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IMP3 Revision > Revision 3 > Flashcards

Revision 3 Flashcards

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1
Q

Name 2 key differences between cholelithasis and cholecystitis (in terms of pain)

A

Cholelithiasis is post-prandial pain, RUQ pain, lasting <6hours
Cholecystitis= RUQ pain, positive Murphy’s sign, abdo mass, pain to shoulder

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2
Q

What is the medical treatment of cholecystitis?

A

Calculous: IV gentamycin and amoxiciilin
Acalculous: IV gent+ metro+ amoxi

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3
Q

What’s the difference between coup and countre coup?

A

Coup= contusion on side of impact and contrecoup= contusion on opp side

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4
Q

Name 4 features of post-concussion syndrome

A

Headache, fatigue, dizziness, depression, sleep disturbance

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5
Q

What are three important things to prevent post a head injury

A

Infections, secondary bleeding and seizures

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6
Q

What is the D/C advice for mild head injury?

A

Observe for 24hrs and provide PRN analgesia. No contact sports for 1/52.

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7
Q

What one feature is the hallmark of healing by secondary intention?

A

Granualtion tissue

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8
Q

Side effects of local anaesthetics

A

In excess, can lead to metallic taste, chest pain, palpitations, syncope, dyspnoea, hypotension and cardiac arrest.

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9
Q

What is the benefit of addint adrenaline to local anaesthetic?

A

Vasoconstriction reduces blood loss and also slows systemic abs of anaesthetic.
Shouldn’t be used on finger tips etc–> necrosis

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10
Q

What advice is given to patients with a <7mm non-obstructing stone? (4)

A

1) PO analgesia PRN
2) Encourage fluid intake +/- IVH
3) urology outpatient XR KUB
4) Dietary advice: reduce intake of oxalate containing foods, tea, coffee,

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11
Q

What is the score used to calculate prostate severity?

A

IPSS (for LUTs symptoms)

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12
Q

What is the name for biopsy procedure for prostate ca?

A

TRUS (10-12 samples taken)

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13
Q

What beta blocker is used in aortic dissection?

A

Labetalol

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14
Q

What are 3 symptoms specific to orbital cellulitis?

A

Reduced vision, diplopia and opthalmoplegia

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15
Q

What are 2 urgent investigations required for orbital cellulitis?

A

Blood cultures and CT orbit.

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16
Q

When is ear synringing contraindicated?

A

In discharging ear (because tympanic membrane likely perforated)

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17
Q

What are 3 features of a bacterial sinusitis (vs viral?)

A

Bacterial is:

1) more than 10 days
2) Lasts longer than respiratory tract infection
3) Worsens, within 10 days. (viral remains the same)

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18
Q

What are 3 investigations required to investigate a sinusitis?

A

CT head, allergy testing and nasal polyps

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19
Q

What is the name of the investigation tool used for SBP?

A

SAAG, need >10 to be positive

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20
Q

What is McBurney’s point and Rovsing’s sign?

A

Examination findings for appendicitis
McBurney: 2/3 between ASIS and umbilicus
Rovsing’s sign: examined on LIF and tender RIF

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21
Q

What is the usual mgmt of a perianal abscess?

A

Surgical drainage under GA the healing by second intention +/- string drain

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22
Q

What disease is an anal fistula associated with?

A

IBD

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23
Q

What imaging investigation is used for ?anal fistula?

A

Regid sigmoidoscopy

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24
Q

Crohn’s typically has a mass on which side?

A

Right. ( C- R-ohns)

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25
What is the name of the initial medical treatment for Crphn's vs UC?
Crohns: Azathioprine or methotrexate (after steroids) UC: Mesalazine +/- steroid for inflammation
26
What is the difference in presentation between a gastric and duodenal ulcer?
Gastric: pain increases after eating and relieved by antacids. Duodenal ulcer: pain on empty stomach, relieved by food.
27
What is the typical pain presentation for pancreatitis?
Severe epigastric pain radiating to the back, improves o leaning forward
28
Name 4 causes of pancreatitis (acute)
Alcohol, gallstones, autoimmune and iatrogenic (ERCP)
29
What treatment is required for patients with chronic pancreatitis? (4)
ADEK, creon, insulin, dietary modification.
30
What is the typical pain presentation for intestinal angina/chronic ischaemia?
Recurrent, post-prandial epigastric pain within the first hour of eating. Can lead to food aversion and weight loss.
31
Why can you NOT do a coloscopy for diverticulitis?
Risk of perforation! Need CT abdo pelvis
32
What is the main source of bleeding for an extra-dural haemorrhage?
Middle meningeal artery
33
What is the difference between appearance of extra and subdural haemorrhage on CT?
Extrandural: lentiform, bi convex Subdural: banana, concave
34
Which population is extradural haemorrage most common in?
Younger people, +++ trauma
35
What is an important consideration when managing intracranial bleeds?
CALL NEUROSURG!!
36
Name 3 broad categories for urinary retention
Functional (prostatic inflammation), obstructive and neurogenic
37
What investigations (bloods) are required for urinary retention?
FBC, UEC, PSA, coags (?clotting)
38
What is the most important management for someone with a urinary catheter?
Catheter insertion and fluid monitoring
39
Name 3 factors on Hx and examination to differentiate between testicular torsion and epididymoorchitis
Torsion: testes horizontal lie, cremasteric reflex lost, younger patient, sudden onset ++severe pain Epididymo: Hx of unprotected sexual intercourse, verticle lie of testis and cremasteric reflex NOT lost. Gradual onset.
40
What is Ramsay Hunt syndrome?
Reactivation of herpes zoster in the nucleus of the facial nerve
41
What is Wriggler's sign?
Being able to see both sides of the colon (due to air in/around it)
42
What are the timing limits for eating+drinking before a surgery?
6hours: no food | 2hrs before op: can have some sips of water
43
In a low CVD riks patient (<10%) what does the BP needs to be to start treatment?
>160/100
44
What are the 4 steps in mgmt of HONK
1) Normal saline 2) Start insulin if BSL not reduction by 5mmol/hr 3) Watch k+ 4) Correct Na for glucose
45
What is the test for chalmydia/gono in females?
Endocervical swab for NAAT
46
Name 4 side effects of PPIs
Osteoporosis, pneumonia, malabs of vitamins, increased risk of C.Diff infections,
47
What bug causes diarrhoea in immunocompromised patients and/or those who've had recent Abx?
C. Diff
48
What are 3 common symptoms of ischaemic colitis?
Acute onset abdo pain, diarrhoea and rectal bleeding
49
How do you treat ischaemic colitis?
Supportive care with bowel rest! NBM and IVH until symptoms resolve. Antibiotics not usually recommended.
50
Name 5 side effects of the COCP
nausea, headache, breakthrough bleeds, weight gain, bloating, acne, mood changes
51
List 4 contraindications to the COCP
Migraine with aura, prev/current breast ca, liver disease, IHD, 6/52 post-partum, prev DVT, AF, vascular disease
52
What are 2 contraindications to using the progresterone only pill?
If prev breast ca or severe liver disease
53
What are 3 contraindications to using Implanon?
Prev breast ca, severe liver disease or undiagnosed vaginal bleeding
54
Name 3 s/e of Implanon
Pain at site of insertion, mood changes, spotting, periods can become heavier, acne
55
What is the only non-hormonal contraceptive?
Copper IUD
56
What are 4 contraindications to using the Mirena?
STI, PID, pregnancy or undiagnosed vaginal bleeding
57
Name 3 methods of emergency contraception (include how many days they can be taken in)
Levonorgestorol: taken within 72 hours of UPSI, OTC. UPA: most effective, can be taken 5 days after. Needs script Copper IUD: most effective at preventing pregnancy, inserted 5 days after UPSI
58
What are 5 tests for haemolysis
FBC, bilirubin (raised), LDH (raised), haptoglobulin (low) and reticulocytes
59
What anaemia is caused by hypothyroidism?
MACROCYTIC
60
Which anaemia is vitiligo associated with?
Pernicious anaemia (autoimmune, reduced B12)
61
What is the best antiemetic for migraine?
Prochloperazine (stemetil)
62
What is a complicated migraine?
Normal migraine with neurological features ie hemiplegia, hemianopia, vertigo. Familial usually.
63
Name 5 causes of secondary osteoporosis
Iatrogenic, immobilisation, malabs, endocrine or alco use
64
What does a T score of <2.5 indicate?
Osteoporosis
65
What is the major side effect of bisphosphonates?
Osteonecrosis of the jaw and heartburn! Also atypical fracture of the femur with long term use
66
What are two tests when testing for organic cause of depression apart from the routine ones?
24hr urinary cortisol and testosterone in males
67
What is an important question to ask on asthma Hx?
Any previous ICU admissions?
68
Lay person description of asthma
Chronic, reversible inflammatory condition of the airway that is secondary to airway hyperresponsiveness
69
What is the 4x4x4 rule for asthma?
Keep giving the person four separate puffs of reliever medication, taking four breaths for each puff, every four minutes until ambos
70
What is the preferred anticoagulant for vavular AF?
Warfarin!
71
Name 6 symptoms of menopause
Hot flushes, weight gain, sleep disturbances, mood changes, reduced muscle mass, dry/shrinking vagina, headache, irritability, night sweats
72
Name treatment modalities for menopause
Oral, patch or pessary. Continous or sequential
73
What are 4 side effects of HRT?
Increased VTE risk, risk of breast ca, risk of stroke and unwanted bleeding
74
What are 3 absolute contraindications for HRT?
Active VTE, oestrogen dependent ca or undiagnosed vaginal bleeding
75
What two categories are LUT symptoms divided into/
Storage and voiding
76
Name 3 storage symptoms for LUTS
Urgency, nocturia, frequency
77
Name 3 voiding symptoms
weak stream, incomplete emptying, straining
78
What are 3 side effects of duodart?
Postural hypotension, erectile dysfn and gynaecomastia
79
Name 3 questions that should be asked of a pregnant female when coming in for anything
PV loss, pain and foetal movements
80
Three questions to ask before neonatal resus?
Tone, term, tantrum (cried at birth)
81
What is the skin condition with a herald patch?
Pityriasis rosea
82
What is the 5 step process for management of a AAA rupture?
1) ABCDE 2) Insert 2 large IV bore cannulas and maintain BP >90systolic 3) Consider activation of massive transfusion protocol 4) Analgesia 5) Transfer for surgery
83
What is a formula for adult maintenance fluids? (Think water, K, Na, Cl and glucose)
30ml/kg/day of NaCl, 1mmol/kg/day or sodium, chloride and pottasium and 1g/kg/day of glucose
84
What are the 5 components of fluid management?
1) Resuscitate 2) Rehydration 3) Routine fluids 4) Replace losses (ie diarrhoea, post-op drains) 5) Re-evaluate
85
What is the fluid mix given to kids for resus?
0.9% normal saline and 5% dextrose

IMP3 Revision (4 decks)

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