Important x2

Question 1

How do we group ascites

Answer 1

SAAG <11
SAAG >11

Question 2

Causes of ascites
SAAG <11

Answer 2

Liver:
- liver cirrhosis
- acute liver failure
- liver mets

Cardiac:
- RHS heart failure
- constrictive pericarditis

Other:
- Budd-Chiari
- Myxoedema

Question 3

Causes of ascites
SAAG >11

Answer 3

• nephrotic syndrome
• TB
• pancreatitis

Question 4

Management of ascites

Answer 4

1. reduce dietary sodium
2. fluid restrict if Na+ <125
3. bacterial prophylaxis: (PO cipro - note treatment for SBP is with IV ceftriaxone)
4. Spiro
5. Drainage (if more than 5L will require albumin as well)

Question 5

Warfarin
- major bleed

Answer 5

Stop warfarin
IV vitamin K 5mg
Prothrombin complex

Question 6

Warfarin
- INR >8.0
- minor bleed

Answer 6

Stop warfarin
Give IV vitamin K 1-3mg
Repeat INR if remains high to repeat vitamin K dose
Restart warfarin when INR < 5.0

Question 7

Warfarin
- INR >8.0
- no bleeding

Answer 7

Stop warfarin
Given IV vitamin K 5 mg in oral form
Repeat in 24 hours if INR not less than 5.0
Repeat INR and restart once INR < 5.0

Question 8

Warfarin 5.0-8.0
- Minor bleeding

Answer 8

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

Question 9

Warfarin 5.0-8.0
- no bleeding

Answer 9

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

Question 10

When to add oral cipro for ascites

Answer 10

People with cirrhosis and ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved

Question 11

What do you need to rule out in acute UC

Answer 11

CMV

Question 12

Diagnostic indicator for SBP

Answer 12

neutrophils >250

Question 13

SBP treatment and prophylaxis

Answer 13

Treatment: Oral cefotaxime
Prophylaxis: Oral cipro

Question 14

K+ replacement

Answer 14

1mmol/kg/day

Question 15

Type 1 renal tubular acidosis

Answer 15

low K+, renal stones

Question 16

Type 2 renal tubular acidosis

Answer 16

low K+, osteomalacia

Question 17

Type 3 renal tubular acidosis

Answer 17

low K+

Question 18

Type 4 renal tubular acidosis

Answer 18

high K+

Question 19

Tumour lysis syndrome electrolytes

Answer 19

Low Ca2+, high PO43-, high K+

Question 20

Tumour lysis management

Answer 20

Rasburicase (uric acid to allutonin)

Question 21

Prevention of haemorrhagic cystitis

Answer 21

Mesna

Question 22

Sideroblastic anaemia management

Answer 22

Pyridoxine

Question 23

Acute promyelotic leukaemia

Answer 23

DIC t(15;17)

Question 24

Hodgkins chemo

Answer 24

ABVD

Question 25

Non hodgkins chemo

Answer 25

RCHOP

Question 26

TIA management

Answer 26

Aspirin 300mg then aspirin 75mg for 2 weeks and then switch to clopidogrel 75mg note if already on an anticoagulant continue this

Question 27

Brown-Sequard sx

Answer 27

1. Ipsilateral motor loss 2. Contralateral temperature and pain and vibration loss

Question 28

Multiple system atrophy symptoms

Answer 28

Parkinsons + cerebellar + postural hypotension

Question 29

PSP

Answer 29

Parkinsons + downward vision

Question 30

Miller Fisher Syndrome

Answer 30

Like GBS but affects the eyes GQ1b antibodies

Question 31

PCA stroke

Answer 31

CN III palsy, ipsilateral (down and out)

Question 32

PICA stroke

Answer 32

ipsilateral facial pain and temp. loss, nystagmus and ataxia

Question 33

AICA stroke

Answer 33

Like PICA but also has facial paralysis and deafness

Question 34

Chlamydia antibiotics

Answer 34

PO doxy for 7 days (azithromycin if pregnant)

Question 35

Toxoplasmosis treatment

Answer 35

Sulfadazine and pyrimethiadone

Question 36

Falciparum malaria mx

Answer 36

artenusate

Question 37

Non-falciparum mx

Answer 37

quinine and doxy (need to check for G6PD deficiency)

Question 38

Rabies histology

Answer 38

Negri bodies

Question 39

Prostaglandin analogues

Answer 39

end in -prost

Question 40

Endothelin antagonists

Answer 40

end in -tan

Question 41

Clari moa

Answer 41

Inhibits ribosome 50s subunit

Question 42

Hep A cause

Answer 42

Seafood (hep E is pork)

Question 43

Herpes in question with pneumonia

Answer 43

Pneumococcal pneumonia

Question 44

Malaria with high parasitic count

Answer 44

Plasmodium Knowles

Question 45

Cyclical fevers with malaria - 48 hours - 72 hours

Answer 45

48: plasmodium vivax 72: plasmodium malariae

Question 46

Diptheria management

Answer 46

IM penicillin

Question 47

Cat scratch cause

Answer 47

Bartonella

Question 48

Dog scratch cause

Answer 48

Pasturella mucocida

Question 49

Pleural effusion transudate

Answer 49

<30g/L

Question 50

Transudate causes

Answer 50

Heart failure Hypoalbuminaemia e.g. nephrotic Liver disease Meigs Hypothyroid

Question 51

Meigs

Answer 51

Ovarian cancer +pleural effusion +ascites

Question 52

Pleural effusion exudate

Answer 52

>30g/L

Question 53

Pleural effusion exudate causes

Answer 53

Infection - pneumonia, TB RA, SLE Malignancy

Question 54

Pleural effusion ix

Answer 54

PA chest XR, US, CT if exudative cause

Question 55

Pleural effusion should be sent for

Answer 55

pH, protein, lactate dehydrogenase (LDH), cytology and microbiology

Question 56

Lights criteria

Answer 56

Protein level is between 25-35 g/L An exudate is likely if at least one of the following criteria are met: pleural fluid protein divided by serum protein >0.5 pleural fluid LDH divided by serum LDH >0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Question 57

When to insert a chest drain for pleural effusion

Answer 57

If septic, empyema, cloudy fluid If clear, pH less than 7.2 then chest drain should be inserted

Question 58

MEN I

Answer 58

Parathyroid gland: hyperparathyroidism Pancreatic: pancreatic neuroendocrine tumour Women: breast cancer

Question 59

MEN 2a

Answer 59

95% of patients with MEN 2 have MEN 2a - medullary thyroid cancer - phaeochromocytoma - hyperparathyroidism

Question 60

MEN 2b

Answer 60

- medullary thyroid cancer - phaeochromocytoma - mucosal neuroma - skeletal abnormalities - Sjogrens

Question 61

MEN 1 gene mutation

Answer 61

MEN 1

Question 62

MEN 2 gene mutation

Answer 62

RET