Part 2 set I
What Ecg changes would you see with an ASD?
Right Bundle Branch Block in all ASDs
If its primum (low) - LAD
If its secundum (high) - RAD
Learning disability + epilepsy lead you to think of 3 diagnoses - how do you differentiate between them?
NF1 - Basal ganglia calcifications on CT, Cafe-au-lait spots.
Tuberous sclerosis - calcified phakomas in the periventricular white matter,
Early stage head and neck cancers without local spread - what are the treatment options?
External beam radiotherapy
Which vaccines are recommended for HIV patients?
Hep B - coz they get it
Pneumococcal - coz they get it
Yearly influenza - coz they get it really bad
What is the most concerning progression of SAH?
Delayed cerebral ischaemia due to Vasospasm
Secondary to a variety of factors
Typically starts on day 3 post bleed
Maximal at day 5-12 and resolves by 21
Nimodipine is given prophylactically and they need Neuro ITU
Leading cause of death following SAH
What is the most common glomerulonephritis in SLE?
A.K.A. Diffuse Proliferative Glomerulonephritis
Worst prognosis of all of them
Treat with IV cyclophosphamide and High dose pred
What is Felty's syndrome?
In a patient with long standing seropositive RA
What can you do for Pretibial myxodema?
Reassure them, most of them will go away
If its really painful and swollen, consider Topical fluocinolone (potent steroid)
What is Relapsing Polychondritis?
What it says on the tin.
auricle of ear - Sparing of earlobe
Costochondral joints - pleuritic CP
Tracheal cartilage leading to stenosis and life threatening stridor
Can damage kidneys
Failure of the BP to increase when exercising?
Evidence of Left main stem disease causing a dysfunctional ventricle.
Arrange angiography urgently.
What do you do with a thyrotoxic pregnant lady?
Give them carbimazole at the lowest possible dose.
If its the first trimester - give propylthiouracil at lowest possible dose.
Propranalol, Radioiodine and potassium percholate are contraindicated in pregnancy.
How do you differentiate between LGV, Chancroid and Granuloma inguinale
Chancroid (h.ducreyi) -ve = painful ulcers
LGV = initial painless ulcer
Granuloma inguinale (donovanosis) = indolent painless ulcers
Which factors bypass chads vasc and mean that you go straight to warfarin?
When do you stop antiobesity drugs?
If weight loss is less than 5% at 12 weeks.
Also you cant use them in conjunction
broad complex irregular tachycardia caused by an accessory pathway.
Which drug would you use to stop it and which drugs would you avoid like the plague?
AVOID Verapamil, adenosine and digoxin - they all block the AV node and will cause the all the impulses to go down the accessory
Red, angry painful mid foot in a diabetic with peripheral neuropathy?
DO NOT give antibiotics unless signs of infection
This is the beginning of charcot foot and you need to plaster it and fully immobilise it.
Change the plaster every week or 2 to protect the skin and then use a full foot brace after 12 weeks.
What is co-danthramer and whats it for?
Its a mix of dantron + poloxamer.
Dantron is a peristaltic
Poloxamer relaxes the effect of opioid induced constipation. also causes colon and liver tumors.
Use it for terminally ill patients on loads of opioids only.
Part 2 set I