wrong answers Flashcards
1
Q
How is normoglycemic ketoacidosis different to DKA?
A
DKA - type 1 diabetes
NKA - type 2 diabetes, risk factor SGLT-2 inhibitors
2
Q
What is a side effect of antithyroid medications?
How does this present?
A
Agranulocytosis
Fever, sore throat, illness etc after being commenced on anti-thyroid medication (eg. carbimazole, propylthiouracil)
3
Q
What is the treatment of newly diagnosed type 1 diabeties
A
Immediate insulin therapy and referal
4
Q
How to treat DKA?
A
Continue basal insulin - start on fixed rate (cells start to use glucose, switching off ketone production)
Correct dehydration over 48hrs –> to dilute hyperglycaemia and ketones
5
Q
How to treat HHS
A
Fluid
6
Q
How does adrenal crisis present and why?
A
Hypotension (low aldosterone –> no water retained)
Hypoenatremia (Na follows water)
Hyperkalemia (oposite to Na)
Hypoglycemia (low cortisol –> increase glucose utilisation/ insulin response to increase energy)
7
Q
What is plummers disease?
A
Toxic multi nodular disease - nodules release thyroid hormones and are NOT regulated by thyroid axis
8
Q
What is key for diagnosis of graves disease and why
A
Anti TSH receptor antibodies –> Graves is autoimmune disease - bind to TSH receptors and TSH is released –> increase T3 and T4
9
Q
How to visualise the pituitary gland?
A
MRI is preferred but CT if not MRI devices (eg. pacemaker)
10
Q
What is the most common reason for DKA?
A
Insulin ommision
11
Q
What is the presentation of hypercalcemia
A
Stones - renal stones
Bones - painful bones
Thrones - polyuria, polydipsia, constipation (increased sitting on the toilet)
Groans - Abdominal moans
Moans - Psychiatric groans
12
Q
What is the presentation of hypocalcemia
A
Tetany
Muscle spasm
Cramping
Parastesia
Muscle cramping
Cardiac arrtyhmias
13
Q
How to stabilise the cardiac membrane?
When is this needed?
A
Calcium gluconate
Calcium chloried
Hyperkalemia
Hypocalcemia
14
Q
When are SGLT2 inhibitors beneficial in diabetic control
A
Beneficial in diabetic nephropathy and cardiac issues
15
Q
What is (and how to test for):
Addisons
Conns
Phaeochyrom
Cushings
A
Addisons - Adrenal insufficiency
- Low cortisol, low aldosterone
- 9am cortisol, ACTH stimulation test
Conns - high aldosterone
- Renin:aldosterone
Phao - high adrenaline
- 24hr urinary catecholamies
Cushings - high cortisol
- Dexamethasone supression test
16
Q
What is thyrotoxicosis
How to treat?
What to avoid?
A
Excess state of circulating thyroid hormone causing excess thyroid activity
Treat with NSAIDS
avoid anti-thyroid drugs
17
Q
How to differentiate between thyrotoxicosis and graves disease?
A
Anti-thyroid antibodies - positive in graves
18
Q
How does thyrotoxicosis present?
A
Proceeding viral prodrome
Raised EST
Tender goitre
19
Q
How to distinguish between myeloma and hyperparathyroidism?
A
Calcium released via myeloma with SUPPRESS PTH as is not a problem with the pituitary (axis will still work)
20
Q
What percentage of oxygen is in air?
How does % oxygen relate to litres?
A
21%
1 litre –> 24%
increase 4% with every litre
21
Q
When to use NIV in COPD management?
A
When patients are on maximum treatment with ongoing resp acidosis
22
Q
How to calculate the CURB65 score
A
Confusion
Urea >7
Resp rate >30
BP <90/60
>65
23
Q
What is the most common causative organism for CAP?
A
Streptococcus pneumoniae
24
Q
What is the most common causative organism for HAP?
A
Haemophillia influenza
MRSA
25
What is bronchiectasis?
How does it present
Permanent dilation and scarring of the airways
Obstructive condition
Cough
Purulent sputum
Fatigue
Crepatations
Recurrent infections in childhood
26
What is gold standard for diagnosis of bronchiectasis?
CT scan
27
What is pulmonary fibrosis?
How does it present?
Scarring in the lungs
Restrictive pattern
Coal miners
Clubbing
Dry cough
SOB
Inspiratory crackles
Reticular shadowing on CXR
Ground glass opacificities on CT scan
28
What is a pancoast tumour
Tumour at the apices of the lungs
Horners syndrome
Involvement of the brachial plexus
29
What are the different types of lung tumour and how to distinguish between them?
Small cell
- metastasises quickly - normally before diagnosis
- mediastinal mass
Squamous cell
- most common
- smokers
- centra
Adenocarcinoma
- non-smokers (BUT more common in female smokers)
- peripheral
Pancoast
- apex
- horners
- brachial plexus involvement
Mesothelimoa
- asbestos exposure
- pleural thickening
- not circular
30
When to use oxygen therapy in COPD?
When sats <92 when stable
31
COPD managment
1. SABA or SAMA
2. LABA and LAMA (discontinue SAMA)
32
What is trimbow inhaler
triple therapy
33
What is ventolin inhaler
saba (salbutamol)
34
What is symbicort inhaler
SABA and LABA
35
FEV/FVC for obstructive
<70%
36
FEV/FVC for restricitve
>70%
37
obstrucitve lung conditions
38
Restrictive lung conditions
39
COPD vs asthma spirometry
Asthma >12% reversable
40
What is life threatening asthma?
33 peak flow
92 sats
Normal PCO2
oxygen <8
Features of respiratory distress
41
What is the causative organism for pneumonia that occurs with target lesions and dry cough
Mycoplasma pneumonia
42
What are hypotension, muffled heart sounds and raised JVP a sign of?
What is the first investigation?
Cardiac tamponade (Beck's triad)
Echo
43
Describe the ECG location of ST elevation and which vessels this relates to
44
Describe aortic stenosis murmur
45
Describe aortic stenosis regurg murmur
46
Describe mitral stenosis murmur
47
Describe mitral regurg murmur
48
When is digoxin used over bisoprolol for rate control?
heart failure or low BP
49
How to calculate CHA2DS2VASc score
CHF Hx
Hypertension Hx
Age (2 for >75, 1 for 65-74)
Diabetes Hx
Stroke/TIA/PE Hx (2)
Vascular disease Hx
Sex (1 for female)
50
First choice of antihypertensive in black origin?
CCB
51
First choice of antihypertensive in diabetics?
ACE inhib
52
What to use in treatment of HTN in black african origin when CCB is not tolerated?
Thiazide diuretic
53
What is indapamide?
Thiazide like diuretic
54
What is spironalactone?
K sparing diuretic
55
What is fruosemide?
Loop diuretic
56
What is the starting dos of ramapril?
2.5
57
What is the treatment for c diff?
Oral vancomycin (first episode)
Fidaxomicin (resistant, recurrent)
Metronidazole (severe)
58
Why not use loperamide in c diff infection?
Reduced diarrhea - antimotility --> reduced expulsion of the c diff toxin
59
What is the treatment for cholesytitis?
co amox
60
What score for upper GI bleed for outpatient management?
Glasgow-blatchford - before endoscopy
Rockall score - after endoscopy
61
What does constipation feel like on PR exam?
Hard stool in the rectum
62
What is the treatment for H pylori
PPI
Amox
Clari
Metronidazole
63
What are the complications of H pylori?
GORD
Peptic ulcers
Stomach cancer
64
How to tell the difference between different type of peptic ulcer?
Gastric - Worse after eating --> tend to loose weight
Duodenal - better after eating --> tend to gain weight
65
What are the risks for peptic ulcers?
Things that disrupt the mucosal membrane or increase the stomach acid
- stress
- spicy food
- alcohol
- smoking
66
What are the investigations for an obstructing gallstone?
USS - if one not seen then MRCP
67
What is an MRCP compared to an ERCP?
MRCP - MRI
--> visualise gall stones
ERCP - endoscopic procedure
--> visualise and remove gall stones
68
What is chronic mesenteric ischemia and how does it present?Why?
Narrowing of the mesenteric arteries (think risk factors)
- abdominal bruit
- colicky epigastric pain --> occurs after eating and relieved by defication
- weight loss due to food fear
Blood supply to the gut is adequate during rest but inadequate during active digestion
69
How to diagnose chronic mesenteric ishemia?
CT angio
70
How to check for strictures in the small bowel?
CT
71
What are the more specific differences between chrons and ulcerative collitis?
UC:
Extra-intestinal disease (episcelriis, erythema nodosum)
Reduced globlet cells and granulomas
Drain pipe colon risk
lower left abdominal pain
Crohns:
Strictures
Fistulas
Increase in goblet cells
Granulomas
Right illiac fossa mass (terminal ileum mostly affected)
cobblestone appearance, skip lesions
72
Is there more weight loss in UC or crohns? Why?
Crohns - affects the terminal ileum mostly (where nutients etc are absorbd)
73
What is the difference between primary billiary cholangitis and primary sclerosing cholangitis?
Biliary:
- Affects women more
- Affects the inside of the liver
- AMA antibodies, raised ALP (cholestatic picture)
- Associated with other rheumatoid conditions --> Sjogrens, RA, systemic sclerosis
Sclerosing:
- Associated with ulcerative collitis
- Affects the inside and outside of the liver
- Males affected more
- MRI bile ducts
- Beads on a string
74
What is ursodeoxycholic acid used for?
Treatment of gallstones
PSC
75
What is Charcots triad?
Abdominal pain, jaundice, fever
Associated with ascending cholangitis
76
What is the most common causative oragnism for ascedning cholangitis?
E coli
77
What is the next step for somebody presenting with dysphagia?
2WW endoscopy to rule out malignancy
78
How does intussception present?
Who is it more common in?
between 6 months - 2 years of age
redcurrant jelly stool
sausage shaped mass in abdomen
More common in children with CF
79
How does pyloric stenosis present?
projectile vomiting
between 2-12 weeks old
80
What is the difference between a strangulated hernia and an incarcerated hernia?
Incarcerated - not reducible
Strangulated - blood supply is compromised
81
What can be used as treatment for visceral pain in IBS?
Amityptaline
82
What are the risk factors for biliary colic?
Female
fat
forty
fertile
83
What score is used to assess mortality rate in cirrhosis?
Child pugh score
84
How is cirrhosis described on a scan?
nodular liver surface
hypoechoic nodules
85
What are the presentations of neurosyphillis?
Pupils react to accommodation and not light
Lack of proprioception and vibration sensations
Focal neurological signs
20-40 years after first presentation
86
What is Zollinger-Ellison syndrome?
What is the test for it?
Traid of:
Pancreatic cancer
Gastric hypersecretjons
Peptic ulcers (in unusual places)
Test —> secretions
THINK if features of ZES - cancers
87
What is a HINTS exam?
What do the results indicaete
Test to perform following prolonged vertigo and nystagmus with a normal cerebellar examination
Head impulse, nystagmus, skew
- NEGATIVE HEAD IMPULSE --> central issue (eg posterior stroke)
88
What is the treatment and prophylaxis for migrane?
Prophylaxis propranalol
Treatment tryptans
89
What is the classification for CT within 1 hr following fall
more than one episode of vomiting
GCS <13
GCS deteriorating within 2 hrs
Opened or depressed skull fracture
Focal neurology
Post traumatic seixure
90
What is the classification for CT within 8 hr following fall
retrograde amnesia
on anticoagulation
dangerous mechanism of injury
LOC
91
What is the treatment for seizures in hospital
Lorazepam over diazepam
92
What are the treatments for AD?
1) ACh inhbitors (donzepil, rivatigmine, galantamine)
2) memantine
93
What are the treatments for seizures?
Male - sodium valproate
Female - lamotrigine or levetiracetam
94
What is the treament for temporal arteritis? bells palsy? trigeminal neuraliga?
TA - prednisolone
Bells palsy - prednisolone
TN - carbamazepine
95
What is venous sinus thrombosis? How does it present?why?
Stroke
Headache
vomiting
difficulty speaking/understanding language
BLURRED VISION due to increase in ICP behind the clot (unable to drain blood out of the brain) --> pappiloedema
96
How does polycythemia ruba vera present a risk for venous sinus thrombosis?
increase in RBC --> more cells --> thicker blood --> clot
ALSO concurrent increase in platelets
97
What are the differences between focal and complex seizures?
focal - one side of the brain. repetative movments. can be comples (not aware) or simplae (aware)
comples - both hemispheres, lose conciousness, tonic-clonc (grand mal), absence (petite mal)
98
meningitis prophylaxis?
cipro
99
How to screen for gestational diabeties?
OGTT at 24-28 weeks
100
What are the different emergency contraceptives and when can they be taken?
Copper coil
ulipristal
<120 hrs (5 days)
levenogesteral <72 hrs (3 days)
101
When is ulipristal effectiveness reduced?
If the patient is on progesterone pill
102
When is levenogesteral as EC effectiveness reduced? How to over come?
If obese (overcome by doubling dose)
103
How to treat seizure in pregnancy?
Mag sulf until 24hrs post delivery or last seizure (whichever is first)
104
What is the first line treatment for heavy periods?
IUS
105
What is sheehans syndrome? Cause? Sx? tretmanet?
complication of postpartum haemorrhage --> pituitary infarction (hypopituitary) du to rapid depletion of blood in heamorrhage/obstetric shock
amenoherra
Lack of lactation
fatigue
loss of pubic hhair
HRT is the treatment
106
How to visualise ectopic pregnancy?
Transvaginal USS
107
What is the abx of choice for ottitis media?
when to use
amoxicillin
use when sx lasting more than 4 days/not improving
systemically unwell
immunocompromised
<2 y/o with bilateral otitis media
108
what abx are contraindicated in tympanic membrane perforation?
When can these abx used
gentamycin
used in ottis externa
109
what is the centor score?
when to prescribe abx?
fever
lymphandopathy
lack of cough
exudate
Prescribe DELAYED abx in score of 3 or 4
110
Treatment of acute sinusitis?
nasal douche
intranasal corticosteroids - reduce inflammation
abx considered after 10 days OR if bacterial
111
treatment of ottitis externa
mild vs more severe
What are mild sx
MILD: acetic acid
More severe: topical abx +/- topical steroid
Mild - no hearing loss or discharge
IF systemically unwell - consider abx
112
Treatment for ottis media with perforation/
ORAL abx
113
What is the difference between acute and chronic sinusitis?
Acute <12 weeks
Chronic >12 weeks (3 months)
114
How to distinguish between CSOM and acute otitis media and ottitis media with effusion?
CSOM has membrane perforation and a prolonged Hx of discharge and hearing loss
115
Difference between chalazion and stye?
Stye tends to be painful whereas chalazion tends to be none painful as C is sterile inflammation
116
Blephritis vs uveitis vs scleritis vs keratitis vs episcleritis?
BLEPHRITIS: inflammation of the eyelash margin - gritty, red, crusting
UVEITIS/IRITIS: inflammation of the uvea of the eye (including where the AH is released from the cillary body) --> cloudy AH, flare
painful red eye, pain on movement, abnormally shaped pupil, hyponon, photophobia, pain on movement, flashes, floaters
SCLERITIS: inflammation of the sclera of the eye (white part)
SEVERE pain, photophobia, abnormal pupil reaction to light, redness, associated with rheumatoid conditions
KERATITIS: inflammation of the cornea (covering the front of the eye) due to microbial invasion
common in contact lens wearers
forgein body sensation
EPISCLERITIS: inflammation of the lateral part of the eye causing segmental redness and dilation of the blood vessels
Mild pain, watering, forgein body sesation
associated with herpes and inflammatory conditions
117
What is the difference between smith and colles fracture?
Smith - Spade deformity ( back of hand to floor - hand makes s shape
Colles - Dinner fork deformity (distally displaced) Palm flat on floor - hand make c shape
118
what confirms the diagnosis of polymyalgia?
response to oral steroids
119
Heberdens nodes vs bouchards nodes?
H - OA
B - RA
B before H in the alphabet (B closet to body)
120
What is goodpastures disease? How to diagnose?
Affects the lungs and the kidneys --> Ant GBM
121
Is codine used in gout?
NOT indicated - but NSAIDs are
122
What is APTT affected by?
vW disease
Haemophillia A
Hameophillia B
123
What is PT affected by?
Vit K deficiency
Warfarin
124
How to remember leukemia types
ALL downsyndrome (most common in kids)
CLL richter, smudge
AML rods
CML philladelphia chromosome
All dogs cant really sit amonst really crap people
125
Difference between leukemia, lymphoma and myeloma
LEUKEMIA - cancer of the bloods cells -->
LYMPHOMA - cancer of the lymph nodes --> lymphandopathy
MYELOMA - cancer of the plasma cells --> infiltrate into the bone marrow. Hyperviscosity.
126
What is tumor lysis syndrome?
Release of substances from RBC that are destroyed using chemo/radiotherapy
--> uric acid, phosphate, potassium
127
What is a myeloproliferative neoplasm and how is this different to a myelodysplastic syndrome
myeloproliferative --> uncontrolled proliferation of single type of stem cells
myelodysplastic --> mutation of the myeloid cells in the bone marrow
128
What investigations confirm a diagnosis of myeloproliferative syndrome?
Bone marrow aspiration/biopsy
JAK2 mutation
129
What sydromes have the potential to turn into AML?
Myelodysplastic and myeloproliferative
130
What happens in myeloproliferative disease?
Bone marrow is replaced with scar tissue --> production of blood cells takes place in other areas of the body
--> splenomegaly
--> hepatomegaly
--> spinal cord compression if happens in the spinal cord
131
What are the different types of myeloproliferative diseases?
132
What is seen on the blood film from myeloproliferative disease?
Tear drop RBC
Blasts
Anisocytosis (varying sizes of RBC)
133
How might myeloproliferative diseases present?
POLYCYTHEMIA/THROMBOCYTHEMIA:
Thrombosis - DVT and PE
due to increased number of cells
- blood clots in unusual places
POLYCYTHEMIA:
Due to increased number of RBC AND platelets
Ruddy complexion (red face)
Conjunctival plethora (opposite of conjunctival pallor)
Splenomegaly
Hypertension
134
What are the different types of myelodysplastic syndromes?
Anemia
Neutropenia
Thrombocytopenia
135
Diangosis of myelodysplastic disease?
Blood count
Blood film
Bone marrow biopsy
136
What are the causes of normocytic anemia?
Anemia of chronic dieases
Acute blood loss
Aplastic anemia
Haemolytic anemia
Hypothyroidism
137
What is aplastic anemia?
Pancytopenia with hypocellular bone marrow in the absence of any infiltrates (unlike marrow fibrosis or leukemia)
138
How does heamophillia A present
Prolonged APTT that does not correct with mixing (similar to lypys, clotting factor INHIBITORS)
Mixing --> highlights DEFICIENCY not inhibitors/antibodies
139
How are heamophillia A and B inherited
X linked
140
what is G6PD deficiency?
when does it usually present
lack of the enzyme that helps RBC to function properly --> RBC break down/heamolyse --> jaundice, dark urine
Usually presents following oxidative challenge (eg fever, viral illness, exposure to drugs) --> nitro, cipro
FAVA BEANS
141
What are the causes of megaloblastic anemia?
B12 or folate deficiency (large cells)
142
What is seen in warm hemolysis?
cold agglutinin?
IgG
C3d
143
What conditions are hyper-segmented neutrophills seen in?
Megloblastic anemias (B12, folate)
144
What anemia can metformin cause?
Aspirin?
Metformin --> B12
Aspirin --> iron deficiencyW
145
What do heinz bodies show?
GPD6 deficiency
146
What do reed steniburg cells show
Hodgkin lymphoma
147
What do target cells show
iron D anemia
Sickle cell anemia
thalassemia
148
What do schistocytes show?
fragments of RBC --> haemolytic anemaic, TTP
149
What do tear drop RBC show
Myeloproliferative disease
150
What type of anemia is sickle cell?
normochromic normocytotis
151
How does thalasemia present?
Heamolysis --> fragile RBC due to defective RBC
Splenomegaly --> due to removal of the damaged RBC
Microcytic anemia
Bone deformity -->strain of producing extra RBC
152
How does major B thalasemia presnet
same as other B thalasemia but MORE serious:
- fractures
- faliure to thrive
153
how does major A thalasemia present?
interuterine death
154
treatment for moderate B thalasmeia
Blood transfusion
Iron chelation
155
treatment for major B thalasmeia
Blood transfusion
Iron chelation
Splenectomy
Bone marrow transplant (curative)
156
What deficiency is more common in patients taking methotrexate?
Folate
157
What are the electrolytes seen in tumour lysis syndrome?
RELEASE OF ELECTROLYTES
high K
High phosphate
High Urea
BUT low Ca --> mopped up by phosphate
158
How to distinguish between ALL/CLL and CML/AML
Dependant on the FBC - different cell lines
myeloid gives rise to RBC, platelets and WBC
Lymphoid gives rise to WBC only
THEREFORE - CLL/ALL --> platelets and RBC decreased and WBC increased
AML/CML --> All increased
159
How to diagnose ITP
Diagnosis of exclusion -isolated low platelets with no other cause of low platelets
160
Rouleaux formation in cells?
Multiple myeloma
161
What to suspect with painless asymmetric swelling in the neck?
Hodgkin lymphoma
162
Shingles treatment
Acyclovir if present <72 hrs of rash
Support if >72 hrs and no Hx of immunocompromise
163
What is dermatitis herpatiformis?
Skin bumps and blisters caused by sensitivity to glutenT
164
Treatment for perioral dermatitis? Why?
Topical metronidazole as it if often preceeded by used of steroids (eg. hydrocortisone)
165
What is SJS?
What is often the cause?
Rapid epidermal necrosis of the skin and mucositis following viral prodrome and rash that spreads over the skin --> blistering of the skin
affects the skin, mucous membranes
eyes inflamed and ulcerated
Can affect the internal organs
85% are drug related --> especially lamigotrine
166
when should antiviral treatment be used for shingles?
immunocompromised
those with non-truncal shingles, those with moderate or severe rash and/or pain
and those over 50 years old (in the latter group, antiviral treatment has been shown to reduce the incidence of post-herpetic neuralgia, persistent neuropathic pain in the affected dermatome after the shingles has resolved)
167
Who to avoid when have shingles?
Anybody who has not had chickenpox (can catch virus --> cause chicken pox)
168
What is erysipelas?
How does it present?
What is it caused by?
Infection of the deeper layers of the skin - form of cellulitis that affects the lower legs and the face
Erythema with raised, well demarcated areas, superficial
Streptococcus pyogenes (not staph aures --> affects more superficial layers of the skin)
169
What is SLE?
Inflammatory autoimmune connective tissue --> SYSTEMIC: affecting multiple systems
ERTHEMATOSUS: Malar rash across the face
170
What is kawasaki disease?
How does it present?
What is the main complication?
Treatement?
Lymph node disease/vasculitis
High grade fever FOR MORE THAN 5 DAYS
Conjunctival irritation
Cracked, dry lips
Strawberry tongue
Lymphandopathy
Rash
Red palms and feet that peel
Main complication - coronary artery aneurysm
Treatment - high dose aspirin, IV immunoglobulins
171
How to differentiate aplastic anemia from other leukemias?
Blood film --> no abnormalities
172
What does parovirus B19 cause?
slapped cheek
aplastic crisis in patients with:
- Sickle cell
- Thalasemia
- Hereditary spherocytosis
173
How to distinguish between splenic sequestration and aplastic crisis
BOTH cause LIFE THREATENING ANEMIA BUT
splenic sequestration - due to rapidly increased spleen size --> traps RBC
--> reticulocyte (RBC number) is increased as cells produce more
--> common with sickle cell
aplastic crisis - bone marrow stops producing RBC
--> reticulocyte count decreased as cells cannot produce more
--> common with hereditary spherocytosis
174
Which leukemia causes splenomegaly?
CML and AML
CRAZY MASSIVE LARGE spleen
175
Where are blasts seen on blood smear?
ALL and AML
176
How to differentiate between lymphoblastic leukemia and myeloid leukemia?
Myeloid - spleen enlarged
Lymphoma - lymph nodes enlarged
177
What can cause anemia in pregnancy?
Normal physiological reaction (dilutional) with normal MCV
178
What is the difference between HUS and TTP?
HUS triad:
- Acute renal faliure
- Microangiopathic heamolyric anemia
- Thrombocytopenia
Associated with E coli
TTP:
Above +
- fever
- neurological
ADAMTS 13
179
How is HSP diangnosed?
Purpura
abdo pain
arthritis
glomerulonephritis
periarticular oedema
renal faliure
usually follows URTI
180
What malignancy is associated with HIV? (AIDS-related)
Non hodgkin
181
What is the difference between hodgkin and non hodkin lymphoma
Hodgkin - painless, lymp node swelling. reed-steinburg cells
Non- hodgkin - spreads to involve other sites eg. skin, brain, gi tract
182
How does diabeties insipidus present?
What happens to these patients following fluid restriction?how is this different to normal people?
Excess fluid loss and excess fluid intake
Fluid restriction - urine output remains high and osmolality (concentration) is decreased
Normal people in fluid restriction - urine output is reduced and urine osmolality (concentration) is increased
183
What happens to urine output and osmolality in central diabeties insipidus patients when desmopressin is given?why?
Nephrogenic?why?
Decrease in urine volume and and increase in osmolality (returns back to normal patient)
--> due to lack of ADH (vasopressin) release from the brain BUT kidney still responsive
--> bypass this
--> replace this and kidney can work
No change in nephrogenic
--> lack of the ability of the kidney to respond to ADH (vasopressin) so increasing vasopressin has no affect
184
How is potassium lost from the body
vommiting, diahrrea
185
What is the main cause of addisons disease?
Medication -steroids take over the production of ACTH --> withdrawal of steroids, symptoms become evident
186
What visual disturbance is associated with a pituitary adenoma?
Bilateral hemianopenia
187
What is one of the main causes of SIADH?
How does it present?
meningitis, stroke, tumours, SCC, chest infections
Normo/euvolemic hyponatremia
'peeing out salt when you dont have enough salt in the body already'
188
How to diagnose SIADH?
urine and plasma osmolality
ADH levels
189
What is the difference between SIADH and conns syndrome?
SIADH --> too much vasopressin
(from the hypothalamus)
- Vasopressin increases the water permeability of the tubule
Conns --> too much aldosterone (in the adrenal gland)
- Aldosterone increases reabsorption of Na
- Affects the electrolytes
190
What are the symptoms of phaeochromocytoma?
PH
P palpitations
H headaches
PH phlushing (flushing)
191
Difference between diagnosing type 1 diabeties vs type 2 diabeties
type 1 --> fasting
type 2 --> HbA1c
192
What is the test for diabeties insipidus?
Water deprivation test
193
What precipitates pseudogout?
hypothyroidism
194
How to diagnose cushings (pituitary adenoma) vs ectopic producing tumours
High dose --> diagnose CUSHINGS or ECTOPIC ACTH
- if cortisol is suppressed --> pituitary adenoma (semiautonimous)
- if cortisol not supressed --> ectopic producing tumour
195
How to diagnose cushings? (inpatient vs outpatient tests and order)
Outpatient:
- 24hr urinary cortisol
- over night dex
Inpatient:
- ACTH
- high dose dex
196
What is postpartum thyroiditis?
How to treat?
thyroid antibodties attack the thyroid, 2 stages
1) Hyper (4 months)
- As the cells release T3/T4
- treat symptomatically with propranolol
2) Hypo (6 months)
- As t3/t4 is used up/depleted and TSH levels have to catch up
- treat with levothyroxine
197
Investigation of a thyroid lump?
USS
followed by fine needle aspiration
198
What is increased thirst a symptom of?
Hypercalcemia
199
when to use warfarin with AF
Antiphospholipid syndrome
metalic heart valves
200
When to give VZIG to newborn of mother?
If she gets rash between 7 days pre and 7 days post delivery
201
treatment for pyloric stenosis?
check for any abnomalities in electrolytes
USS
202
What is used in the prevention of cluster headaches?
verapamil
203
how to treat IIH?
diuretics
204
what are the indications of hypocalcemia?
S spasms
P perioral parastehesia
A anxious
S seizures
M muscle tone increase in smooth muscles
O orientation impaired
D dermatitis
I impetigo herpatiformis
C chozveks sign
trousseus sign
205
What medication to use in thyroid crisis?
PTU (blocks conversion, carbimazole has slower effect)
206
What do paraneoplasms release?
What is the affect of this?
PTH --> hypercalcemia
ADH(vasopressin) --> hyponatremia
hCG --> gynaecomastia
GH --> acromegaly
ACTH --> Cushings
207
when to reduce dose of metformin?
When to stop
eGFR <45
eGFR<30
208
What is the test for congenital adrenal hyperplasia?
17-hydroxyprogesterone
209
primary vs secondary hyperparathyroidism?
LOOK AT PTH
primary - calcium high, PTH normal or high
- due to excess PTH (problem with parathyroid)
secondary - calcium low, PTH high
- PTH high to compensate for low Ca (problem with calcium)
OPPOSITE to thyroid where look at T4 levels first and then TSH levles
210
what is conns
hypertension with hypokalemia --> hyperaldosteronism
sodium normal or at high end of normal
211
treatment for SIADH
Fluid restriction
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How to distinguish between graves and thryroiditis vs solitary nodule vs toxic multinodular? How to treat?
BOTH cause hyperthyroidism
Graves, solitary nodule, multinodular - uptake of radioactive iodine is increased ('hot')
Graves - ani TPO and TSH receptor antibodies. Diffuse uptake of iodine
solitary nodule - One painless swelling. uptake of iodine in specific small area
Toxic multinodular -diffuse swelling. multiple areas of iodine uptake
Thyroiditis - uptake of radioactive iodine is reduced. Usually following URTI --> PROPRANALOL
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What is needed for a diagnosis of diabeties?
1) Diabeties symptoms AND abnormal value
OR
2) 2 abnormal values
- HbA1C >48
- fasting glucose >7
- 2 hrs post p >11
(think 7/11)
214
How to differentiate between vWd and haemophillia and DIC
vWD --> mucosal bleeding
Hameophilia --> bleeding into joints and muscles
Reduced active form of clotting factor
DIC --> bleeding everywhere. PT and APPT prolonged
215
What is the difference between ITP and TTP
How are they similar?
ITP - happens following an URTI --> produced antibodies agains antibodies
- Absence of schistocytes
- Bili normal
TTP - due to mutation with ADAM13 --> unable to produce vWF. precursors to vWF produce thrombi. RBC passing through the vessels shear --> systerocytes --> heamolysis (MAHA). Altered mental status
- Schistocytes present
- Bili rised
Similar:
BLEEDING TIME increased (as low platelets) BUT PT and aPTT normal
216
Side affects of thiazide diuretics?
Postural hypotension
Hyponatremia
Hypokalemia
Gout
217
What are the initial investigations for black outs?
Lying standing blood pressure
ECG
218
What is the treatment for heart faliure?
A ACE inhib
B Beta blocker
A Aldosterone agonist (when sx not controlled with A or B)
L Loop diuretic (fruoesemide)
219
When to avoid NSAIDs? Why?
Heart faliure - exacerbated due to the reduced effectiveness of ACE inhibitors and the reduction of clearance of Na from the kidney --> retain more water
Kidney disease - cause reduced renal perfusion
Ischemic heart disease
220
Initial intervention 3rd degree heart block
Atropine
THEN if no response - temporary pacing whilst waiting for permanent pacemaker
221
How to treat atrial fib?
1) Rate control - beta blocker OR CCB (diltiazem) OR dig
2) Combination of rate control
3) Rhythm control IF
- not working
- unstable (electrical cardiov)
- young patients
- first presentation
- paraxosimal
- symptomatic
--> amiodarone
222
What is adenosine used for?
amiodarone?
Cardioversion in SVT
Cardioversion in atril fib, VF, VT
223
What is the normal length of the PR interval?
3-5 small squares (begning of P to start of Q)
224
How does AF present?
SOB
Chest pain
syncope/dizziness
225
Causes of AF?
S – Sepsis
M – Mitral valve pathology (stenosis or regurgitation)
I – Ischaemic heart disease
T – Thyrotoxicosis
H – Hypertension
226
What is secondary prevention of ACS?
6 A's:
A spirin 75mg indefinitely
A CEinhib
A torvastatin
A tenalol (or other)
A ldosterone antagoist
A nother antiplatelet (tigacrelor or clopi for 12 months)
227
symptoms of aortic stenosis
syncope
dysponea
chest pain
228
What is long QT associated with?
Ventricular T
229
What is tetralogy of fallot?
VSD - Blood can flow between ventricles (normally L-->R due to increased pressures in the L side)
Pulmonary valve stenosis - Greater resistance --> encourage blood from R-->L instead of L-->R
Overriding aorta - placed more to the right than normal, blood can pass through into circulation from the R side - deoxygenated)
Right ventricular hypertrophy - has to pump against resistance of the L ventricle and the pulmonary valve that is stenosed
230
What is a tet spell
Temporary cyanotic episodes where L-->R shunt is temporarily worsened
231
What does a split of the second heart sound indicate?
Pulmonary and aortic valves closing at different times due to blood flowing between the atria through the defect (L --> R) increasing the pressure in the R atrium before th
232
which murmurs are pan systolic?
VSD
MR
TR
233
What type of murmur is heard in ASD?
Mid systolic
234
What type of murmur is heard in PDA?
Continuous machinery like murmur
235
What are normal mumurs in children
Soft
Systolic
Short
Symptomless
Situation dependant (eg. quiet on standing, appears when the child is unwell)
236
What is an atrial myxoma?
Symptoms?
Benign tumours in the left atrium --> cause obstruction similar to mitral stenosis
- fever, malaise
- a fib
- mid diastolic murmur
- tumour plot (hitting the mitral valve)
- better on lying down due to clearing the obstruction from the mitral valve
- loud first heart sound at the apex
237
What is hydroxcobalamin treatment for?
B12 replacement in B12 deficiency
238
What to do if somebody has recurrent balanitis?
Check blood sugar
239
What is the treatment for pomphylx?
Topical steroids
240
Wells score 2 what to do?
Wells score 1 what to do?
2 - USS
1 - d dimer
241
What is the most common cancer of the oesophagus?
Bladder?
Osophagus - adenocarcinoma
Bladder - transitional cell
242
What are the side affects of tamsulosin?
Finesteride?
T - retrograde ejaculation
F - erectile dysfunction, loss of libico
243
What is the treatment for a collateral ligament tear?
Partial (redness, swelling, pain) --> RICE
full (no pain) --> refer
244
What to test if hair loss and low MCV?
Ferritin (regardless of Hb)
245
Treatment of TIA?
300mg aspirin, stroke follow up 24hrs
246
What happens with verapamil and lithium
lithum toxicity
247
Treatment for warts
Topical salicylic acid
248
Differene between atinic and sebhorraic keratosis?
atinic - skin colour, sandpaper
Sebhorraic - brown
249
Measles sX?
3 C
- coryza
- cough
- conjunctivitis
250
How to treat mastitis?
Infective (nipple discharge) --> fluclox
non infective/milk mastitis --> warm compress, continue to breastfeed
251
Alarm bells for malaria?
fever
neurological involvement/meningism
recent vist to endemic area
252
When is IGF-1 increased?
Acromegaly (increase in GH)
253
What is fecal elastase used to measure?
Pancreatic function - if high, pancreatic function is normal (no chronic issue)
254
What raises suspision of wilms tumour?
recurrent UTI
Abdominal mass
Raised BP
Haematuria
255
How to visualise brain tumour?
MRI
256
Prophylaxis against pneumonia in HIV?
co trimoxazole
257
What to do with a patient with a high BNP?
ECHO and referall within 2 weeks
258
What to do if wells score >2 but ddimer is neg?
repeat doppler in 1 week
259
How can ferritin be high in iron deficiency anemia? How to tell if it still is iron deficiency?
Ferritin - acute phase reactant, raised in infection
Iron biding capacity high
transferrin saturation low
260
What is the test to diagnose chronic pancreatitis?
Acute pancreatitis?
Chronic --> fecal elastase
Acute --> amylase/lipase
261
What causes sudden cardiac death in children?
How does this murmur present?
Hypertrophic cardiomyopathy
Ejection systolic mumur that increases in intensity during the VALSAVA MANOUVERE
262
What should hypertensive patients with ACR >30 be started on?
ACEinhib
263
How to treat somebody who is immunocompromised who has been exposed to chicken pox?
obtain seriology (regardless of previous exposure)
264
What medications should people be started on following an MI (STEMI or NSTEMI)
Ace inhibitor
Atorvastatin
Atenalol
Aspirin
Another antiplatelet
265
What is diagnostic for PCOS?
high LH:FSH
265
Treatment for PCOS?
Infertility - clomifine
Acne/menstural cycles - COCP
266
What is seen in scarlet fever?
White coating on the tounge 'strawberry tounge'
Rash
Swollen neck glands
sore throat/infection
High temperature
267
What is the difference between hypertrophic obstructive cardiomyopathy and restrictive cardiomyopathy?Dilated cardiomyopathy?
Restrictive - heart chamber stays the same size but the muscle walls become less compliant, equal thickening of the wall of the heart
Hypertrophic obstructive
- young athletes with family Hx of collapse and sudden cardiac arrest
- one side of the ventricle thickens --> chamber is smaller
Dilated cardiomyopathy
- event which damages the myocardium
268
What should diabetics with microalbuminemia be started on?
ACE inhibitor
269
Treatment for c diff?
Vancomycin
270
difference between sigmoid volvulus and caecel volvulus on XR?
Sig - coffee bean sign
Caecel - Foetus sign
271
How to visualise bowel obstruction?
Xray
272
First line for GORD
Trial of PPI (full dose)
273
ANYBODY presenting with dysphagia what to do?
OGD
274
Incarcirated vs strangulated hernia?
Incarcerated - cannot be reduced
strangulated - Blood supply cut off, systemic symptoms
275
How to investigate elderly patient for suspected UTI?Why?
MSU - urine dip is not reliable as bacteria and inflammatory cells can be in the urine without infection
276
nitro dose?
3 days 50mg
277
What is merckels diverticulum?how does it present?
Out pouch of the lower intestine - remains of the umbilical cord
Painless rectal bleeding, 2 years old
278
what causes scarlett fever?
strep pyrogenes
279
Difference between presentation of scleritis and episcleritis?
Scleritis - painful, light pressure doesnt move the vessles
Episcleritis - painless, light pressure moves the vessels
280
how to diagnose MS
MRI brain - shows areas of demyelination
281
risk factor for retinal detachment>
myopia
282
Advice on DVLA with TIA?
Stop driving for 1 month (no need to tell them if drive car if one TIA)
W
Need to inform DVLA if multiple TIA or drive lorry
283
What antibody aids in diagnosis of SLE?
anti-dsDNA (anti-double stranded DNA)
284
What to use in post stroke neuropathic pain?
Gabapentin
285
treatment for ring worm?
topical miconazole
286
likely cause of collapse in young people?
prolonged QT --> preciptates psaudes des pointes/VF
287
What medication causes increase in WBC?
steroidst
288
treatment for ottitis media with perforation?
ammoxicilin
289
treatment for urge incontinence?
tolteradine
290
treatment for oral thrush?
fluconazole
291
what is seen in central artery occlusion?
PALE retina with cherry red spot
292
how to distinguish between diabetic retinopathy and hypertensive?
Hypertensive - AV nicking (veins cross arteries)
diabetic - exudates
293
how long does adjustment disorder last?
6 months
294
What is a galactocele
milk filled cyst in breast feeding women, hard, painless
295
How to investigate raised ICP?
MRi brain to see if brain tumour THEN lumbar puncture if dont see anything
296
what is osteomalacia?
Bone softening in adults due to lack of vitamin D
297
what is pagets disease?
How to diagnose?
bone recycling problem - bones become missshapen, bone pain
Isolated rise in ALP (nothing to do with calcium/PTH axis)
298
How to treat squint in children?
Patch the UNAFFECTED eye
299
COnsitpation treatment in pregnancy
IH first
Lactulose second
300
What organism is present in osters?
Vibrosis
301
what improves long term survival of COPD patients?
Stop smoking
Long term oxygen therapy
302
What to do if cant visualise foetus in early pregnancy?
Rescan 7 days
303
What is the time frame that poeple are infectious for with chicken pox?
what is the incubation period
2 days before and 5 days after rash appears
21 days
304
What is the test for T1D
Random blood glucose
