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year 6 > week 2 > Flashcards

week 2 Flashcards

1
Q

asthma

A

50-75 = moderate
silent chest
aspergillus serology
IV hydrocortisone
PO 5-7 days
48 hours follow up
stable 12-24 hours
>20% diurnal variability 3 x a week
>12% improvement with bronchodilator
FeNO

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2
Q

heart failure

A

low utput vs high
EF<40
dobutamine - hypotension, ITU
CPAP
hydralazine
no bb if brady
IHD, HT, valvular
BNP, CXR, ECG, transthoracic echo
drugs decrease BNP
annual pneumococcal, influenza
NYHA - no limitation, slight, marked but comfort at rest, always discomfort and nitrate
acei for cardiac remodelling

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3
Q

svt

A

ablation chronic
verapamil asthma
IV digoxin, beta b locker, amiodarone
digoxin toxicity\caffeine, alcohol

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4
Q

pericarditis

A

malignancy, sarcoid, SLE
ECG = pr depression
perciardial tamponande
pulsus paradoxus -drop in SBP by 20 on insp

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5
Q

alcohol withdrawal

A

acomprosate
CIWA
glucose not before thiamine
48-72 hours
anterograde

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6
Q

gi perforation

A

psoas sign = intraperitoneal fluid
riglers sign - intrabdominal air
pleural lavage in boerhaves
peritoneal lavage
amylase

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7
Q

peritonitis

A

rebound tenderness
urinary catheter
central venous line
SBP
rigid abdomen
reduced bowel sounds

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8
Q

portal HT

A

caput medusa
portosystemic shunt
hepatic venous pressure gradient
pre-hepatic - portal vein thrmbosis, congenital stenosis
post - constrictive pericarditis, budd chiari, RHF
hepatorenal syndrome

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9
Q

viral hep

A

IVDU = C, transfusions, HCC
direct acting antivirals
nucleoside analogues/ peginterferon alpha in B and D

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10
Q

cardiomyopathy

A

ejection systolic, apical thrill, double apex beat
displaced
scleroderma, amyloidosis
doxorubicin - dilated
arrhythmias cause of death
kussmaul’s - rise jvp on inspo in restrictive
deep s v1/v2, tall r v5/v6
amiodarone, beta, cardiac defib, dyal chamber pacemaker, endo prophylaxis

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11
Q

tia

A

amourosis fugax
diffusion weighted MRI
CHADVASc
asprin 300mg for 2 weeks
no driving 1 month, no need to inform
75mg clopi, statin
>50% stensosi
if bleeding disorder, on DOAC/ warfarin, severe carotid stensois - admit and CT head

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12
Q

type 2

A

suphony - weight gain
pancreatitis - dpp4, glp1
gi distaurbance, lactic acidosis - metformin
background, pre-prof, prolif
58 change
53 target if hypo durgs
urine albumin creatinine
cushings, pancreatitis, steroids

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13
Q

type 1

A

psychosocial support
BP control
hypoglycaemia awareness
3rd party assistance
increased monitoring when sick
ACEi, diuretics, NSAIDs stop if unable to keep fluids - AKI
above 40 on statin
metformin if BMI>25

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14
Q

dka

A

<1 ketones = subcut stop after 1 hr
resolution <0.6
§0% dextrose if <14
potassium therapy
septic screen
thromboprophylaxis
euglycaemic - glifozins

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15
Q

pckd

A

mitral valve prolapse and aortic regurg
CKD mx
tolvaptan
flank pain
diverticular disease

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16
Q

benign breast

A

both menopasual
microdochectomy in papilloma
duct ecstatsia - smokers
warm compresses

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17
Q

breast cysts

A

aspirated if probleatic
if blood stained, pus - biopsy and excision

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18
Q

gangrene

A

wet, dry, gas
surgical debridement
steroids
x-ray of joint
LDH

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19
Q

uveitis

A

hlab27
tb, behcet’s, sle, ms
posterior: yellow/ white retina, blurred vision and progressive visual loss
ciliary flush, hypopyon
cycloplegic mydriatic drops - atropine
hourly steroid regime
may need methotrexate .etc.

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20
Q

brain mets

A

lung, breast, renal, melanoma
cerebral oedema, seizures
give dex

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21
Q

cellultiis

A

erypsipelas only skin
sub cut and dermis = cellultiis
strep pyogenes = eryp
orbital decomrpession, ct/mri orbital sinuses
IV if systemic signs
swelling of lymph nodes

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22
Q

bcc

A

morphoeic, nodular ulcertaive (central ulcer), pigmented, superficial
imiquimod

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23
Q

hhs

A

glucose >30, hypotension , 320
0.9% saline if not <5osm drop then 0.45%
0.05U if fail to drop glucose or ketones >1

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24
Q

dic

A

maha
trauma/ burns
APML
raised d dimer

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25
Q

aplastic

A

dyskeratosis congenita: leukoplakia
schwanman diamond
autoimmune -most common
immunological assays
immunosuppressants
chloramphenicol

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26
Q

sickle cell

A

penicillin V
o2, abx,blood transfusions, pain relief
new pulm infiltrates
silent strokes, visual floaters
salmonella osteomyelitis
hb electrophoresis, sickle solubility test, hip x ray
howell jolly

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27
Q

colorectal

A

smokig, alcohol
liver lungs bone brain mets
ascites
lfts normal in mets
60-74 every 2 years

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28
Q

crohns

A

IV hydrocortisone if severe induce–> infliximab if not 5 days
flare up: above - fluids, immunosuppressants, parenteral nutrition
dmards - axathioprine, mercaptopurine for maintenance
fistula, abscess
string of kantor = barium swallow
no live vaccines
OGD and colonoscopy
terminal ileitis - gallstones

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29
Q

AR

A

valve: IE, rheumatic, bicuspid
aoritic root - aorittis, syphilis
low DBP
thrusting displaced apex beat
MDT
reduce afterload
corrigan’s - neck

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30
Q

dermato, poly

A

breast cancer, lung, pancreas, bowel
CXR, mammo USS
myeloma
nail abnorm - capillary dilatation
immunosuppressants
symmetrical proximal, distal spared
intersitial lung
spirometry

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31
Q

constricitve

A

echo
kussmaul
advanced - cachexia, jaundice, muscle wasting

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32
Q

anal fissure

A

break in squamous lining
anal sphincter spasm
conservative
if reisstant 6-8 weeks of GTN then sphincterotomy
opioids

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33
Q

VT

A

long Qt –> torsades
erythromycin, ondansetron, TCAs, citalopram, haloperidol, hypokal, mag, cal, roman ward, methadone, amiodarone
stable - IV amiodarone and correct e-
unsatble - shock then cpr, then adrenaline
ICD if syncope, MI, <35% EF, previous cardiac arrest

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34
Q

cholecystitis

A

NBM, fluids, analgesia, anti-emetics

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35
Q

epilepsy

A

24 hrs apart
10 years seizures, 5 years med
lam - steven johnson
phenytoin - liver, lymphadenopathy, bleeding gums, peripheral neuro
SUDEP
levitiractiam for women in myoclonic as lamotrigine CI

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36
Q

osteoporosis

A

RA, coeliac
reduced bone density
-1–2.5
bulky physeal plates
coeliac screen
>75 may not need
if prev fragility fractures no need
empty stomach
teriperamide - anabolic, romosozumab (sclerostin inh), HRT
strontium inc risk of MI
osteonecrosis of jaw and atypical stress fractures

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37
Q

graves

A

acropachy - clubbing
beta receptors - fine tremor
pretibial myoedema - orange peel
MI, surgery, trauma, infection, DKA - crisis
12-18 months tx
block and replace regime - euthyroid give thyroxine
radioiodine if reisstant - CI, eye and preg
smoking increases eye
IV propanolol –> IV PTU + IV lugol’s idione –> IV hydroxortisone

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38
Q

polymyalgia

A

15mg daily
>45 mins stiffness, >2 weeks
myeloma differential if no improvement w/ steroids
vit D and calcium
DEXA, steroid card

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39
Q

otitis media

A

delayed if not improved in 3 days
perforation - 5 day then review in 6 weeks
mastoidits, facial enrve palsy, labyrinthitis
passive smoking
unilateral glue ear - 2ww
chole - ENT
hearing test 3 months apart, if no imporvement 6-12 weeks –> surgical/ non surg

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40
Q

uc

A

biopsy - crypt abscesses, loss of goblet cells
rectal - mild ,4
moderatie + oral - 4-6
severe = steroid + ciclosporin .6
maintenance - rectal (+ oral if no impr after 4 weeks), if extensive both
if >2 exacerbations - oral azathioprine/ mercapto
Hb, temp, bowel movements, esr
barium - loss of haustra
emerg - hartman’s proctosigmoidectomy and end ileo

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41
Q

coeliac

A

dapsone
gluten for 6 weeks before endo
EATL
villous arrophy, crypt hyprrplasia, inc lymph

42
Q

gastroenteritis

A

giardia like coeliac - swimming poos
yersinia and TB - RIF mimic crohn’s
48 hours home
HUS, GBS
botulinism - decsenidn gparalysis, canned food
listeria - cheese, unpasteruisied milk

43
Q

haemochromatosis

A

erectole dysfunction
inc iron absorption
trasnferrin sat and ferritin to monitor
weekly vene to induce then 2-4 x a year
perl’s stain

44
Q

mesenteric ischaema

A

chronic is psot prandial pain, weight loss and abdo bruit
acute: clinical findsings disppropirtion to shock
ischaemic coltiis - bloody diarrhoe,a colonosocpy
ABG, cross match, ECG, ACR - thumbprinting, gasless abdomen
CT first inv
superior mesenteric
anticoag

45
Q

acute pancreatitis

A

A{CHE II, GLASGOW - o2, calcium, ldh/ast, albumin, glucose, age, neutrophils, rneal function - 3or more
amylase
cullen’s, grey turner’s, fox’s
sodium valproate
removw gallstones
correct electorlytes/ underlying cause, parenteral nturition, glucose control
USS before ERCP

46
Q

chronic pancreaittis

A

faecal elastase
bloating
pancreatin + omeprazole
surgical

47
Q

peptic ulcer

A

early satiety
ssris
dudodenol no need biopsy
abx and ppi free for 2 weeks
triple 1-2 weeks
if nsaids concurrent 3 months ppi then triple
if no improvmeent 6 months - endosocpyically sugery - sclero, laser
serum gastrin
urease in h pylori break down urea

48
Q

psc

A

ercp - beading
cirrhosis, ascending cholangitis
cholestyramine and vitamin ADEK
inc lymphocyte infiltration

49
Q

volvulus

A

caecum - SBO (clockwise) - adhesions,
sigmoid - LBO (Chagas, neuro - aprkinsons, cosnti, schizo)
drip and suck in sigmoid - rigid sigmoidoscopy and rectal tube
caecum - righ hemiolectoy

50
Q

lung cancer

A

tsh - hyperthyroid - squamous
hypertrophic pulmonary osteoarthropathy
haemoptysius
clubbing
laryngeal nerve
lobar collapse, pleural effusion
lobectomy, wedge resection, pneumonectomy
ci for surgery - svc obstruction, malignant pleural effusion, vocal cord paralysis
pre-op - abg and pfts
adeno - gynaecomastia

51
Q

multiple sclerosis

A

central scotoma
internuclear ophthalmoplegia - medial longitudinal fasciculus - 3-6
natalizumab
baclofen
cerebellar signs
Marburg’s - death within weeks

52
Q

raised icp

A

redcued gcs
cheynes stokes breathing
papilloedema
IV mannitol, raise head, repeated LP
controlled hyperventilation
idiopathic intracran ial ht = obese females

53
Q

subdural

A

burr hole craniotomy
acute <72 hours
chronic > 3 weeks - progtressive memory loss
correct coaguloapthy - FFP, vit K

54
Q

adrenal insufficiency

A

5% dextrose, hydrocortisone bolus then 6 hourly until bp stable
emergency needles and hydrocoritosne, treat rpecipitating cause
majority of hydrocortiosne in morning
doubling sick day rukes
waterhouse friderichse n - haemorrhage

55
Q

thyroid nodules

A

cervical lymphadenopathy, increasing in size
emergency if stridor, signs of upper airway obstruction
thyroid cysts

56
Q

aki

A

1.5-1.9, 2-2.9
creatinine over 350, <0.3 for 12 hours
sepsis, anaphlyaxis
renal bruits
rhabdomyoslysis
drug chart
ckd signs and ix
nephrology referral if renal
stop nephrotoxic drugs
cystatin c
vasopressor e.g. adrenaline if severe hypotension

57
Q

uti

A

preganncy, haematuria, elderly, sepsis, male - urine MCS
IV for pyelo
confusion and falls
KEEPS

58
Q

kidney stones

A

uretetic - tamsulosin ad lithotripsy
<5, 5-10 - litho, 10-20: litho/ ureteroscopy, >20 - percutanatenous lihtotomy
haematuria
loop diuretics
renal tubu;lar acidosis type 1
thiaxide and low salt diet
in young -potassium citrate
allopurinal in urate
high fluid itnake
cholestyramine for oxalate
within 48 ours surgery if really bad

59
Q

acoustic neuroma

A

loss of corneal reflex - V
cerebellopontine angle MRI and audiometry
vertigo

60
Q

vestibular neuronitis

A

naudea and vomitting
horizontal nystagmus
prochlorperazine - IM if severe, otherwise oral
vestibular rehbailitation exercises

61
Q

beningn eyelid

A

squamous papilloma - hpv, molluscum, xantholelasma
stye is painful pointing otuwards - hair follicles , staoh
chaklazion - non tender swelling pointing inwards, meibomian gland

62
Q

diabetic eye

A

retinal detachment and vitreous haemorrhage
anti-vegf for macular odema
blot haemorrhages and microaneuryms sin background
vitrectomy if vitreous haemorrhage
oct for mac oedema

63
Q

macular degen

A

early age and late age (dry and wet)
drusen spots
amsler grid distorted
day to day variation
subacute in wet
fluorescein angiography in wet
OCT
vitamin ACE and zinc
bevacizumab

64
Q

typhoid

A

cipro or cef
osteomyelitis

65
Q

chlamydia

A

gram -ve parasite
azithromycin in pregnant
fitz hugh curtiz

66
Q

hiv

A

gp120
hiv antigen and antibody first line
elisa for screening - p24 antigen
viral load for mx response
cd4 for aids conversion
rategravir - integrase, lamivudine - nrti
2nrti + ii, pi .etc.
colonoscopy for cmv colitis, baso all ix
cmv reitiniis - pizza pie like

67
Q

pjp

A

bilateral interstial pulm infiltrates
dry cough
co-trimoxazole
penumothorax most common comp
<200 cd4 need prophylaxis

68
Q

cd4 stuff

A

500 –> 50
<500 = thrush, shingles, hairy, kaposi (virus stuff)
<200 = pcp, toxo, cryptosporidiosis, PML - neuro and resp, gi
<100 = oesophageal, cryp menin
<50 - TB - myco avium and cmv retinitis

69
Q

cryptosporiasis

A

modified ziel neison - red cysts
watery diarrhoea
nitozoxanide

70
Q

neuro comp

A

toxo - ring enhaving and thalium -ve
CNS lymphoma
PML
TB

71
Q

thalassaemia

A

hba2 >3.5
desferrioxamine w/ blood transfusions
howell jolly
osteopaenia

72
Q

ITP

A

DAT = evan’s with AIHA
<30 = steroids
emergency bleeding = IV methypred _ IVIG + platelet transfusion
>30 = observation

73
Q

MM

A

M protein in blood/ urine as criteria
hyp[erviscosity, infections, Al amyloidosis
rouleux on blood film
randrop skull
daratumumuba induction adn autologous stem cell transplant
if not transplant - MPT (mephalan, pref and thalikdomide)
also treat symps
rpognosis - LDH, b2 microglobulin, CRP
alp high in mets

74
Q

ank spond

A

sydesmophytes, sacroillitis, squaring of vertebra, loss of joint space
reduced chets expansion, lateral lfexion and forward flexion
schober - <5cm
AV node block
etanercept –> sekukinumab

75
Q

osteoarthritis

A

nsaids + PPI
diclofenac topical
varus, squaring of thumb, heberdons (DIP), bouchard’s
subchondral sclerosis and cysts

76
Q

paget’s

A

area sof sclerosis and lysis
isotoep bone scan
bidphosphonates
sensorineural heating loss - VIII
axial skeelton - head and neck

77
Q

compartment syndrome

A

paralysis, paraesthetis, pulseness - not necessaringly
>20 mmhg abnormall, >40 is diagnositic
myoglobuniria can cause AKi - fluids

78
Q

ascending cholangitis

A

sepsis, confusion

79
Q

gastric cancer

A

mary joseph node
early satiety, haemetemesis
high salt
krukenberg
FBC for anaemia - ACD/ haemetemesis

80
Q

NASH

A

FIB4 and ELF - refer if >F3
fatty liver index = BMi, waist circum, GGT, TGs
>5% fat

81
Q

aortic stensosi

A

bicuspid in young, williams
<50% EF, symptomatic
surgery if bicuspid
non dispalced heaving apec beat
s2 softened if more severe
p mitrale

82
Q

vf

A

implantable cardiovertor defribillator in most survivors (ICD)

83
Q

bronchiectasis

A

alpha 1, abpa, ra
tram track cxr
signet rings ct
po cipro, iv tazocin - pseudo
haemoptysis, clubbing, high pitched insp crackles

84
Q

pneumonia

A

cxr after 6 weeks
bronchial breathing
coarse crackles
+ clarithromycin
ABG
empyema
copd give steroids
staph after influenza

85
Q

sah

A

nimodipine + coil aneurysm
diagital subtraction cathter angiography
xanthochromia 12 hours LP
meningism
ECG - torsades de pointes
photophobia

86
Q

cluster headaches

A

verapamil is preventative
nasal symps

87
Q

tonsilitis

A

centor - cent so age
<3 day symps - fevrpian
trismus
if persistent change in voice for 2 weeks –> laryngoscopy
lemierre’s - jugular vein - benzylpen

88
Q

glaucoma

A

acute, chronic, primary
steroids
rubeosis iridis
ahloes, headache, N+V, fixed dilated pupil
hazy cornea
cupping of disc
gonioscopy and tonometer
prostaglandin - lantoprost - long eyelashes
beta blcokers, carbonix anhydrase, miotics - pilocarpine, symptomimetics
>34 = selective laser trabeculoplasty
laser peripheral iridotomy

89
Q

blepharitis

A

seborrhoeic dermatitis
grittiness and discomfort

90
Q

central vein occlusion

A

HT, cardiovascular, glaucoma
sudden painless loss of visiob, retinal vitrieous haemorrhages
hyperaemia
stormy sunset
branch -blockage of retina at arteriovenous crossings
anti VEGF, laser photocoagulation

91
Q

enteropathic

A

sekukinumab may exacerbate
etanercept may not work

92
Q

sarcoidosis

A

extrapul features, black, no erythema nodosum = poor prognosis
keratoconjunctiviis sicca, uvieits
lofgren’s - acute arhtitis and bihilar lymphadneoapthyr- self limtiing , can give NSAIDs

93
Q

systemic sclerosis

A

pulm HTN - right heart catheterisation, annual PFTs, sldienafil
renal crisis - ACEi
cyclophosphamide for lung fibrosis
HTCT
sclerodactyly

94
Q

osteomyelitis

A

MRI
6 weeks oral
surgical debridement
pott’s disease - TB

95
Q

cholangiocarcinoma

A

ca19-9
ercp

96
Q

liver abscess + cyst

A

parasitic
south/ central america travel
tender hepatomegaly
stool culture for entamoeba
nitroimidazole for amoeba
may get chest signs
refer to ID and GUM

97
Q

wilson’s

A

kaysher fleischer rings
sunflower cataract
blue nails
haemolytic anaemia
king wilson score - acute, lvie rtranpslant (>=11)
penicillamine + zinc
avoid soya, dark choc, nuts
norm sensation, reflexes, strength

98
Q

mitral stenosis

A

non dispalced tapping apex beat
thready pulse
PHT, RHF
valvulopalasty
treat AF
atrial myoxma
RA
parasternal heave
<1.5cm = intervention
pen V for RHf prophylaxis

99
Q

vasovagal syncope

A

fatigue after episode

100
Q

WPW

A

ebstein anomoly, HOCM
VF
broad QRS
red end diastolic filling
svt mx, ablation

year 6 (4 decks)

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