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Yr 3: CN2 > PM2 > Flashcards

PM2 Flashcards

1
Q

[] is the intervention of choice for severe mitral stenosis

A

Percutaneous mitral commissurotomy is the intervention of choice for severe mitral stenosis

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2
Q

A patient is waiting for PCI.

They are within 2hrs of a PCI centre / in a PCI centre.

What is the longest time they can wait from symptom onset before considering alternative to PCI treatment?

A

within 12 hours of symptom onset and within 2 hours of medical contact

If patients present more than 12 hours of symptom onset, pharmacotherapy should be the management of choice provided they are asymptomatic and stable

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3
Q

A mammogram typically shows a star or rosette-shaped lesion with a translucent centre AND asymptomatic with no evidence of lumps = ?

A

Radial scar
- A radial scar is a benign breast condition which can mimic a breast carcinoma. It describes idiopathic sclerosing hyperplasia of the breast ducts

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4
Q

What are contraindications to thrombolysis for PCI? [+]

A

Aortic Dissection
GI bleed
Allergic reaction
Iatrogenic: recent surgery
Neurological disease: recent stroke (within 3 months), malignancy
Severe HTN (>200/120)
Trauma, including recent CPR

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5
Q

Label the side effects

A
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6
Q

What platelet levels indicate a transfusion in a normal patient? [no ongoing bleeding]? [1]

A

A threshold of 10 x 109 except where platelet transfusion is contradindicated or there are alternative treatments for their condition

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7
Q

What are the platelet levels that would indicate a transfusion for patients with:
- a clinically significant bleeding risk
- severe bleeding from critical sites, such as CNS

A

Offer platelet transfusions to patients with a platelet count of < 30 x 10 9 with clinically significant bleeding (World Health organisation bleeding grade 2- e.g. haematemesis, melaena, prolonged epistaxis)

Platelet thresholds for transfusion are higher (maximum < 100 x 10 9) for patients with severe bleeding (World Health organisation bleeding grades 3&4), or bleeding at critical sites, such as the CNS.

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8
Q

What causes this change? [1]
What FBC would you expect to see with this? [2]

A

Sideroblastic anaemia is a condition where red cells fail to completely form haem, whose biosynthesis takes place partly in the mitochondrion:
- hypochromic microcytic anaemia
- high ferritin iron & transferrin saturation

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9
Q

Infective endocarditis infection with Strep bovis indicates which further investigations? [1]
Why? [1]

A

Colonoscopy
- important link with colorectal cancer. Need to consider colonoscopy and biopsy in these patients.

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10
Q

Patient with suspected IE.
ECG recording reveals new PR interval length to be increased.
What is the next appropriate treatment? [1]

A

The newly lengthened PR interval (1st degree heart block) suggests peri-valvular abscess as a complication of infective endocarditis - indicates need for valve replacement

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11
Q

History of subacute infective endocarditis x acute abdominal pain = ?

A

Infective endocarditis caused acute mesenteric ischaemia

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12
Q

Common exam question: PR interval prolongation in a patient with Infective Endocarditis is an indication for [] as it can be secondary to []

A

Common exam question: PR interval prolongation in a patient with Infective Endocarditis is an indication for surgery as it can be secondary to aortic root abscess

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13
Q

Which of the following types of renal stones are radio-lucent?

Triple phosphate stones
Cystine stones
Calcium phosphate
Xanthine stones
Calcium oxalate

A

Which of the following types of renal stones are radio-lucent?

Triple phosphate stones
Cystine stones
Calcium phosphate
Xanthine stones
Calcium oxalate

cystine stones: semi-opaque
urate + xanthine stones: radio-lucent

If it helps, I just remember that the stones at the back of the alphabet are radio-lucent - Urate and Xanthine :) and then cystine being semi-opaque is just a weird one to rote learn

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14
Q

You believe he has Balanitis Xerotica Obliterans. What can be associated with this condition?

Protection from cancer
Phimosis
Protection from infection
Prostate hyperplasia
Basal cell carcinoma

A

You believe he has Balanitis Xerotica Obliterans. What can be associated with this condition?

Protection from cancer
Phimosis
Protection from infection
Prostate hyperplasia
Basal cell carcinoma

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15
Q

Describe how changes in potassium relate to digoxin toxicity [2]

A

Hypokalemia increases the risk of digoxin toxicity by facilitating binding to the sodium-potassium ATPase pump, and in turn, digoxin toxicity can lead to hyperkalemia due to excessive pump inhibition

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16
Q

What is the first line management for persistent pneumothorax?

A

First-line management is with surgical pleurodesis.

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17
Q

his patient has several signs of chronic (high-pressure) retention: >1L retention volume, abnormal renal profile and possibly postobstructive diuresis (>200 mL/h).

How do you manage this patient? [1]

A

Leave the catheter in situ
- These patients should not have a trial without catheter (TWOC) as it can further exacerbate renal impairment. Instead, they should have a long term catheter until further specialist review with regards to the underlying cause

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18
Q

How do you treat WPW? [1]

A

definitive treatment: radiofrequency ablation of the accessory pathway

medical therapy: sotalol, amiodarone, flecainide
sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation

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19
Q

Anal fissures are normally located in which position?

A

More than 90% of anal fissures are located in the posterior midline of the anal canal. There is evidence that circulation here is poor and anal spasms further reduce blood supply.

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20
Q

What can you use to reverse digoxin toxicity? [1]

A

DigiFab or Digibind are digoxin specific antibodies used in digoxin toxicity to neutralise free digoxin

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21
Q

What are the symptoms of digoxin toxicity? [+]

A

dizziness, nausea and vomiting, palpitations, bradycardia, visual disturbances, confusion, and hyperkalaemia.

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22
Q

What is the MoA of digoxin? [1]

A

Inhibiting the Na+ K+ ATPase enzyme, also known as the sodium-potassium pump. This causes sodium to build up inside the heart cells, decreasing the ability of the sodium-calcium exchanger to push calcium out of the cells, consequently causing calcium to build up in the sarcoplasmic reticulum.

Increased intracellular calcium results in a positive inotropic effect, which in turn has the effect of increasing the force of the heart’s contractions.

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23
Q

Patient has heart failure and presents with:
* Yellow-green colour disturbance
* Visual haloes
* Confusion

what is your first differential? [1]

A

Digoxin toxicity

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24
Q

A person has SVT.

What pathology would be a contraindication to giving them adenosine? [1]
What would you give instead? [1]

A

Asthma - instead give them verapamil

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25
How would you define functional incontinence? [1]
This involves an individual having the urge to pass urine, but for whatever reason they're unable to access the necessary facilities and as a result are incontinent.
26
Cholera can present with diarrhoea and []
Cholera can present with **diarrhoea** and **hypoglycaemia**
27
Which two meaurements are used to monitor tx of haemochromatosis? [2]
**Ferritin and transferrin saturation** are used to monitor treatment in haemochromatosis
28
A patient is in asystole. Whilst you are performing CPR they switch to VF. How do you manage this patient? [1]
**Continue the 2 min of CPR then prepare to shock**
29
What is amyloidosis: - pathophysiology? - difference between primary and secondary?
**Pathophysiology:** - extracellular and or intracellular tissue deposition of insoluble amyloid fibrils that prevent the normal functioning of tissues and organs affected **Primary**: - deposits of monoclonal light chains in tissue **Secondary**: - Due to malignancy or chronical microbrial infection
30
Describe the clinical features of amyloidosis
31
Describe how you diagnose and treat amyloidosis
**Dx**: - The diagnosis of Amyloidosis requires a **tissue** biopsy that shows apple-green birefringence when stained with **Congo red and viewed under polarised light** **Tx:** - In amyloid AA, management of chronic infection and inflammation is important - In amyloid AL, strategies similar to myeloma therapy can be used (eg. dexamethasone and bortezomib as a first line) with measurements of serum-free light chains to assess response
32
The INR of a patient who has recently started treatment for tuberculosis drops from 2.6 to 1.3. Which one of the following medications is most likely to be responsible? Rifampicin Streptomycin Ethambutol Isoniazid Pyrazinamide
The INR of a patient who has recently started treatment for tuberculosis drops from 2.6 to 1.3. Which one of the following medications is most likely to be responsible? **Rifampicin** Streptomycin Ethambutol Isoniazid Pyrazinamide Rifampicin is a P450 enzyme inducer and will therefore increase the metabolism of warfarin, therefore decreasing the INR.
33
What is a sign that a patient might be suffering from salicylate
**Tinnitus** is a feature of salicylate poisoning.
34
The biopsy findings and rapid decline of more than 50% in eGFR are suggestive of **[]** **[]** glomerulonephritis What would this show on an biopsy? [1]
**Rapidly progressive glomerulonephritis**, also called cresenteric glomerulonephritis The biopsy findings would show **epithelial** **crescents** (crescent-shaped scars) in most glomeruli.
35
Describe a complication of peripheral TPN [1]
TPN contains a combination of glucose, lipids and essential electrolytes. It is highly **irritant to veins** - **thrombophlebitis**
36
What deficiency increases a risk of anaphylaxis? [1]
**IgA**
37
How would warfarin poisoning present on a clotting screen? [3]
Rasied APTT; PT and INR Normal platelet count
38
What is the first line treatment for TTP? [3] What's the aim for this? ^ [1]
1. **Plasma exchange** 2. **IV methylprednisolone** 3. **Rituximab** Aim is to get rid of **ADAMST13 antibodies**
39
Burkitt lymphoma is associated with which chromosome swap? [2]
**8-14**
40
If a patient has recurrent VTE, what anti-coagulant and INR do you aim for? [1]
**Lifelong warfarin** - target of **3.5**
41
What happens to insulin and c-peptide levels when have a glicazide OD? [1]
Both increase
42
What effect does haemodialysis have on HbA1C levels? [1]
Falsely low
43
Give 5 causes of falsely increased HbA1C [5]. Describe why this occurs [1]
B12 deficiency IDA deficiency Chronic alcoholism Splenectomy Pregnancy All increase the lifespan of Hb
44
Give 5 causes of falsely decreased HbA1C [5]. Describe why this occurs [1]
SCA Haemodialysis Splenomegaly Thal. Decreases the lifespan of Hb
45
Name a neurological side effect of pred. use [1]
**steroid pyschosis**
46
Describe how you would investigate if you suspect patient has diabetic kidney disease [1]
Peform an **A:Cr screen**: 1. Spot sample 2. Repeat if abnormal
47
How can HIV lead to adrenal insufficiency? [1]
CMV related necrotising adrenalitis
48
Budd-Chiari presents with a triad of...
- ascites - abdomen pain - tender hepatosplenomegaly
49
A patient has cancer. Prevent with DVT. How long do u ac them? [1]
**6 months**
50
'mirror image nuclei' refers to which cell type? [1]
Reed-Sternberg cells (HL)
51
Pregnancy & DMT2 Tx? [2]
**Meformin & Insulin**
52
How do you manage AIHA? [4]
Blood transfusions Prednisolone Rituximab (a monoclonal antibody against B cells) Splenectomy
53
State 5 triggers for cold AIHI [4]
lymphoma leukaemia EBV/HIV SLE
54
What is the most common cause of warm AIHA? [1]
Warm autoimmune haemolytic anaemia is the more common type. Haemolysis occurs at normal or above-normal temperatures. **It is usually idiopathic, meaning that it arises without a clear cause.**
55
How do you treat acute mesenteric ischaemia? [1]
urgent surgery is usually required - **laporoscopic**
56
Increased MCV and isolated GGT = ?
Alcohol XS
57
Which of TRALI & TACO cause hyper/otenion? [1]
**TACO** - hypertension **TRALI** - hypotension
58
If patient has COPD and undergo rapid oxygen desaturation - what is the likely cause? [1]
**Mucus plugging**
59
Most asthma exacerbations are: - bacterial - fungal - viral
- **viral**
60
A patient has warm AIHA - where does the haemolysis usually occur? [1]
In extravascular sites like the spleen
61
What is the usual surgery that patients with FAP undergo? [1]
**Total proctocolectomy with end ileal anastomosis**
62
Describe the first line management for sigmoid volvulus [2]
* **endoscopic decompression is first-line**, using either flexible or rigid sigmoidoscopy - corrects the volvulus; can leave in and later remove * If there is evidence of **ischaemia**, **perforation** or **mucosal** **gangrene**, **surgical management is still required in the first instance**; might be **laporoscopic** or a **Hartmans**
63
Tx of caecal volvulus? [2]
Ileocaecal resection or R hemicolectomy
64
This patient has received which drug for treating a tachycardia Adenosine Amiodarone Atropine Aspirin
This patient has received which drug for treating a tachycardia Adenosine **Amiodarone** Atropine Aspirin
65
When is an S3 considered normal? [1]
Under 30
66
S4 can be heard in which cardiac conditions? [2]
HOCM AS
67
How do you treat acute [1] and chronic [1] hydronephrosis?
Acute: **nephrostomy** Chronic: **ureteric stent**
68
First and second line tx for acute constipation? [2] how do you treat opiod induced constipation? [1]
1. **Ipsaghula husk** 2. **macrogol** opoid induced: **senna**
69
A patient is diagnosed with DMT1. What insulin regime are they started with? [1]
**Twice daily basal-bolus** **insulin determir** (l.a) with **insulin aspart **(s.a)
70
Dx of achalasia? [1]
**high resolution manometry**
71
Swimming pool + gastro problems? [1]
Gardia lambia
72
Symptomatic perianal fistuala tx: - simple? [1] - complex? [1]
SImple: oral metronizadole Complex: seton placement
73
Overdosing on which substances would indicate the following reversal agents? [4] formepizone desferrioxamine flumazenil bicarb
**anti freeze** - formepizone **heavy metals**- desferrioxamine **benzos**- flumazenil **salicylate/ tricyclics**- bicarb
74
Which complication of haemochromatosis does venesection help to reduce? [1]
**HF** (induced by cardiomyopathy)
75
How do you treat SVCO? [1]
Give **dexamethasone**
76
A patient presents with lipomas, supernumerary teeth, osteomas, and epidermoid cysts. A 25 year old male patient presents to the general practitioner with a 1 month history of constipation, PR bleeding, and weight loss. He reports a family history of gastrointestinal problems. What is the most likely diagnosis? [1]
**Gardner's variant of familial adenomatous polyposis (FAP):** lipomas, supernumerary teeth, osteomas, and epidermoid cysts. FAP is caused by mutation of 1 allele in the APC gene A tumour suppressor gene)
77
When is the use of morphine CI? [1] Name two alternatives that can be used [2]
Renal impairment / dialysis Can use **oxycodone** or **tramadol**
78
How would you manage a hypertensive emergency in a patient undergoing simultaneous ACS? [1]
In the context of ACS, the first-line treatment of a hypertensive emergency is **IV GTN** as in addition to lowering the blood pressure, it will lead to coronary vasodilatation and help provide pain relief
79
80
What do you give to reverse poisoining from anti freeze? formepizone desferrioxamine flumazenil bicarb
What do you give to reverse poisoining from anti freeze? **formepizone** desferrioxamine flumazenil bicarb
81
What do you give to reverse poisoining from benzos? formepizone desferrioxamine flumazenil bicarb
What do you give to reverse poisoining from anti freeze? formepizone desferrioxamine **flumazenil** bicarb
82
What do you give to reverse poisoining from heavy metals? formepizone desferrioxamine flumazenil bicarb
**desferrioxamine**
83
What do you give to reverse poisoining from salicylates? formepizone desferrioxamine flumazenil bicarb
What do you give to reverse poisoining from salicylates? formepizone desferrioxamine flumazenil **bicarb**
84
[] is the most common complication of haemodialysis.
**Dialysis-induced hypotension** is the most common complication of haemodialysis.
85
What stain type do you use for PCP? [1]
**Silver Stain**
86
A patient presents with the following, alongside respiratory symptoms. Which infective organism is most likely to have caused this?
**Mycoplasma pneumonia**
87
A patient presents with the following, alongside respiratory symptoms. Which infective organism is most likely to have caused this?
Streptococcus pneumonia | Herpes labialis
88
What are the four criteria that determines if something is ARDS? [4]
The four criteria: - **acute onset** (within 1 week of a known risk factor) - **pulmonary oedema**: bilateral infiltrates on chest x-ray ('not fully explained by effusions, lobar/lung collapse or nodules) - **non-cardiogenic** (pulmonary artery wedge pressure needed if doubt) - **pO2/FiO2 < 40kPa (200 mmHg)**
89
What do you give patients prior to bronchoscopy? [2]
Benzodiazepam - for sedation Fentanyl - for pain
90
When do you use CMV serenegative components? [2]
Patients at risk of severe CMV disease: - **Pregnant** - **Neonates**
91
When do you give irradiated components? [4]
92
When plalelet concentrates indicated for transfusion? [4]
93
When are fresh frozen plasma transfusions indicated? [4]
94
Which extra-intestinal manifestation occurs independently of the disease activity of IBD? Episcleritis 1 Scleritis 2 Erythema nodosum 3 Primary sclerosing cholangitis 4 Large joint arthritis
Which extra-intestinal manifestation occurs independently of the disease activity of IBD? Episcleritis 1 Scleritis 2 Erythema nodosum 3 **Primary sclerosing cholangitis** 4 Large joint arthritis
95
What is the commonest cause of anovulation in women? [1]
**PCOS**
96
HLA class I is made from which loci? [3] Which cells do the HLA class 1 loci present to? [1]
HLA A B, C: Class 1 (e.g. HLA-A) Present to CD8T cell | Class 1 = 1 letter (1x8 = 8)
97
HLA class II is made from which loci? [3] Which cells do the HLA class 1 loci present to? [1]
Class II: DP, DQ, DR Present to CD4 T cells | Class 2; (4x2=8)
98
What is the difference between potency and efficacy with regards to drugs? [2]
**Efficacy**: relative ability of drug-receptor complex to produce maximum functional response **Potency**: amount of drug needed to give desired effect
99
Which blood group is associated with a risk of gastric cancer A B AB O
Which blood group is associated with a risk of gastric cancer **A** B AB O
100
How do you calculate osm.? [1]
2x (Na + K) + glucose
101
How d you treat a thrombotic and embolic acute limb ischaemia? [2]
**For thrombotic causes:** - **Angiography** for incomplete ischaemia. This helps map the occlusion site and plan for intervention. Potential endovascular procedures include **angioplasty, thrombectomy, or intra-arterial thrombolysis**. - **Urgent bypass surgery** for complete ischaemia. **For embolic causes**: - the leg is typically threatened, and **immediate** **embolectomy** is required. If embolectomy fails, on-table thrombolysis may be considered.

Yr 3: CN2 (29 decks)

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