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Qus Flashcards

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1
Q

carbimazipine mech of action + side effect

A

sodium channel blocker

folate deficiency –> macrocystic anaemia

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2
Q

phenytoin mech of action + SE

A

sodium channel blocker

profound folate deficiency –> macrocystic anaemia

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3
Q

types of neuro tumours (3) + which are most common

A

60% gliomas
20% meningiomas
10% pituary tumours

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4
Q

how to treat increased ICP due to tumour mass

A

dexamethasone

vasogenic oedema caused by the breakdown of the BBB

swelling reduction

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5
Q

young female, obese - what you thinking?

A

idiopathic intracranial pressure

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6
Q

post herpatic neuralgia - what is your treatment for neuropathic pain?

A

duloxetine - SNRI
amytrypiline - TCA
gabapentin - GABA analogue
pregabalin - GABA analogue

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7
Q

how can you treat a child who is unresponsive to anti-epiletics?

A

ketogenic diet

high fat
low carb
controlled protein diet

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8
Q

oxygen is used as treatment for what kind of headache?

A

cluster

100% oxygen (80% response rate within 15 minutes)

SC triptans (75% response rate with 15 minutes)

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9
Q

cluster headache prophylaxis

A

verampiril - CCB

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10
Q

what drugs can exacerbate trigger mysthenia gravis?

A 
penicillamine - Wilson's disease
quinidine - anti-arrhythmic agent 
beta blocker
lithium
phenytoin
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11
Q

what do heinz’s bodies in a blood film signify?

A

Glucose 6 Phosphate Deficiency

a predisposition of RBC breakdown

G6PD is needed to protect RBC from oxidative stress

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12
Q

hyaline casts seen in urine - what does it mean?

A

patients taking loop diuretics

also healthy people after strenuous exercise

from distal convoluted tubule

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13
Q

brown granular cast in urine

A

acute tubular necrosis

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14
Q

what is a vesicucreteric reflex + imaging

A

back flow of urine from the bladder into the ureters + kidneys

diagnosed by micturating cystourethogram

common in kids –> can develop UTI

35% develop scarring

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15
Q

what immunisation is given at birth?

A

bcg

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16
Q

what can give a false-negative mantoux result

A

immunosuppression (AIDs)
sarcoidosis - reduced immunity
lymphona

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17
Q

roseola infantum

A

Human herpes virus 6 (HHV6)

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18
Q

measles

A

RNA parvmyxovirus

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19
Q

mumps

A

RNA parvmyxovirus

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20
Q

rubella / german measles

A

toga virus

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21
Q

chicken pox

A

varicella zoster virus

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22
Q

scarlet fever

A

group A haemolytic strept (strept pyogenes)

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23
Q

hand, foot + mouth

A

coxsackie A16

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24
Q

reasons for <24 jaundice

A

rhesus haemolytic disease
ABO heamolytic disease
hereditary spherocytics
G6P deficiency

measure bilirubin urgently <2hrs

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25
At what timeframe should you refer for undescended testis ?
3 months
26
what is reflex anoxic seizures (RAS)?
non-epiletic seziures due to excessive stimulation of vagus nerve quick post-ict recovery
27
Causes of widened mediastinum?
vascular problems - thoracic aneurysms lymphoma retrosternal goitre thymus tumour
28
Infective COPD - most common organisms (3)
h.influenza strept pneumonia morexella catahhalis
29
NG tube is inserted. At what pH is it safe to feed??
<5.5 if >5.5 CXR is needed to confirm
30
What should you see on CXR to confirm correct NG placement?
NG tip is below the diaphragm
31
what is aspergillioma?
infection due to mould / fungi --> spore inhalation commonly affects immunosuppressed severe haemoptysis PHx of TB CXR shows rounded opacity
32
describe sarcoidosis
multisystem, chronic disease with granulatous inflammation
33
diagnostic asthma parameters (4)
FeNO >40 parts / billion post bronchodilator >12% FEV1 post bronchodilator > 200ml lung volume FEV1 / FVC ratio < 70%
34
diagnostic asthma parameters (5)
FeNO >40 parts / billion post bronchodilator >12% FEV1 post bronchodilator > 200ml lung volume FEV1 / FVC ratio < 70% peak expiratory flow rate variability >20% FEV1 / FVC ratio <70% (asthma is an obstructive disease)
35
what are the risk factors + features of transient tachypnoea of the newborn
c-section - fluid in the lungs as they weren't squeeze out as baby hasn't gone through birth canal settles in 1-2 days
36
what drugs are associated with cleft platelet when taken in pregnancy
anti-epileptics
37
loperimide
long-acting synthetic antidiarrheals antagonize histamine and interfere with acetylcholine release locally. brand name - imodium
38
tacrolimus
immunosuppresant calcineurin inhibitor
39
irbesartan
angiotension receptor blocker HTN tx block the formation of angiotension II
40
dipyridamiole
platelet inhibitor given in combo with aspirin
41
venlafaxine
Serotonin-Noradrenaline Reuptake Inhibitor
42
obstructive + restrictive lung conditions
OBSTRUCTIVE - asthma - COPD - bronchietasis - A1AT RESTRICTIVE - interstitial lung disease (fibrosis, coal miner, asbestos) - neuromuscular (GBS) - structural (scoliosis, ank spon, obesity)
43
high ACE levels signify?
acute sarcoidosis
44
how to certify for death?
A --> E assessment (minimium of 5 minutes) Respiratory effort Verbral stimuli Painul stimuli Carotid pulse Pupils - fixed + dilated
45
end of life drugs (4)
sedation (midazolam) analgesia (morphine) anti-secretory (hyoscine) anti-emetic (ondansatron)
46
what test should you do before starting azthromycin ?
``` LFTs ECG (long QT) ```
47
what is churgg strauss? Mx
eosinophillia + vasculitis (p-ANCA) 1. Allergic (asthma) 2. Eosinophilia infilitrates to the tissue 3. Vascultis Mainstay of treatment is corticosteroids
48
what is granulomatosis with polyangitis?
systemic vasculitis (small + medium vessels) triad 1. Upper RTI 2. Lower RTI 3. Glomerolonephritis
49
what is flail chest? most common comp?
detached ribs moving separately of the rib cage inspiration - moves in expiration - moves out
50
asthma admission --> what are looking out for on ABG and what does it signify?
CO2 retention pH <7.35 (due to the CO2 retention) means that patient is tiring --> escalate quick
51
4 types of markers of disease from asbestos
pleural plaques - benign + don't undergo maligancy - most common / calcification pleural thickening - similar pattern seen in empyema / haemothorax asbestosis - severity = length of time - LOWER LOBE fib mesothelioma - malginant form of asbestos exposure - very limited exposure can cause mesothelioma
52
what is a lesion in optic nerve (II) called and features (2)
marcus-gunn pupil 1. deafferent pupil 2. constricts to consensual light but not direct
53
name the eye muscles and their innervations ?
oculomotor (III) - medial rectus - inferior rectus - superior rectus - inferior oblique trochlear (IV) - superior oblique abducens (VI) - lateral rectus
54
whats the limit of Hb1Ac for adding 1st diabetes drug and 2nd diabetes drug?
1st - 48mmol | 2nd - 58mmol
55
what is the criteria for giving fluids for burns?
fluids are not given for 1st degree burns Given only for 2nd/3rd, covering >15% BSA
56
Chart used for most accurate burns?
lund and browder
57
two skin conditions caused by maslasseai furfur?
Pityriasis versicolor | seborrhatic dermatitis
58
describe features acne rosacea
``` flushing pustules + papules telangiestais nasal liabial sparing rhinophyma ```
59
how do you treat ance rosacea
metronidazole / tetracycline
60
Mx lichen planus
clobetsol propionate - steroid
61
describe features of ance vulagaris
pustules + papules oilly skin comodomes (closed + open)
62
complication of draining effusion too quickly
re-expansion of pulmonary oedema
63
Mx actinic keratoses
Fluorouracil binds to uracil --> RNA --> destroys malignant cells
64
Mx seborrhatic dermatitis
ketoconazole
65
antibodies for Graves
TSH receptor antibodies (90%) | Anti-thyroid perioxidase (75%)
66
hashimoto's
chronic immune thyroiditis non-painful goitre
67
de quervain
1. hyperthyroidism 2. hypothyroidism painful- gotire
68
what scores signify impaired fasting glucose?
Fasting Glucose 6.1 - 7.0 mmol/l
69
what scores signify impaired glucose tolerance?
fasting plasma glucose <7.0 mmol/l OGTT 2-hour value greater than 7.8 to 11.1mmol/l
70
post surgery stress response
insulin oestrogen testosterone
71
what is the first treatment regime for newly diagnosed T1DM?
basal bolus insulin regimen | w/ twice daily insulin detemir
72
what is buerger's disease
small / medium vessel disease strong association with smoking
73
statins mech of action what test is used to monitor statins?
HMG-CoA reductase --> rate limiting enzyme in hepatic cholesterol synthesis LFT measured baseline, 3 months, 12 months stop in pregnancy
74
cardiac tamponade features
large drop in BP in inspiration = pulsus paradoxus
75
what is kussmaul's sign? where is it seen?
raise JVP with inspiration constrictive pericarditis
76
side effects of statins
myopathy liver impairment
77
Nicorandil
potassium channel activator vasodilator --> angina
78
long QT syndrome mx
1. long QT drug avoidance 2. beta blockers 3. impantable cardioverter debib (if >500ms)
79
what drug gives you angioedema ?
ACE-i
80
Mx torsades de pointes
magnesium sulphate
81
orthostatic hypertenson mx
fludrocortisone - steroid increases renal sodium reabsorption and increases plasma volume
82
what is doxazosin?
selective a1 - blocker treats HTN
83
pathophysiology of HHS
hyperglycaemia >30mmol hyperosmolality >320 in the absence of lipolysis (small enough insulin production to suppress this reduced insulin results in increased gluconeogenesis 1. hyperglycaemia --> osmotic diuresis 2. hypernatraemia along with hypovolaemia 3. leads to progressive decline in eGFR --> aggrevates the hyperglycaemic state
84
pathophysiology of DKA
complication of T1DM due to the lack of insulin --> glucolysis stops body uses fatty acids for energy --> lipolysis resulting in the production of ketones
85
diagnostic criteria for HHS
hypovolaemic hyperglycaemia >30mmol w/o ketoanaemia / acidosis serum osmolality >320 mosmol/kg
86
Mx HHS
1. monitor osmolality 2. replace fluid / electrolytes --> potassium 3. normalise blood glucose aim to replace 3-6L within first 12 hours IV 0.9 sodium chloride already relievely hypotonic compared to blood os correct potassium levels AKI = causes hyperkal Diuretics = causes hypokal
87
what are the indications for insulin in HHS?
presence of ketonaemia (mixed DKA/HSS picture) then the recommended insulin dose is a fixed rate intravenous insulin infusion given at 0.05 units per kg per hour. if NO ketonaemia then don't give insulin
88
describe and explain the effects of hyper / hypo / isotonic fluids?
hyper - higher osmolality in order to draw fluid out from cells (intra --> extra) iso - same osmolality for extravascular volume expansion hypo - lower osmolaity in order to shift fluid into cells (intra --> extra)
89
how dehydrated are patients with HHS?
100 - 220ml/kg so 70kg pt has lost 7 to 15.4L develops over several days so is more profound than DKA
90
Mx of DKA (5)
``` 1. fluids (isotonic) pts have usually lost 5-8 litres 2. short acting insulin (0.1units/kg/hr) 3. 5% dextrose (once glucose <15) 4. correction of hypokalaemia 5. switch short insulin --> long insulin ```
91
what kind of patients more at risk of developing cerebral oedema?
younger patients (18-25)
92
diagnostic criteria for DKA (4)
1. glucose > 11mmol / known diabetic 2. pH < 3.5 3. bicarb <15 (high anion gap) 4. ketones > 3mol
93
most common precipating factor for DKA
infection missed insulin dose MI
94
complications of DKA
- gastric stasis - thromboembolism - arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia - iatrogenic due to incorrect fluid therapy: cerebral oedema*, hypokalaemia, hypoglycaemia - acute respiratory distress syndrome - acute kidney injury
95
administering vancomycin - what are concerns?
allergic reaction red man syndrome (significant release of histamine) pruritus, erythema burning sensation of the upper chest
96
dengue fever
viral haemorrhagic fever a form of DIC called dengue haemorrhagiv fever may develop low plateletts raised ALT myalgia maculopapular rash
97
HIV risk needle stick injury
encourage bleed run under water may start treatment 72 hours following exposure refer to ED + oral antiretroviral therapy for 4 weeks serological testing at 12 weeks following completion of post exposure
98
painful genital ulcer more common
herpes simplex virus (more common) - HSV type 2 (type 1 cold sores) chancroid - painful genital ulcers - inguinal node enlargement
99
painless genital ulcers
syphilis (more common) lymphogranuloma - chlamydia trachomatis --> Mx Doxycyline
100
Extensive otitis externa Mx
flucloxacillin
101
PID Mx
Doxycycline + metronidazole + ceftriaxone
102
atypical pneumonia
clarithromycin
103
Acute pyelonephritis
Broad-spectrum cephalosporin or quinolone
104
typhoid
salmonella typhi 1. pea green diarrhoea 2. fever >39 3. relative bradycardia for level of infection ciprofloxacin
105
what pneumonia causes: - deranged LFTs - hyponatriemia
legionella pneumophilia
106
erythema multiforme
mycoplasma pneumoniae
107
pneumonia following influenza
staph aureus
108
erythema migrans / lymes disease
Borrelia
109
test for lymes disease
ELISA antibodies then if positive immunoblot test for lymes
110
Mx for lymes
doxycycline (tetragenic) ceftrixone if disseminated
111
Mx genital warts
HPV 6 / 11 multiple / non-keratinised - topical podophyllum solitary, keratinised - cryotherapy
112
herpes simplex infection
HSV 1 - cold sores HSV 2 - genital herpes primary infection: 1. gingivostomatitis (gum + mouth infection) 2. cold sores 3. painful gential ulceration Mx - oral / topical aciclovir
113
herpes simplex infection in pregnancy --> what is advised
if infected post-28 weeks | --> c-section advised
114
erythema infectiosum
parvovirus b19 IgM - recent infection IgG - immunity
115
organism most associated with gangrene
staph aureus - type 1 nec fas strept pyogenes - type 2 nec fas clostridium perfringens - type 3 nec fas
116
lactational mastitis
staph aureus
117
sewage worker
leptosporosis 1. bilateral conjuctivits 2. bilateral calf pains 3. high fevers
118
most common CAP
strept pneumonia
119
most common infective COPD
H.influenza
120
bacterial vagionsis
gardenerella vaginalis Mx - oral metronidazole
121
syphilis investigations
EIA - detects acute igM antiobody to syphilis TPPA - remains positive for people who have been previously infected Rapid plasma reagin (RPR) - used to monitor activity + reinfection - --> the number of times a sample needs to be diluted to be come undetectable - --> higher diluation means greater infection
122
Mx syphilis
IM benzathine penicillin G
123
3 types of pathogen for viral encepthalitis
herpes simplex virus (most common) enterovirus vericella zoster virus
124
Mx for MRSA from carrier once identified
``` mupirocin (nose) chlorhexidine gluconate (skin --> creases) ```
125
Chagas disease
95% patients are asymptomatic african + american origin concerned about cardiomyopathy = echocardiogram
126
how many tetanus jabs needed for lifelong immunity?
5
127
bupropion
anti-depressant used to aid smoking cessation lowers epilepsy threshold - bad
128
which pneumonia is associated with neurological symptoms?
mycoplasma pneumonia
129
how do you treat PID?
doxycycline + ceftriaxone + metronidazole
130
lymes disease pathogen + effects
borrelia facial nerve involvement
131
post-splenectomy what organisms are patients at risk from?
pneumococcus Haemophilus meningococcus
132
what vaccines are given to patients undergone splenectomy?
annual influenza vaccine | pneumococcal vaccine every 5 years
133
what is given for post-splenectomy sepsis
Penicillin V or amoxicillin

P4 (11 decks)

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