS, macular degeneration

What are the stages of hypertension?

Stage 1 – 140/90 Stage 2 – 160/100 Severe - >180 systolic or >100 diastolic

What are the symptoms of hypercalcaemia?

Bones, stones, abdominal groans and psychic moans (high Ca low PO4)

What is the first-line management of stable angina?

BB/CCB/long-acting nitrate BB - if previous MI CCB - if hypertension Nitrates - if preferred or cannot have the other meds

What medications can be used to treat an overactive bladder?

anti-muscarinics - oxybutynin and tolterodine

What conditions are generally autosomal recessive and dominant?

Autosomal recessive conditions are 'metabolic' - exceptions: inherited ataxias Autosomal dominant conditions are 'structural'