questions Flashcards
What are the features of opioid misuse?
Rhinorrhoea Needle track marks Pinpoint pupils drowsiness watering eyes
What is the typical presentation of B12 deficiency?
Bilateral distal parasethesia
What are the triad of features in nephrotic syndrome?
Proteinuria (>3g/24 hr)
Hypoalbuminaemia (<30g/L)
Oedema
What are the features of nephritic syndrome?
Hypertension, haematuria
How do central rentinal vein and central retinal artery occulusion present differently?
Curtain coming down
vein occulsion has retinal haemorrhages on fundoscopy
artery occlusion has afferent pupillary defect and ‘cherry red’ spot on a pale retina
How does retinal detachment present compared to vitrous haemorrhage?
Haemorrhage is numerous dark spots then sudden loss of vision
Retinal detachment is a dense shadow that starts peripherally and moves towards the middle
How do you work out a morphine prescription?
Add up the total dose over 24 hours and prescribe this a slow release, one sixth of this dose is the breakthrough PRN dose
What is the presentation of lithium toxicity?
Coarse tremor
Confusion
Jerking leg movements
What are the antibodies in graves and hashimotos?
In graves there are antibodies to the TSH receptors causing them to be activated
In hashimotos there are antibodies against thyroid peroxidase resulting in reduced T3 and T4 production
What are the signs in fat embolism?
Typically following multiple fractures
Causes tachycardia, tachypnoea and pyrexia
A petechial rash and confusion
What is the presentation of epstein barr virus?
sore throat, fever, and malaise and also has
lymphadenopathy and pharyngitis
What are the triad of features in Wernicke’s encephalopathy?
Ataxia
Opthalmoplegia
Nystagmus
What is Charcots triad?
This is for ascending cholangitis
Fever
RUQ
Jaundice
What is the most important factor in determining the prognosis of melanoma?
Breslow thickness gives indication of 5 year survival
How is high INR managed pre-operatively?
On the day prior to operation INR must be corrected if >1.4
-Aggressive correction (if on warfarin for AF) - 5-10mg IV vit K then repeat INR in 6 hours, if no success speak to haem for prothrombin complex
-Cautious correction if recent PE or valve replacement, speak to seniors, usually reverse warfarin and cover with unfractionated heparin
If INR raised due to liver disease give 10mg IV vit K
How should high INR with warfarin be managed if urgent surgery is required?
If can be delayed for 6-12 hours then give phytomenadione (vit K)
If cant delay give vit K and prothrombin complex
What kind of rash does lichen planus cause?
It causes a itchy papular rash that is on flexor surfaces, palms and soles
It has white line pattern on the surface and exibits koebner phenomenon
What is the treatment of lichen planus?
Topical steriods are mainstay of treatment
What is the management of bells palsy?
1mg/kg prednisolone should be prescribed for 10 days if within 72 hours of onset
What is the pathogenesis of guillian barre?
It is an immune mediated demyelination typically following infection e.g. campylobacter
What are the presenting feauters of guillian barre?
Typically ascending with legs affected before arms
Proximal muscles are affected before distal ones
Can progress to involes resp muscles and cranial nerves
Can be treated with IV immunoglobulin
What are the management steps for stroke?
300mg aspirin should be given asap once haemorrhagic stroke excluded
Anticoags for AF should not be started until 14 days after ischaemic stroke
If cholesterol over 3.5 start statin but delay until 48 hours after stroke to reduce risk of haemorrhagic transformation
What is the time frame for thrombolysis? contraindications?
Within 4.5 ours of onset absolute contra: -prev intracranial haem -intracranial neoplasm -SAH suspected -Stroke in last 3 months -GI haemorrhage in last 3 weeks -active bleeding -pregnancy
How can stroke severity be assessed?
With the NIHSS
