PASSMED MARCH Flashcards
(101 cards)
1
Q
Causes of post-splenectomy sepsis?
A
remember NHS (encapsulated bacteria)
Neisseria meningitis
H. Influenza
S. Pneumonia
2
Q
Whats the causative organism of syphilis?
A
A spirochete called treponema pallidum
3
Q
Outline the 3 steps of the surgical safety checklist and when they occur?
A
Sign in - before induction of anaesthesia
Time out - before incision of skin
Sign out - before pt leaves operating room
4
Q
What is a bisferiens pulse?
A
A double pulse noticed during systole in the peripheral pulse
5
Q
What causes a bisferiens pulse?
A
Aortic valve regurgitation - think of it as back flow of blood causing the double systolic waveform
6
Q
Causes of finger clubbing?
A
Congenital cyanotic heart disease & CF
Lung cancer & absess
UC
Bronchiectasis
Benign mesothelioma
Iidippathic pulmonary fibrosis or IE
Neurogenic tumours
Granulomas e.g. sarcoidosis
7
Q
What antibodies are raised in Hashimoto’s thyroiditis?
A
Anti-TPO and anti-thyroglobulin antibodies
8
Q
What antibodies are raised in Graves’ disease?
A
Anti-TSH in 90%
Anti-TPO in 75%
9
Q
What do we measure thyroglobulin antibodies for?
A
For part of thyroid cancer follow up - measured yearly to detect early recurrent disease
10
Q
Which type of thyroid cancer causes raised serum calcitonin?
A
Medullary carcinoma
11
Q
First and second-line treatment for episodic viral wheeze?
A
SABA or anticholinergic via a spacer
Intermittent LTRA or ICS or both
12
Q
Most likely cause for proximal muscle weakness, respiratory symptoms and an elevated CK?
A
Polymyositis
13
Q
Symptoms of PMR?
A
aching morning stiffness in proximal limb muscles but NOT weakness
mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
14
Q
What can cause a vascular necrosis of the hip?
A
long-term steroid use
chemotherapy
alcohol excess
trauma
15
Q
How does GCA affect the eyes?
A
It causes inflammation of the posterior ciliary arteries = anterior ischaemic optic neuropathy
16
Q
Fundoscopy signs of anterior ischaemic optic neuropathy?
A
Pale swollen optic disc with blurry margins
17
Q
What % of pts with ankylosing spondylitis are HLA B27 positive?
A
90%
18
Q
Outline stepwise treatment of ankylosing spondylitis?
A
NSAIDs and PT
If peripheral joint involvement -> DMARDs
If severe - anti-TNF
19
Q
Contraindications to bisphosphonates?
A
Abnormalities of oesophagus
hypocalcaemia
factors which delay emptying (e.g. stricture or achalasia)
EGFR <35
20
Q
What % of patients with dermatomyositis have malignancy?
A
20-25%
21
Q
What is the triad for feltys syndrome?
A
RA
Splenomegaly
Low WCC
22
Q
Blood test results (ca, vit D, PTH etc) in osteoporosis?
A
All normal
23
Q
What drugs can cause drug-induced SLE?
A
Procainamid
Hydralazine
Quinidine
Lower risk:
Isoniazid
Phenytoin
Minocycline
24
Q
First line treatment for RA?
A
DMARD +/- a short course of bridging prednisolone
25
Presentation of left ventricular aneurysm as a complication of an MI?
Signs of left ventricular failure - bibasal crckles, SOB, loud S3 and S4
Persisting ST elevation
26
How do we manage ascites secondary to liver cirrhosis?
Spironolactone
27
Early symptoms of haemochromatosis?
Fatigue
ED
Arthralgia
28
At what point in pregnancy can a diagnosis of pre-eclampsia be made?
new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria
other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction
29
What type of renal stone is most likely in a pt undergoing chemotherapy for ALL?
Uric acid
30
Which type of renal stones are associated with an inherited metabolic disorder?
Cystine
31
Which renal stones are radio-lucent?
Uric acid
32
Signs in right posterior inferior cerebellar artery stroke (lateral medullary syndrome)?
Cerebellar signs - ataxia, nystagmus
Contralateral limb sensory loss
Ipsilateral horners, facial numbness and dysphagia
33
How is TRALI differentiated from TACO?
TACO - hypertension
TRALI - hypotension
34
Blood results for calcium, ALP, PTH and phosphate in osteoegenesis imperfecta?
All normal
35
Presenting features of osteogenesis imperfecta?
Fractures following minor trauma
Blue sclera
Deafness secondary to otosclerosis
Dental imperfections
36
What is placenta accreta?
Attachment of the placenta to the myometrium due to a defective decidua basalis
37
What is placenta increta?
When chorionic villi of placenta invade into the myometrium
38
What is placenta percreta?
When chorionic villi of placenta invade into the perimetrium
39
Whats the definition of a primary postpartum haemorrhage?
The loss of 500ml or more of blood from the genital tract within 24 hours of the birth of a baby
40
What factors determine if an IV glycoprotein 1B/2a receptor antagonists should be given for NSTEMIs?
High GRACE risk score and whether a percutaneous coronary intervtjopn is to be performed
41
Triad for Wernickes encephalopathy?
Confusion
Ataxia
Nystagmus/opthalmoplegia
42
Presentation of degenerative cervical myelopathy?
Neck pain and stiffness
Tingling or numbness in limbs
Clumsiness in hands/change in dexterity
Imbalance -> falls
Difficulty mobilising
Disturbance of bladder or bowel function
Pain in limbs or trunks
Fatigu
43
What organism causes necrotising fasciitis?
Group A strep
44
Do you get hearing loss in vestibular neuronitis?
No
45
Long term anticoagulant drug and target for metallic valve for aortic stenosis?
Warfarin with an INR target of 3
46
What organism that can cause pneumonia causes hyponatraemia?
Legionella pneumophilia
47
Why when you start a synthetic GnRH drug should you use an anti-androgen alongside at the start?
As GnRH agonists can cause an initial rise in testosterone for 2-3 weeks - this is a tumour flare = can cause bone pain, bladder obstruction
48
Tumour markers for Seminomas?
HCG
49
Tumour markers for non-seminomas?
AFP
Beta-hCG
50
Whats the most Ilkley intracranial haemorrhage when the pt experiences a lucid interval and then briefly regains consciousness before progressing to a coma?
Extradural haematoma
51
Likely cause of ongoing loin pain, haematuria and pyrexia of unknown origin?
RCC
52
Incubation period of impetigo?
4-10 days
53
What % of primary renal neoplasms do renal cell cancers make up?
85%
54
What is the most common histological subtype of renal cell cancer?
Clear cell - up to 85%
55
Features of renal cell carcinoma?
Haematuria
Loin pain
Abdominal mass
Pyrexia of unknown origin
Left-sided varicocele
56
What are the possible endocrine effects of renal cell carcinoma?
Polycthemia - may secrete EPO
Hypercalcaemia - may secrete PTHrp
Cushing - can produce ACTH
57
What is the pathophysiology of ITP
IgG antibodies directed against glycoprotein 2b-3a or 1B complex on platelets
58
Investigations for ITP?
Bone marrow aspiration should be done before starting steroids to rule out leukaemia
59
What would be seen on bone marrow aspiration in ITP?
Normal-increased number of megakaryocytes in the bone marrow
60
What are contraindications for platelet transfusions?
Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopemia
Thrombotic thrombocytopenic purpura
61
What is Samter’s triad?
asthma + aspirin sensitivity + nasal polyposis
62
What is a normal fundal height growth per week after 24/40?
1cm per week
63
When would you expect the fundus to be palpable at the umbilicus?
20 weeks
64
When would you expect the fundus to be palpable at the xiphoid sternum?
36 weeks
65
PH in trichomonas vaginalis?
>4.5
66
What causes scarlet fever?
A reaction to erythrogenic toxins produced by group A haemolytic streptococci usually strep pyogenes
67
Peak age of incidence for scarlet fever?
4 years (2-6)
68
What are features of myelofibrosis?
Anaemia symptoms
Massive splenomegaly which may cause pain or loss of appetite
Hypermetabolic symptoms e.g. weight loss, night sweats
With progression:
Bleeding due to thrombocytopenia
Bone pain
Hyperuricaemia and gout
69
What causes urge incontinence?
Overactive detrusor activity in the bladder
70
Features of papilloedema during fundoscopy?
venous engorgement: usually the first sign
blurring of the optic disc margin
elevation of optic disc
loss of the optic cup
Paton's lines: concentric/radial retinal lines cascading from the optic disc
71
What is a Stanford type A aortic dissection? How does this relate to the DeBakey classification?
involves the ascending aorta and can propagate to the aortic arch and descending aorta
I.e. deBakey type 1 and 2
72
What is a Stanford type B aortic dissection? How does this relate to the DeBakey classification?
When the dissection affects the descending aorta and the origin is distal to the left subclavian artery
This is a type 3 DeBakey classification
73
What investigations are needed for an aortic dissection?
ECG as pt has chest pain so excludes MI
CXR - widened mediastinum
CT angiography of CAP is investigation of choice
If pt is unstable and CT is too risk a transoeseophageal echocardiography may be done
74
Abdominal XR findings in NEC?
Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis
Portal venous gas
Pneumoperitoneum
Rigler and football sign
75
What is rigler sign on AXR?
Air inside and outside of the bowel wall - a sign of pneumoperitoneum
76
What is the football sign on AXR?
Air outlining the falciform ligament and creating a radiolucent oval contour similar to a football - caused by massive pneumoperitoneum
77
What is the strongest risk factor for anal cancer?
HPV infection
78
Age of cystic hygroma vs branchial cyst?
Cystic hygroma. Present before 2
Branchial cyst - presents in early adulthood
79
What is the main cause of mitral stenosis?
Rheunatici fever
80
Symptoms of vestibular neuronitis?
Recent viral infection
Recurrent vertigo attacks lasting hoursdays
N&V
Horizontal nystagmus
(No hearing loss of tinnitus!)
81
How can vestibular neuronitis be differentiated from a posterior circulation stroke?
HiNTs exam
82
Outline how we can use the HiNTs exam to distinguish between peripheral and central causes of vertigo?
If head impulse test shows corrective saccade - peripheral cause
If head impulse test is normal - central cause
If no nystagmus or its unidirectional -peripheral cause
If nystagmus is bidirectional or vertical - central case
Test of skew: if no vertical skew = peripheral cause. If vertical skew = central cause
83
What are the 2 most common valvular heart diseases in order?
1. AS
2. MR
84
Which valve is most commonly affected by infective endocarditis?
Mitral valve
85
Most common causes of aortic regurgitation?
Acute - IE or aortic dissection
Chronic - RF, age related calcification, biscuspud valve, CTD or rheumatological conditions
86
Most common causes of aortic stenosis?
Age related degeneration and calcification or a bicuspid valve
87
Most common causes of mitral regurgitation?
Post-MI - rupture of chordae tendinae and papillary muscle
Mitral valve prolapse
IE
RF
88
What organism is the most common cause of infective endocarditis?
Staph aureus
89
Which cause of infective endocarditis is associated with poor dental hygeiene?
Streptococcus viridans
90
Which cause of infective endocarditis is associated with recent prosthetic valve surgery (<2 months)?
Coagulate-negative staph e.g. Staphylococcus epidermidis
91
Which cause of infective endocarditis is associated with colorectal cancer?
Strep bovis
92
What are the culture negative causes of infective endocarditis?
HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
Coxiella burnetii
Bartonella
Brucella
93
What are the pathological criteria for the modified duke criteria?
Positive histology or microbiology of pathological material obtained in cardiac surgery or autopsy
94
What are the major criteria for the modified duke criteria?
2 positive blood cultures showing typical organisms for IE
Persistent bacteraemia from 2 blood cultures taken >12 hours apart or 3 or more positive blood cultures where pathogen is less specific
Positive molecular assays for specific gene targets
Positive echocardiogram
New valvular regurgitation
95
What are the minor criteria for the modified duke criteria?
Predisposing heart condition or IVDU
Microbiological evidence that does not meet major criteria
Fever >38
Vascular phenomena e.g. petechia, splinter haemorrhages, emboli, clubbing, janeway lesions
Immunological phenomena e.g. oslers nodes, Roth spots, glomerulonephritis
96
How can you diagnose infective endocarditis with modified duke criteria?
One of the following:
- pathological criteria positive
- 2 major criteria
- 1 major and 3 minor criteria
- 5 minor criteria
97
What causes radio-radial delay?
Subclavian artery stenosis
Aortic dissection
Aortic coarctation
98
What causes a collapsing pulse?
Cardiac - AR or PDA
Normal physiological states e..g fever, pregnancy
High output states - anaemia, AV fistula, thyrotoxicosis
99
What is a collapsing pulse also known as?
Water hammer pulse
100
Symptoms of infective endocarditis?
FROM JANE
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anaemia
Nail bed haemorrhage
Emboli (not PE)
101
How can infective endocarditis cause splenic infarction?
A septic emboli can result in this
