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Flashcards in Passmedicine Deck (245):
1

Procedures that require special preparation:

Thyroid surgery; vocal cord check.
Parathyroid surgery; consider methylene blue to identify gland.
Sentinel node biopsy; radioactive marker/ patent blue dye.
Surgery involving the thoracic duct; consider administration of cream.
Pheochromocytoma surgery; will need alpha and beta blockade.
Surgery for carcinoid tumours; will need covering with octreotide.
Colorectal cases; bowel preparation (especially left sided surgery)
Thyrotoxicosis; lugols iodine/ medical therapy.

2

Preoperative steps for diabetic Pts

Poor Glycaemic control inc rsk of Infx

1st on list
Stop long acting Insulin the night before
Check glucose regularly
Insulin sliding scale until 1st meal
5% Dex c¯ 20mmol
KCl 125ml/hr

3

Testing for PSA

6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise or ejaculation

4

Differentials for breast lump

Fibroadenoma - highly mobile smooth
Breast cyst - Small discrete, fluctuant
Sclerosing adenosis - may mimic Ca on mammography
Fat necrosis - trauma
Duct papilloma - discharge
Breast Ca - Hard, irregular, tethering (Paget's disease of the breast = eczematous changes around the areola)

5

Feeding in head injury w/o BOS #

NG tube

6

Feeding after oesophagectomy

Jejunostomy
RIG

7

Coffee bean on AXR

Sigmoid volvulus

8

Volvulus MX

Sigmoid: Rigid sigmoidoscopy
Caecal: operative, often hemicolectomy

9

Caecal volvulus RF's
Sigmoid volvulus RF's

Pregnant, adhesions

Older pts, chronic constipation, Chagas

10

Hartmann's procedure

Anterior resection, anorectal stump and end colostomy.

11

Specific pre-operative complications: Anticoagulation

Based on thromboembolic risk
Low risk e.g. AF
Stop Warfarin 5d's pre-op
Restart next day
High risk e.g.
Stop Warfarin 5d's pre-op
Start LMWH
Stop LMWH 12-18hrs pre-op
Restart LMWH 6hrs post op
Start Warfarin next day
Stop LMWH when INR>2

12

Anal/rectal cancer procedure

Abdominoperineal resection
+/- Total mesorectal excision (fatty tissue and LN's)

13

TUR syndrome

Complication of TURP
Absorption of electrolyte-free irrigation fluid
1. Hyponatraemia: dilutional
2. Fluid overload
3. Glycine toxicity

14

Universal donor

O rhesus negative

15

Colle's #

FOOSH
Dorsal displacement and angulation of distal bone segments
1 inch proximal to radio carpal joint

16

Smith's #

Opposite of Colle's
Palmar angulation

17

Bennett's#

Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal

18

Monteggia's #

Dislocation of the proximal radioulnar joint in association with an ulna fracture
Fall on outstretched hand with forced pronation
Needs prompt diagnosis to avoid disability

19

Galeazzi's #

Radial shaft fracture with associated dislocation of the distal radioulnar joint
Direct blow

20

Pott's #

Bimalleolar ankle fracture
Forced foot eversion

21

Barton's #

Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
Fall onto extended and pronated wrist

22

Lisfranc #

Tarso-metatarso joint injury. Subtle widening in between 1st and 2nd Metatarsals

23

Billous vomiting Differentials

Duodenal atresia - assoc w/ Down's
Malrotation w/ volvulus - 3-7 days of life
Meconium ileus - 24-48hrs of life, assoc w/ CF
Necrotising enterocolitis - 2nd wk of life, assoc w/ prematurity and intercurrent illness

24

AXR finding chronic pancreatitis

Calcific foci

25

Chronic pancreatitis

pain following a meal, radiates to back
steatorrhoea 5 and 25 years after the onset of pain
diabetes mellitus
Ix
AXR - calcified foci
ACT - more sensitive
Function test - faecal elastase
Mx
Pancreatic enzyme supplements
Analgesia

26

Imatinib

Gastrointestinal stromal tumours

27

Infliximab
Adalimumab
Etanercept

TNF alpha inhibitor
Chron's
Rheumatoid disease

28

Basiliximab

IL2 binding site
Renal transplants

29

Bevacizumab

Anti-VEGF
Colorectal
Glioblastoma
Renal

30

Trastuzumab

HER receptor
Breast Ca

31

Cetuximab

EGF inhibitor
Colorectal Ca

32

Vessel causing upper GI bleed in duodenal ulcer

Gastroduodenal

33

Pseudomxyoma peritonei

rare mucinous tumour most commonly arising from the appendix. The disease is characterised by the accumulation of large amounts of mucinous material in the abdominal cavity. It is rare, with an incidence of 1-2/1,000,000 per year

34

Drug used in SAH to minimise complications

Nimodipine - to prevent vasospasm

35

Irregular nodule in Testes AFP and HCG not raised

Seminoma

36

TPN complications

Derranged LFT's

37

Unexplained IDA Ix

Faecal occult blood testing

38

Urgent referral guidelines Bowel Ca

patients >= 40 years with unexplained weight loss AND abdominal pain
patients >= 50 years with unexplained rectal bleeding
patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces (see below)

39

Hormone therapy for Breast Ca (ER+ve)

Anastrozole

40

UC and Crohn's differences

UC
Bloody
Rectal extending proximally
Submucosal inflammation
Crypt abscesses
Primary sclerosing cholangitis
Crohn's
Non bloody
Skip lesions
All thickness inflammation
Caseating granulomas

41

Extra intestinal manifestations of IBD

Skin - Pyoderma gangrenosum, Clubbing
Eyes - Iritis, Conjunctivitis
Joints - Arthritis, Ank spond, sacroilitis
HPB - PSC (UC), Cholangiocarcinoma (Crohn's)

42

Inducing remission UC

1st line: 5-ASA
2nd line: Prednisolone

43

Maintaining remission UC

1st line: 5-ASAs PO – sulfasalazine or mesalazine
 Topical Rx may be used in proctitis
2nd line: Azathioprine or 6-mercaptopurine
 Relapsed on ASA or are steroid-dependent
 Use 6-mercaptopurine if azathioprine intolerant
3rd line: Infliximab / adalimumab

44

Indication for surgery in IBD

Perforation
Haemorrhage
Failure to respond to Rx
Ca

45

Inducing remission in Crohn's

1st line: glucocorticoids. Budesonide is an alternative
2nd: 5-ASA drugs (e.g. mesalazine) not as effective
3rd: azathioprine or mercaptopurine not used as monotherapy. Methotrexate is an alternative to azathioprine
4th: infliximab is useful in refractory disease and fistulating Crohn's. Patients typically continue on azathioprine or methotrexate
N.B. metronidazole is often used for isolated peri-anal disease

46

Rx for Diabetic neuropathic pain

1st line: amitriptyline, duloxetine, gabapentin or pregabalin

if the first-line drug treatment does not work try one of the other 3 drugs
tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain
topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
pain management clinics may be useful in patients with resistant problems

47

Rx for diabetic gastroparesis

Metoclopramide, domperidone or erythromycin

48

Diabetic gastroparesis Px

Erratic blood glucose control, bloating vomiting

49

Increased INR 5-8 No bleeding Rx

Withhold 1-2 doses, reduce maintenance dose

50

Increased INR 5-8, minor bleeding Rx

Stop warfarin
IV vit K 1-3mg
Resume when INR <5

51

Increased INR >8 no bleeding Rx

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

52

Increased INR >8 minor bleeding Rx

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

53

Major bleeding increased INR Rx

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

54

ECG features of Hypokalaemia

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

55

ECG features of hyperkalaemia

Peaked T waves
Flattened P waves
↑ PR interval
Widened QRS
Sine-wave pattern → VF

56

Monitoring of T1DM

HbA1c
every 3-6 mnths
Aim for 6.5% or lower
Bld Glucose
4x a day, before every meal and before bed
Aim for 5-7 on waking and 4-7 before meals
Inc frequency with illness and sport

57

PEA Rx

DR ABCDE
CPR for 2 mins assess rhythm
1mg adrenaline, then adrenaline every other cycle

58

Drug causes of galactorrhoea

Metoclopramide
Chlorpromazine
Haloperidone
Domperidone

59

Ix of choice for suspected Bladder Ca

Cystoscopy

60

Chemo that causes cardiomyopathy

Doxorubicin

61

Side effects of methotrexate

Lung fibrosis
Liver fibrosis

62

Acute causes of confusion

Constipation
Pneumonia
UTI
COPD exacerbation

63

Mx of Bell's palsy

Conservative
Eye drops
Educate
Med
Pred if w/in 72hrs onset

64

Inheritance of HOCM

Autosomal dominant

65

Lung function results for idiopathic pulmonary fibrosis

Increased FEV1/FVC ratio
Reduced transfer ratio

66

Restrictive lung diseases

Pulmonary fibrosis
Sarcoidosis
Acute respiratory distress syndrome
Neuromuscular disorders

67

Obstructive lung disorders

Asthma
COPD
Bronchiectasis

68

Ix for Legionella pneumonia

Urinary antigen test

69

K/Na/Cl requirement /kg/day

1mmol/kg/day

80kg pt = 80mmol

70

Water requirement /kg/day

25-30ml/kg/day

80kg pt = 2 liters

71

Glucose requirement /kg/day

50-100g/kg/day

72

Diagnosis of DM

If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)

Asymptomatic must have two recorded values

73

Rx of Epilepsy

1st line generalised: Sodium valproate
1st line partial: Carbamazepine
2nd line: Lamotrigine

74

Skull XR in exam

Paget's disease - Marked thickening of the calvarium

75

pANCA most strongly associated w/

Churg-Strauss

76

cANCA most strongly assoc w/

Granulomatosis with polyangitis

77

Sickle cell anaemia
Sudden low Hb and low reticulocyte count

Parvovirus

78

Blood transfusion threshold

70g/L

79

Diagnostic Ix for asthma

Fractional exhaled nitric oxide FeNO
Spirometery and bronchodilator reversibility test

80

DM diagnosis based on HbA1c

>6.5% with symptoms

81

Diarrhoea in HIV pts

Cryptosporidium

82

Resp infx in HIV pts

Histoplasmosis

83

Carcinoid syndrome

Liver mets that release serotonin into the circulation
Hypotension
watery diarrhoea

84

Ototoxic drugs

Loop diuretics

85

QRISK2

Risk of cardiovascular disease

86

Monitoring of statins

Check LFT's
Discontinue if 3x the upper limit

87

Infx assoc w/ Guillian-Barre syndrome

Campylobacter jejuni

88

Which joint condition is assoc w/ lung fibrosis

Rheumatoid arthritis

89

Triad of symptoms for Ascending cholangitis

Fevers
RUQ pain
Jaundice

90

Ca assoc w/ Crohn's

Mucosal associated lymphoid tissue lymphoma

91

Marker raised to diagnose anaphylaxis

Tryptase

92

Opioids in CKD

Buprenorphine, fentanyl, alfentanil

93

Wilson's disease Px

diagnostic Ix

Dementia, tremor, dyskinesias

Cu & caeruplasmin, urinary Cu excretion

94

Wilson's Rx

Chelating agent, Penicillamine

95

Peutz-Jeghers syndrome
Def
Px

Autosomal dominant condition causing harmatomatous polyps in the GI tract. characteristically having freckles on the lips face palms and soles

Px: intestinal obstruction (intussusception), GI bleeding

96

Glucose in DKA and HHS
Hyperglycaemic hyperosmolar state

>30mmol/L

97

Scoring system for PE

Wells
>4 PE likely
<4 PE unlikely

98

Child-Pugh scoring system

Liver cirrhosis

99

APGAR

Child's health straight after birth

100

HAD
GAD

Hospital anxiety and depression
general anxiety scoring system

101

Cha2ds2vasc

Anticoagulation with AF

102

Aspirin MOA

Antiplatelet inhibits production of thomboxane A2

103

Clopidogrel MOA

Antiplatelet Inhibits ADP binding to platelet receptor

104

Enoxaparin

Anticoag Activated antithrombin III = potentiates inhibition of anticoagulation factor Xa

105

Fodaparinux MOA

Anticoag activaates antithrombin III = potentiates inhibition of anticoagulation factor Xa

106

Abciximab MOA

GpIIb/IIIa receptor antagonist

107

PDA pulse character

Bounding, collapsing

108

Qrisk scoring system

risk of stroke w/in next 10 yrs
>20= statin

109

ETOH RF for which cardiomyopathy

Dilated

110

PCI indication on ECG

ST elevation
>1mm in II, III or aVF
>2mm in 2 or more consecutive anterior leads v1-v6

111

Glycaemic control following MI

Dose adjusted insulin infusion

112

HF investigation
w/ prev MI
w/o prev MI

w/ = Echo
w/o = BNP

113

Features of Small cell lung cancer

Usually central
Associated w/ secretions:
ADH - hyponatraemia
ACTH - Cushing's syndrome
(Lambert-Eaton syndrome Ab's to Ca channels mimicking MG)

114

Mx of Small cell lung cancer

Very early disease: T1-2aN0M0 considered for surgery
Most Pts recieve cehmo w/ radio adjuvant

115

Indication for long term O2 therapy

Two arterial bld tests w/ O2<7.3kPa

116

Transpyloric plane

Level L1
2nd part of the duodenum
Pylorus - stomach
left kidney hilum
Fundus of gallbladder
Neck of pancreas
Duodenojejunal flexure
SMA
Portal vein
Lt and Rt colic flexurespleen

117

Histological findings of TB tissue biopsy

Epitheliod histiocytes found in granuloma

118

Histological findings

Owl-Eyes nucleus
Reed sternberg
Psammoma bodies
Keratin pearl
Poikilocytes

CMV infx
Hodgkins lymphoma
Papillary thyroid carcinoma
SCC in lung Ca
Myelofibrosis

119

COPD Rx using salbutamol inhaler PRN

FEV1>50% - LABA or LAMA
FEV1<50% - LABA + ICS or LAMA

120

Pneumonia assoc w/ birds

Chlamydia psittaci
treated with tetracyclines

121

Pneumonia assoc w/ alcoholics and red currant jelly like sputum

Klebsiella
Can cause pleural empyema formation

122

Buproprion MOA

Norepinepherine and dobutamine reuptake inhibitor and nicotinic antagonist

123

Femoral nerve injury Px

Weak hip flexion
Weak knee extension
Impaired quadriceps tendon
Sensory deficit in anteromedial aspect of the leg

124

Common nerves affected during surgery:
1) Varicose veins
2) Posterior approach to the hip
3) Posterior triangle lymph node biopsy
4) Lloyd davies stirrups
5) Thyroidectomy
6) Anterior resection of rectum
7) Axillary node clearance
8) Inguinal hernia
9) Carotid endarterectomy

1) Sural and saphenous nerves
2) Sciatic
3) Acessory nerve
4) Common peroneal
5) Recurrent laryngeal nerve
6) Hypogastric autonomous nerves
7) Long thoracic nerve, thoracodorsal, intercostobrachial nerves
8) Ilioinguinal nerve
9) Hypoglossal

125

Sensation to the anterolateral aspect of the thigh

Lateral cutaneous nerve of the thigh

126

Charcot's triad
Whats it for
Whats it made up of

Mx of condition

Ascending cholangitis

RUQ pain
Jaundice
Fever

Mx
IV Abx
ERCP

127

Anaesthetic agent with anti emetic properties

Propofol

128

Neuro conditions Put simply
G
M
M
M

Guillian-Barre syndrome: immune mediated post (camp J) infx, causing ascending weakness (proximal legs 1st)
Motor neuron disease: UMN + LMN Sx's of unknown Ax after 40, clinical diagnosis = no sensory signs,
Multiple sclerosis: relapsing remitting, affecting eyes, motor nerves (weakness), or sensory nerves (parasthesia)
Myasthenia gravis: Autoimmune affecting nAChr, causing progressive weakness w/ inc used, eyes, swallowing

129

Guillian barre
Ax

Px

Ix


Mx








Ax: Immune mediated demyelination of PN's often triggered by an infx (campylobacter j)

Px: Growing weakness i.e.
Symmetrical: ascending (legs 1st) flacid weakness/paralysis
LMN signs: areflexia, fasciculations
Proximal > distal trunk, respiratory, CN's esp VII
Progressive phase lasts < 4wks

Ix: clinical diagnosis, anti-ganglioside Abs, Spirometry for lung function monitoring, NCS dec or normal

Mx:
Supportive: Airway, Analgesia, Autonomic - inotropes, Antithrombotic - TEDS, LMWH
Med: IVIG or plasmapheresis

85% complete recovery

130

Motor neuron disease
Px

Ix

Mx

Cluster of degenrative disease characterised by axonal degeneration
Px:
UMN+LMN signs, absence of sensory Sx's, doesn't affect eye movements

Ix: clinical diagnosis, MRI to exclude structural lesions, LP to exclude inflam, NCS exclude neuropathy

Mx:
Cons: MDT, palliate
Med: Riluzole (prolongs life by 3mnths), Sx treatment i.e.
Resp failure - NIV
Dyspagia - RIG
Drooling - propantheline

131

Multiple sclerosis
Def

Px

Ix

Mx

Chronic progressive inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space
Classified into relapsing-remitting, progressive, secondary progressive and progressive relapsing

Px: TEAM
Tingling: parasthesia
Eye: optic neuritis (dec central acuity + movement pain)
Ataxia +cerebellar signs
Motor: usually spastic paraparesis, swallowing

Ix: diagnosis clinical MacDonalds criteria
Fundoscopy - swollen optic nerve head
Gd-enhancing MRI - Plaques
LP - oligoclonal Abs

Mx
Acute relapse - high dose steroids dec dur of attacks
Disease modifying - beta interferon reduces relapse rates
Other medical - Glatiramer, natalizumab, fingolimod

132

Myasthenia Gravis
Def

Px

Ix

Mx

Autoimmune disease mediated by Abs vs nAChr in the neruomuscular junction

Px: inc muscular fatigue
Extra-ocular - bilateral ptosis, diplopia
Bulbar - voice deteriation on speaking for 2mins
Face - myasthenic snarl on smile attempt
Limb - asymmetrical limb weakness

Ix
Tensilon test - edrophonium IV, +ve if improvement
Anti-AChr Abs
EMG - dec t train of impulse

Mx
Sx control - long acting anticholinesterase (pyridostigmine)
Immunosuppression - Pred
Myasthenic crisis - Plasmapheresis or IVIg

133

Rx epilepsy guidelines

1st seizure = referral to epilepsy clinic only unless - neuro deficit, sturctural abnormality, EEG changes
2nd = Sodium valproate (carbamazepine for focal)

134

Migraine Rx

Acute episode
1st - paracetamol + metoclopramide/domperidone
2nd - NSAID (ketoprofen) + M/D
Prophylaxis
Avoid triggers
1st - Popanolol, topiramate
Riboflavin, acupuncture

135

Triceps reflex

C7-C8

136

Biceps reflex

C5-C6

137

Ankle reflex

S1-S2

138

Knee reflex

L3-L4

139

Absence seizure EEG sign

3Hz symmetrical oscillations

140

Cluster headache
Px

Rx

Px
Rapid onset severe pain behind one eye
Red, watery eye, nasal congestions
Miosis, ptosis
15-3hrs, 1-2x/day, mostly nocturnal
Cluster last 4-12wks, remission lasts 3mo-3yrs

Rx
High flow O2
Sumitriptan
Prevention - verapamil

141

Triptan
MOA

Inidication

SE

5HT1 agonist

Migraine

Triptan sensations - tightness around the chest, tingling, heat, heaviness

142

Verapmil or digoxin in WPW syndrome

Contraindicated as may predispose to VT or VF

143

Child-Pugh

Scoring system for liver cirrhosis
Bilirubin
Albumin
Ascites
Prothrombin time
Encephalopathy

144

Warterloo on PT

Warfarin Prothrombin time

145

MELD

Calculate pts survival w/ liver cirrhosis

146

Drug contraindicated in Parkinson's

Metoclopramide - D2 antagonist, Ind: nausea, GORD
Chlorpromazine
Haloperidol

147

Polyposis syndromes

FAP - APC gene, screen and resect,
HNPCC - colonic Ca, endometrial Ca
Peutz-Jeghers - pigmentation, harmatomas

148

COPD signs with basal ephysema and derranged LFT's

alpha1-antitrypsin deficiency

149

Statin adverse effects

Myopathy: myalgia
Liver impairment: Rx discontinued if LFT>3xULN
Intracerebral haemorrhage

150

Atorvastatin dose
Primary prevention
Secondary prevention

1ry - 20mg
2rd - 80mg

151

Thiazide diuretics SE

HypoNa, HypoK, HyperCa
Postural hypotension
D\ehydration
Gout
Impaired glucose tolerance

152

Ix of choice for liver fibrosis

Transient elastography

153

Churg-Strauss

Small-medium vessel vasculitis
Px
Asthma
Paranasal sinusitis
Mononeuritis multiplex
pANCA

154

Test for H. Pylori

Urea breath test

155

Weber's syndrome

III nerve palsy
Contrlateral weakness

156

MEN type I

MEN type IIa

MEN type IIa

MEN type I:
3 P's - parathyroid, pituitary, pancreas (ulceration)
MEN type IIb:
2 P's - Phaeo, parathyroid
MEN type IIb:
1 P - Phaeo

157

Pneumonia w/:
Derranged LFT's

Hyponatreamia and lympopaenia

Sig O2 desat on exercise

Upper lobe consolidation

Mycoplasma

Legionella

PCP

TB/Kleb

158

MRSA treatment
1st line
2nd line

Vancomycin

Linezolid

159

Amyloidosis
Def

Px

Ix

Mx

Extracellular deposition of insoluble fibrillar protein

Deposition leads to organ dysfunction e.g. nephrotic syndrome

Congo-Red stain
Serum amyloid precursor scan
Rectal biopsy

160

Blood products in haemorrhage w/ anticoagulants

FFP - clinically sig. but not major haemorrhage INR>1.5

Cryoprecipitate - haemophilliacs, liver disease

Prothromin complex concentrate - severe bleeding, intracranial bleeding

161

Cytotoxic side effects
Methotrexate

Cisplatin

Doxorubicin

Myelosuppression, liver fibrosis, mucositis

Hypomagneseamia

Cardiomyopathy

162

Delerium Rx

Haloperidol or olanzopine 1st line

163

Peri-arrest bradycardia Rx

500micrograms Atropine

164

ECG leads location and blood supply

I - lateral, Lft circumflex artery
II+II+aVF - inferior, rt coronary artery
v1-v2 - anterior, LAD
v3-v4 - septal, LAD
V5-v6 - Lateral, left circumflex

165

Takayasu arteritis

Large vessel vasculitis
Absent pulse
females and asians

166

Statin and erythromycin/clarithromycin

Myopathy
inc CK

167

Addison's Mx

Hydrocortisone 20-30mg a day

Fludrocortisone

Hydro dose double w/ concurrent illness

168

ABG in Conn's syndrome

Hypokalaemic metabolic alkalosis

169

Graves

Anti-TSH receptor stimulating antibodies

170

H. Pylori Rx

PPI +
Amoxicillin + Clarithromycin
or
Metronidazole + Clarithromycin

171

Rx for ruptured varices

ABC
FFP
Vasoactive agents - terlipressin
Abx
Endoscopy - ligation (1st) or sclerotherapy

172

Octreotide

Somatostatin analogue
used in carcinoid syndrome

173

Fluid maintenance rate

25-30ml/kg/day
80kg = 2L/day

174

Adrenaline
Indications and dose

Anaphylaxis = 0.5mg 1:1000 IM

Cardiac arrest = 1ml 1:1000 IM or 10ml 1:10,000 IV

175

Nicorandil
Indication
MOA

K channel activator

176

Kusmaul's sign

JVP ↑ w/ inspiration

177

Distended bowel w/ absent bowel sounds after rt hemicolectomy

Paralytic ileus

178

Which anaesthetic agent stongest analgesic effect

Ketamine

179

VTE prophylaxis in hip replacement

TED stockings and dalteparin <6hrs after op

180

Breast Ca Hormonal receptors and responding therapy

ER - Tamoxifen
HER - Herceptin

181

Surgery for Ca:
10cm from anal verge

Caecal

Sigmoid

Lower anteroir resection w/ loop ileostomy

Rt Hemicolectomy

Lft Hemicolectomy

182

Rx for anal fissure

Diet modification
Laxatives
Lubricants prn
Analgesia
Topical GTN

183

Duke's classification

Staging of colorectal Ca
Dukes A = confined to bowel wall
Dukes B = invasion of muscularis propria
Dukes C = LN metastases
Dukes D = Distant mets

184

Indications for immediate head CT after injury

GCS<13
GCS<15 at 2hrs post injury
?skull fracture
Post traumatic seizure
Focal neurological deficit
More than 1 episode of vomiting

185

Ca markers
Carcinoembryonic Ag
Alphafeto protein
CA19-9

Colonic
Hepatocellular
Cholangiocarcinoma

186

High rupture risk AAA

Symptomatic
Diameter>5.5
Velocity of growth >1cm/yr

187

AAA Rx

low rupture risk <5.5cm US and monitor
High rupture risk
Endovascular aortic repair (EVAR)

188

Surgical jaundice put simply
Pancreatic Ca
Cholangiocarcinoma
Gallstones
Cholangitis

Pancreatic Ca
Painless jaundice w/ palpable mass Courvoisier's law
Cholangiocarcinoma
Gradual obstructive picture, assoc w/ UC+PSC
Gall stones
Intermittent biliary colic, eating a meal, radiates to back
Cholangitis
RUQ pain, fever, jaundice Charcot's triad

189

Ulcers put simply

Venous
Haemosideran deposits, varicose veins, painless
Artery
Painful, punched-out, pulseless, low ABPI
Neuropathic
Pressure points, T2DM, Painless

190

Glasgow criteria

Severity of pancreatitis. Severe pancreatitis if 3 or more are detected w/in 48hrs
PaO2 <8KPa
Age >55y/o
Neutrophillia >15*10^9
Ca <2.0mMol/L
Renal, urea <16mMol/L
Enzymes LDH>600/AST>200
Albumin < 32g/L
Sugar bld glucose <10mMol/L

N.B. Amylase tested in ?paancreatitis but not related to severity

191

Age of presentation of testicular Ca

20-30

192

Renal cell Ca

Nephroblastoma = Wilm's tumour
Adenocarcinoma = Gratwitz
Transitional cell tumours = 80% lower UT
Renal cell Ca = most common renal Ca

193

BPH Rx

alpha 1 antagonist
Surg

TURP

194

Staghorn calculus Infx organism

Proteus mirabilis

195

Diagnostic criteria of Heritary haemorrhagic telangectasia

Or Osler-Weber-Rendu
Epistaxis
Telangectases - lips, oral cavity, fingers, nose
Visceral lesions - i.e. GI or arterio-venous malformations
Family Hx

196

Murmurs

Ejection systolic - aortic stenosis
Pan systolic - Mitral regurg
Early diastolic - Aortic regurg

197

INR target for indications

VTE = 2.5 or 3.5 if recurrent
AF = 2.5
Mechanical heart valve dependent on valve and location

198

MOA of
Tirofiban
Abciximab
Enoxaparin
Clopidogrel

Tirofiban - GPIIb/IIIa receptor antagonist
Abciximab - GPIIb/IIIa receptor antagonist
Enoxaparin - antithrombin III agonist Xa inhibitor
Clopidogrel ADP2Y platelet inhibitor

199

HbA1c normal range and diabetic diagnosis

Different from glucose!
<41mMol/L (5.9%) normal
>48mMol/L (6.5%) diabetes
between = prediabetes

200

Phaeo diagnostic test

24hr collection of metanephrines

201

Idiopathic thombocytopaenic purpura
Path
Px

Immune mediated
Epistaxis , isolated thobocytopaenia in a well pt

202

G6PD def
Def
Crisis protagonists

Most common RBC enzyme defect, commonest in Mediterranean and African, X-linked recessive

Drugs
Ciprofloxacin
Anti-malarials
Sulph-

203

HIV
Multpile ring enhancing lesions on CT head

Cerebral toxoplasmosis

204

Sepsis 6

1. Blood cultures - out
2. Fluids (0.9% Normal Saline) - in
3. Urinary Catheter - in
4. Oxygen - in
5. Lactate (Venous blood gas or Arterial Blood gas) - out
6. Antibiotics - in

205

Abx for the following
Chalmydia
Pyelonephritis
Cellulitis
Exacerbation of COPD
Atypical pneumonia
Syphillis
Gonnorhoea
BV

Chalmydia - Doxy/azithromycin
Pyelonephritis - Broad spectrum cephalosporin or quinolone
Cellulitis - Fluclox
Exacerbation of COPD - Amoxicillin or clari or tetracycline
Atypical pneumonia - Clarithromycin
Syphillis - Benpen
Gonnorhoea - Ceftriaxone or azithromycin
BV - metronidazole
PID - ofloxacin + met

206

Acute vs chronic graft rejection

Acute = <6mnths

207

Parkinson's drugs
Levodopa
Cabergoline
Procyclidine
Selegiline

Levodopa - Dopamine precursor, reduced effectiveness over time
Cabergoline - Dopamine receptor agonist, lung and heart fibrosis
Procyclidine - Anti-muscarinics, help with tremor and rigidity
MAOi - Inhibits breakdown of doapmine

208

Drug used in MND

Riluzole

209

Nerves at risk of injury
Falling from tree/arm traction during delivery
Pronated and medially rotated
# of neck of humerus


Brachial trunks C8-T1 - Klumpke's palsy
Brachial trunks C5-C6 - Erb's palsy
Axillary nerve

210

Features of Wernicke's encephalopathy

Thiamine deficiency

CANOPEN
Confusion
Ataxia
Nystagmus
Opthalmoplegia
PEripheral
Neuropathy

211

Wernicke's encephalopathy relationship with korsakoff syndrome

Korsakoff syndrome can develop if Wernicke's is not treated with thiamine

Features include confabulation and retrograde amnesia

212

Trigeminal neuralgia Rx

Carbamazepine

213

Thiazide diuretics MOA

Na Cl symporter

214

Hernia definition

The protusion of a vicus or part of a viscus through an abnormal defect in the wall that usually contains it

215

Ortho tests
Knee - 3C's
Hip - TT
Shoulder - ISITS
Simmonds

Knee
Collaterals, cruciates, cartilages
Hip
Thomas', Trendelenburg
Shoulder
Impingement, Supraspinatus, infrspinatus, teres minor, Subscapularis
Simmonds
Achilles tendon rupture, feet off of bed and one more dorsiflexed, squeeze w/ no movement

216

Malari Rx

Falciparum severe = Artesunate IV
Falciparum moderate = PO artesunate combination therapy
Non - falciparum = PO ACT or chloroquinine if not resistant

217

Red flags for sepsis

systolic blood pressure < 90mmHg or > 40mmHg fall from baseline
mean arterial pressure < 65mmHg
heart rate > 131 per minute
respiratory rate > 25 per minute
unresponsive or responsive only to voice or pain

218

Abx drug classes and examples

Penicillins - cillin, amoxicillin
Cephalosporins - cef, ceftriaxone,
Macrolide - mycin, clarithromycin, azithromycin, vanc
Tetracycline - Doxycycline

219

Waterlow

Risk of pressure sores

220

Prophlaxis for SBP

Ciprofloxacin

221

Red flag Sx's for gastric Ca

New-onset dyspepsia in a patient aged >55 years
Unexplained persistent vomiting
Unexplained weight-loss
Progressively worsening dysphagia/
Odynophagia
Epigastric pain

222

Plummer-Vinson syndrome

Dysphagia
Glossitis
IDA

223

Strong emotion and collapse or reduced muscular tone

Cataplexy

224

Neurofibromatosis vs Tuberous sclerosis

Both neurocutaneous syndromes
Tuberous sclerosis
Hypopigmented patches
sub-ungal fibromata
Epilepsy
Developmental delay
Neurofibromatosis
Axillary/groin freckles
Acoustic neuromas
Phaeo's

225

Drugs that ↑ prognosis in HF

ACEi
BB
Spironolactone
Hydralazine w/ nitrates

226

Rx for cerebral metastases

High dose dexamethasone to reduce cerebral oedem

227

Loss of corneal reflex, dizziness, hearling loss

Acoustic neuroma

228

SE of phenytoin

Acute
Dizziness, diplopia, confusion, nystagmus, ataxia
Chronic
Gingival hyperplasia, megaloblastic anaemia, peripheral neuropathy, lymphadenopathy

229

Ix for carcinoid sydrome

urinary 5-Hydroxyindoleacetic acid 5-HIAA

230

Most common
Haemophillia
Thrombophillia
Hbopathy

VWD
FV Leiden
G6PD def

231

Small bowel obstruction and air in biliary tree

Gallstone ileus

232

Hepatic encephalopathy

Confusion, altered GCS (see below)
Asterix: 'liver flap', arrhythmic negative myoclonus with a frequency of 3-5 Hz
Constructional apraxia: inability to draw a 5-pointed star Triphasic slow waves on EEG
Raised ammonia level (not commonly measured anymore)

233

Syringomyelia features

Loss of pain and temperature in a shawl like distribution
LMN Sx's - wasting and weakness in arms
Loss of reflexes

234

Status epilepticus steps

Buccal midazolam/IV Lorazepam
IV lorazepam
Pheytoin
Rapid sequence induction of anaesthesia w/ sodium thiopental

235

Most common transplant viral infection

CMV

236

Renal cloic analgesia

IM Diclofenac

237

UTI & pregC

Nitrofurantoin used in pregC

Trimethoprim used in Breastfeeding

238

RA Mx

Combination of DMARD
Methotrexate
Sulfasalazine
Pred short course

239

Rx of tetanus

High risk wound
Tetanus IG

240

Casts in urine meaning

Red cell casts - Glomerulonephritis
White cell casts - Acute pyelonephritis
Granular (muddy-brown) casts - Acute tubular necrosis
Fatty casts - nephrotic syndrome

241

Scrotal problems

Epididymal cyst - most common form of scrotal swelling
Hydrocele - fluid collection in tunica vaginalis, transilluminates
Varicocele - Enlargement of testicular veins, bag of worms

242

High output stoma ABG

Metabolic acidosis, ↓K, ↓Na
due to loss of bicarbonate and cations from bowel

243

Complication of acute urinary retention

Acute kidney injury

244

Scoring system for Prostate Ca

Gleason >5=malignant
↑ score = ↓ prog

245

Thyroid blood testing
Assess completeness of surgical resection
Hashimoto's


Calcitonin
Thyroid peroxidase Ab's