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2a Exam > 2a revision > Flashcards

2a revision Flashcards

1
Q

Degenerative arthritis characteristics

A 
Pain with use
eases with rest
AM stiffness <30 mins
Bony swelling
Not clinically inflamed
Older
Larger joints
No NSAIDs
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2
Q

Inflammatory arthritis

A 
Pain eases with use
worse at rest
AM stiffness >30 mins
swelling due to joint effusion
Inflamed
young
smaller joints
NSAIDs
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3
Q 
Middle aged male
Exercise - makes pain worse
Rest - lessens pain
Stiffness in knees AM - <30 mins
Dx?
A

Osteoarthritis

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4
Q

Osteoarthritis

1) Joints affected?
2) What causes inflammation and pain?
3) RF?
4) Where can you see eburnation -> bone starts to grow -> osteophytes form

A

1) Synovial joints
2) Loss of ARTICULAR CARTILAGE -> friction
3) FHx, age, female, obesity, joint injury/stress, reduced muscle strength
4) PIJ - Bouchard’s (in RA as well) DIJ - Heberden’s - outer, only in RA

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5
Q

Osteoarthritis
X ray findings?
Bloods?
Mx? if severe?

A 
'LOSS'
Loss of joint space
Osteophytes
Subchondral sclerosis
Subarticular cysts
Bloods = normal
Mx = Educate, exercise, wt loss
NSAIDs - topical or oral
Severe? - Intra-articular corticosteroid injections, pain ladder
Surgery
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6
Q 
older male
A and E
woken up in middle of night - pain in big toe (first MTP)
duvet hurts
swollen, red, unable to stand/walk, fever
obese, T2DM
FAT RICH MAN
Dx?
DDx?
A 
GOUT
DDx?
pseudogout
SEPTIC ARTHRITIS
reactive arthritis
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7
Q 
Gout
Polarised light:
type of crystals?
Positive or negative bifringent?
Shape?
A

Monosodium urate crystals in joints
Negatively bifringent
Needle shaped

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8
Q

Gout

Causes?

A 
Reduced urate excretion:
elderly, impaired kidneys, male, post menopause, HTN, Aspirin, Diuretics
Excessive urate: 
alcohol, red meat, seafood
ALL,CLL
Warfarin, cytotoxins
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9
Q

Gout

Weird presentation?

A

TOPHI - chronic tophaceous gout, connective tissues

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10
Q

Gout

Ix?

A

Aspirate joint - polarised light
Bloods - rasied serum uric acid
Xray - soft tissue swellings - PUNCHED OUT EROSIONS

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11
Q

Gout
Mx?
Complications?

A 
Lifestyle
Ice, elevate, rest
NSAIDS, colchicine = 1st
Corticosteroids
Pain ladder
Allopurinol = long term prevention
(Canakinumab - recombinant monoclonal antibody)
Complications?
Renal, severe degenerative arthritis, infection, recurrence, nerve probs
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12
Q 
Pseudogout
Polarised light:
Crystals?
negative or positive?
Shape?
A

Calcium pyrophosphate dihydrate crystals
Positively bifringent
Rhomboid shape

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13
Q 
Pseudogout
Rfx?
Px?
Ix?
Mx?
A

Rfx = elderly, hyperparathyroidism, haemochromatosis, hypophosphatemia, therefore IV fluids and parathyroidectomy
Px = acute pain, usually monoarthrpathy, swollen, warm, red, pain
Ix = aspirate
Xray - soft tissue calcium deposition
Mx = rest and ice, NSAIDs, intra-articular steroids, colchicine

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14
Q 
Any age
Red, hot, swollen knee
systemically unwell - vomiting, fever
recent trauma
rigors
Dx?
Causitive organisms?
A 
Septic arthritis
Organisms:
STAPH AUREUS
also:
Strep. Neisseria gonococcal, gram -ve bacteria
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15
Q

septic arthritis

Pathology?

A

Infection, trauma, surgery

bacteria in synovial cavity destroy articular cartilage with toxins, trigger immune response

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16
Q

Septic arthritis

Rfx?

A 
Pre existing joint disease
DM - foot ulcers
Immunocompromised
renal failure
prostatic joint
Joint surgery
Trauma
Crystal arthropathies - polarised light to rule out gout
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17
Q

Polyarticular septic arthritis

A

e.g. gonococcal arthritis, young sexually active people, haematogenous spread

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18
Q

Septic arthritis
Ix?
Mx?

A 
Ix =
Aspiration: high WCC, +ve gram stain, polarised light, culture
Bloods: bacteraemia, raised ESR,CRP
culture for gonococcal
XRAY: swelling of capsule
MRI/CT/ULTRASOUND 
Mx = 
Abs - start with broad spec then specify
Flucloxacillin - penicillin allergic use clindamycin
surgical wash out
splint
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19
Q

65 year old woman, A and E, NOF fracture after small fall, calcium deficient/vegan, drinks
Dx?

A 
Dx = osteoporosis
RFx = steroids, hypothyroidism, alcohol and smoking, thin, early/post menopause, renal/liver failure, low testosterone - women, RA/SLE, diet low in calcium 'shattered'
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20
Q

Osteoporosis

pathophysiology?

A

low bone mass, micro architectural deterioration of bone tissue, increased fragility
increased osteoclast activity, decreased density

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21
Q 
Osteoporosis
special scan?
T score? what do the numbers mean?
How are most cases presented?
Bloods?
A 
Scan?
DEXA scan
T score?
compare to younger healthy population
-1 = normal
-1->-2.5 = osteopenia
-2.5 = osteoporosis
Px = most asymptomatic until NOF
Bloods = normal
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22
Q

Osteoporosis

FRAX

A

10 year fracture risk
age, sex, weight, height, previous #, parent fractured hip, smoker, glucocorticoids, RA, secondary osteoporosis, alcohol, femoral neck BMD

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23
Q

Osteoporosis

Mx

A 
Lifestyle, increase calcium, stop smoking, reduce risk of falls
1st - bisphosphonate = ALENDRONATE
2nd - RISEDRONATE if cant take 1st
then
DENOSUMAB - monoclonal antibody
stop glucocorticoids if can, start HRT
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24
Q

How do bisphosphonates work?

A

Osteoclasts absorb them, slows action and causes apoptosis

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25
Q

Lower back pain, spasm in cyclic nature, worse on movement, affecting daily activities, 10wk onset, systemically well
Dx?

A

Mechanical back pain

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26
Q

Red flags for mechanical back pain

A 
<20, >50
fever, wt loss, night sweats
Hx of malignancy
sphincter disturbance - cauda equina
Night pain
Numbness
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27
Q

mechanical back pain
Ix?
Mx?

A

Ix- XRAY, MRI, FBC if red flags
Mx- do not rest, continue with normal activities
analgesic ladder
physio, heat/cold, swimming

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28
Q

DDx for mechanical back pain

A

Primary/secondary malignancy
inflammatory
osteoporosis
infection e.g. UTI

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29
Q

Difference between septic arthritis and osteomyelitis

A

Septic - infection in JOINT

osteomyelitis - infection in BONE MARROW

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30
Q

Osteomyelitis
Pathogen?
Types of spread?
Rfx?

A

Pathogen - STAPH AUREUS
Hematogenous spread - travels via blood
Direct - trauma/surgery
RFx- trauma, prosthetic, DM, PAD, chronic joint disease, alcohol, IVDU, chronic steroid use, immunosuppression

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31
Q

Osteomyelitis

Px-

A

SYSTEMIC AND PAIN IN MIDDLE OF BONE
Long bones: acute fever, painful, immobile, swollen, tender, red, hot
Vertebral: localised oedema, red, tender, chronic back pain, night pain, nonspecific malaise
Contiguous: fever, pain, erythema, sx of trauma

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32
Q

Osteomyelitis
Ix
Mx

A 
Ix = 
Bloods
Culture
MRI
XRAY if chronic - patchy osteopenia and signs of bone destruction
Mx = 
surgical debridement 
Ab 
Analgesia
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33
Q

Seronegative arthropathies
Associated with ? tissue type
Rheumatoid factor?

A

HLA-B27

RF -ve

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34
Q

3 types of HLA-B27 seronegative arthropathies

A

Reactive arthritis
Ankylosing spondylitis
Psoriatic arthritis

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35
Q

Middle aged, pain in wrists, pain in ankles, FHx psoriasis, nail pitting, painful red eye
Dx?

A

Dx = Psoriatic arthritis

inflammatory, affects joints and connective tissue, mild stiffness to complete joint destruction

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36
Q

Different patterns of psoriatic arthritis

A
  1. symmetrical polyarthritis - hands, wrists, ankles, DIPJs
  2. asymmetrical pauciarthritis - fingers and toes
  3. spondylitic - spine, sacro-iliac joints
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37
Q

where is psoriasis usually found?

A

elbows, knees, scalp, lower back, face, palms, feet

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38
Q

Conditions associated with psoriatic arthritis

A

eye disease - anterior uveitis
amyloidosis
aortitis - inflammation of aorta
dactylitis

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39
Q

Psoriatic arthritis

Ix?

A

Ix = bloods, RF negative
HLA Typing - HLA-B27
XRAY - pencil in cup appearance, dactylitis, bony destruction, bones joined together, outline of bones thickened
severe - telescopic fingers

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40
Q

Psoriatic arthritis

Mx?

A 
Mx = NSAIDS
DMARDs - Methotrexate
Anti-TNF - Infliximab
Ustekinumab = last line
also surgery, physio, heat, exercise
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41
Q

Younger, episodes of lower back pain, stiffness AM. Had it for a few months and is getting worse, eases throughout the day especially after exercise. Flare ups.
FHx of similar symptoms

A

Ankylosing spondylitis - inflammation of spine and sacroiliac joints

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42
Q

Extra-articular features of ankylosing spondylitis

A 
fever, wt loss, fatigue
achillis tendonitis
anterior uveitis
IBD 
Pulmonary fibrosis
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43
Q

Criteria for diagnosing ankylosing spondylitis

A

New York Criteria

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44
Q

Ankylosing spondylitis
Ix?
XRAY findings?

A 
Schober's test - two dots
ESR, CRP
HLA typing
Xray:
Bamboo spine
Subchondral sclerosis and erosions
Syndesmophytes
Ossification
Fusion of sacro-iliac joints
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45
Q

Ankylosing spondylitis

Mx?

A

NSAIDs
Steroids - PREDNISOLONE
Anti-TNF - Infliximab
Secukinumab if inadequate response to other meds
also physio, exercise, stop smoking, AdCal, bisphosphonates

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46
Q

Pain in knee, conjunctivitis, burning when peeing, recent infection
rash - erythema nodosum
Dx?

A

CANT SEE CANT PEE CANT CLIMB A TREE- Reiter’s triad

Reactive Arthritis

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47
Q

Reactive arthritis

causative organisms

A

Campylobacter, salmonella, shigella, chalmydia, HIV, gonorrhea

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48
Q

Reactive arthritis
Ix?
Mx?

A 
Ix - infection and inflam markers
aspirate
STI screen
urine culture
USS
Mx - NSAIDS
Steroid injections
Systemic steroids - PRED
Abs
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49
Q

Middle aged women
Painful fingers in both hands, stiff all morning, goes away the more they use them. feeling tired
Dx?

A

RA
(symmetrical peripheral)
remember its dysregulated inflammation, antigen presentation, T cell activation and autoantibody production

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50
Q 
Typical patient with RA
gender?
age?
tissue type?
FHx?
Smoker?
A 
Females
middle aged
HLA-DR4, HLA-DR1
FHx yes
Smoker
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51
Q

Presentation of RA
typical joints?
systemic symptoms?
signs in hands?

A

joint pain, swelling, stiffness
joints - small joints of hands, feet, wrists, ankles, MCPS, PIPs
systemic- fatigue, wt loss, flu like, aches and weakness
Hands - ulnar deviation, partial subluxation (curled claw like hand like a puppet), wrist subluxation, swan neck, Boutonniere, Z shaped thumbs. Bouchards nodes

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52
Q

Extra articular manifestations of RA

A 
EYES - scleritis, sjogrens
SKIN - ulcers, rashes
NODULES
NEURO - trapped nerves
RESP - pulmonary fibrosis
CARDIO - valvulitis, anaemia
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53
Q

RA
IX?
XRAY findings
Dx? scoring system?

A 
Ix: 
RF
Inflammatory markers
FBC
Abs - Anti CPP
USS if swelling
XRAY findings:
Loss of joint space
Erosion
Soft tissue swelling
Soft bones
Dx - DAS28 score - looks at 28 joints for swelling, tender, ESR/CRP
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54
Q

RA

management

A 
Steroids PREDNISOLONE
NSAIDs
DMARDS
1st methotrexate
2nd methotrexate + another eg sulfasalazine
3rd methotrexate + TNF inhibitor - Infliximab
4th methotrexate + rituximab
PREGNANT - sulfasalazine
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55
Q

how does methotrexate work?
routes?
what to prescribe with it?
S/E?

A

inhibits metabolism of folate
oral or SC or IM injection
give folic acid with it
S/E mouth ulcers, hepatotoxic, pulmonary fibrosis

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56
Q

young female, a and e, 1 wk Hx progressive SOB and fever. hands have been painful and stiff and having recurrant mouth ulcers. XRAY - see bilateral pleural effusions
RAISED ESR, NORMAL CRP
Dx?

A

SLE

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57
Q

Autoantibody present in lupus

A

Anti-dsDNA

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58
Q

SLE

Pathophysiology?

A

multisystem autoimmune inflammatory disease. auto abs produced by B cells.
activates complement systems - influx of neutrophils
relapsing remitting

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59
Q

SLE
RFx
triggers?

A 
women
20-40
Afro-Carribean
FHx
triggers = UV light, EBV, drugs e.g. Hydralazine, Isoniazid
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60
Q

SLE Px

A

non specific
fatigue, wt loss, arthralgia, fever, photosensitive malar rash, lymphadenopathy, dyspnoea, pleuritic chest pain, mouth ulcers, hair loss, RAYNAUDS
MD SOAP BRAIN - diagnostic criteria, 4/11

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61
Q

SLE
Ix
Mx

A

Ix =
Bloods - ANA screen - sensitive, not specific
ant-dsDNA - specific, not sensitive
Complement - low C3, C4 in active disease
RAISED ESR, CRP NORMAL
Mx = avoid triggers
NSAIDs
Hydroxychloroquine/ prednisolone
Rituximab - anti CD20
severe flare ups - DMARDS (cyclophosphamide) and high dose prednisolone

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62
Q 
Antiphospholipid syndrome
Causes?
Occurs secondary to?
Causes C.L.O.Ts?
Ix?
Mx?
A

-Causes - hypercoagulability of blood - thrombosis and miscarriage
-SLE
-Coagulation defects - DVT, strokes
Livedo reticularis
Obstetric: recurrent miscarriages
Thrombocytopenia
-Ix Anti-cardiolipin antibody
-Mx Manage CV risk, Warfarin and LMWH if trying to conceive, Aspirin

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63
Q

Younger male, feeling really tired, eyes and mouth are really dry, Hx of Coeliac disease, enlarged salivary gland
Dx and what is it?
Ix?
Mx?

A

Dx - Sjogrens = chronic inflammatory autoimmune disease.
primary fibrosis of exocrine glands or secondary to another connective tissue disorder - SLE, RA
Ix - Schirmer’s test
Mx - artificial tears and saliva, NSAIDs, hydroxychloroquine

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64
Q

Middle aged, red veins on cheeks, white nodules on back of her hands. difficulty eating with getting food into mouth and swallowing. skin on hands feels tighter, more painful in cold weather, go red, white and blue
Dx?
2 types?

A

Scleroderma - autoimmune connective tissue disorder causing vascular damage of the small arteries, arterioles and capillaries
2 types - Limited (anti-centromere abs) and Diffuse (anti-scl-70 abs) (systemic)
both have antinuclear abs

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65
Q

Scleroderma
Px
Mx

A 
Px 
'Crest'
Calcinosis
Raynaud's 
Eosophageal dysmotility
Sclerodactyly
Telangiectasia
Diffuse: + CV problems, lung problems, kidney problems
Mx
no cure
treat organs
steroids, immunosuppressants
lifestyle
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66
Q 
Raynaud's Phenomenon
Definition:
Colours? What does it mean?
Primary vs Secondary?
Mx?
A

Definition: digital ischaemia due to paroxysmal vasospasm
Colours: White = ischaemia -> Blue = deoxygenation -> Red = Reactive hyperaemia

Primary = younger, female, no signs of underlying disease/ necrosis/ gangrene, normal ESR, -ve antineutrophil Abx

Secondary = Older, less common, signs of underlying disease, tightness of skin, severe pain, digital ischaemia, RAISED ESR, +ve antineutrophil Abx

Mx = Stop smoking, keep warm, give CCB e.g. Nifedipine (S/E ankle oedema)

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67
Q

Purple bruise on left eyelid, swelling under eye, trouble climbing stairs sober and styling hair in morning, no trouble doing up buttons. no sensory loss.
Muscle pain and tenderness
Dx?
Mx?

A

Polymyositis (inflammation of muscles) / Dermatomyositis (inflammation of skin and muscles)
STAIRS, CHAIR, HAIR
muscle pain, fatigue, weakness +/- skin features
Mx = steroids -> prednisolone

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68
Q

Vasculitis
What is it?
Antibodies involved? 2 types
Px:

A

Autoimmune inflammatory disorder of the blood vessel walls

Abs: ANCA +ve and ANCA -ve

Px: purpura, joint and muscle pain, peripheral neuropathy, renal impairment, GI disturbance

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69
Q

Old woman, new headache, temporal artery tenderness (cant brush hair), ESR>50, abnormal artery biopsy
Dx?
Mx?
Visual changes?

A 
Dx = Giant cell arteritis
need 3/5 to diagnose
Mx= prednisolone and ESR
Temporal artery biopsy
Visual changes - IV methyprednisolone and refer to opthalmology
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70
Q

Bilateral shoulder pain radiating to elbow, bilateral pelvic girdle pain, worse with movement, interferes with sleep, stiffness >45 mins AM
Dx?
Associated with?
Mx?

A

Polymyalgia Rheumatica
GCA
Steroids

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71
Q

Middle aged woman, recently divorced, 4 month history of pain - back, elbows, knees, neck, shoulders
Stiff when she wakes up, lasts less than an hour, very tired even after sleeping
Past medical history of IBS
Dx?
What is it?

A

Fibromyalgia
= non specific muscular disorder, unknown cause
NO INFLAMMATION but painful

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72
Q

Primary bone tumours
Common or rare?
Types?

A

Rare
Osteosarcoma (kids, young adults)
Ewing’s Sarcoma (<25y/o, hips, long bones)
Chondrosarcomas (pelvis)

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73
Q

Secondary bone tumours

Common primary sites?

A 
Breast
Thyroid
Lung
Prostate
Kidney
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74
Q

Nocturnal bone pain, local red/swelling, can be painless, fatigue, wt loss, anaemia, unexplained bone fractures, younger
Dx?
Mx?

A

Bone tumours

Mx = chemo, radio, surgery, bisphosphonates

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75
Q

Anti-acetylcholine receptor antibodies are found in which disease?

A

Myasthenia Gravis

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76
Q

Anti-mitochondrial Abs

A

Primary billiary cirrhosis

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77
Q

Anti-Scl-70 Abs

A

Diffuse systemic sclerosis

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78
Q

Anti smooth muscle Abs

A

AI hepatitis

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79
Q

Collapsing pulse

A

Aortic regurgitation

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80
Q

Pulsus paradoxus

A

Asthma, COPD, Blood loss

happens when BP drops significantly during inspiration

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81
Q

Radio-radial delay

A

Coarctation of aorta

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82
Q

Early diastolic decrescendo murmur, collapsing pulse

A

Aortic regurgitation

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83
Q

Ejection systolic crescendo decrescendo , slow rising, narrow pulse pressure, heard loudest on expiration

A

Aortic stenosis

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84
Q

Apical pansystolic murmur

A

Mitral regurgitation

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85
Q

Apical mid diastolic rumble

A

Mitral stenosis

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86
Q

Ejection systolic murmur heard loudest on inspiration

A

Pulmonary stenosis

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87
Q

R wave looks like?

Slurred S wave looked like?

A 
R = M
SS = W
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88
Q

RBBB
V1?
V6?

A 
V1 = R wave (M)
V6 = Slurred S (W)
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89
Q

LBBB

A 
V1 = Slurred S (W)
V6 = R wave (M)
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90
Q

Four key features of Tetralogy of Fallot

A

Ventricular septal defect
Pulmonary stenosis
Hypertrophy of the right ventricle
Overriding aorta

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91
Q

BP Stage 1
Clinical?
ABPM?

A

> 140/90

145/96

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92
Q

BP Stage 2
Clinical?
ABPM?

A

> 160/100

165/105

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93
Q

BP SEVERE
Clinical?
ABPM?

A

> 180/110 for both

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94
Q

Distinctive signs of infective endocarditis

A 
Splinter Haemorrhages
Osler's nodes
Janeway Lesions
Roth spots 
Fever
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95
Q 
Small bowel obstruction:
Distended?
Bowel sounds?
Pain?
Vomiting?
Constipation? 
Px?
Xray?
A 
Less distended
Increased sounds
Pain - higher up in abdo, epigastric, umbillical
Colicy pain then goes to generalised
Vom - earlier
Constipation - later
Px - nausea, wt loss
Xray - central gas shadow
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96
Q 
Large bowel obstruction:
Distended?
Bowel sounds?
Pain?
Vomiting?
Constipation? 
Px?
Xray?
A 
More distended
Sounds normal -> increased -> quiet
Lower down in abdo
Constant pain
Vom - later and more faecal like
Constipation - occurs throughout
Px - Fullness, bloating, nausea
Xray - peripheral gas shadow
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97
Q 
UC:
Goblet cells?
Skip lesions?
Layers inflamed?
Granulomas?
Appearance on colonoscopy?
Where does it affect?
Crypt abscesses?
Smoking?
A 
Decreased goblet cells
Continuous, no skip lesions, all inflamed
Mucosal layer inflammation only
No granulomas
Inflamed and red, bleeds, ulcers and psuedopolyps
Affects colon up to ileocaecal valve
Increased crypt abscesses
Smoking is protective
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98
Q 
Chron's
Goblet cells?
Skip lesions?
Layers inflamed?
Granulomas?
Appearance on colonoscopy?
Where does it affect?
Crypt abscesses?
Smoking?
A 
Increased goblet cells
Skip lesions
Affects transmural - all layers
Granulomas
Cobblestone appearance, fissures, ulcers
Affects mouth to anus
No crypt abscesses
Worsens symptoms
can cause red tender lumps on legs
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99
Q

Causes of peptic ulcers

A

H. pylori
Increased acid production
Recurrent NSAID use
Mucosal ischaemia

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100
Q

Abdo pain higher up, early onset of vomiting, constipation and bloating. Previous appendectomy
Dx?

A

Small bowel obstruction - didn’t get constipation straight away.
Previous appendectomy could have caused adhesions

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101
Q

H. Pylori infections

Tx

A

CAP
Clarithromycin/metronidazole,
Amoxicillin
PPI - Omeprazole

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102
Q

Bowel obstruction

First line Ix

A

Abdo X-ray

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103
Q

Achalasia

A

Lower oesophageal sphincter fails to open during swallowing -> back up of food into the oesophagus

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104
Q

Duodenal ulcers

Pain?

A

Abdo pain several hours after eating, relieved by eating

Gastric ulcers - pain relieved by eating

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105
Q

Steatorrhea, diarrhoea, wt loss. Rash, dermatitis herpetiformis (skin changes on extensor surfaces). FHx of autoimmune disease
Dx?
Pathophysiology?
Auto Abs?

A

Coeliac disease

Villous atrophy, crypt hypertrophy/ hyperplasm, increased intraepithelial WCC

tTG-IgA (tissue transglutaminase antibodies)
IgA-EMA (endomysial antibody)

need to be eating gluten for the testing to work

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106
Q

G cells produce?

A

Gastrin

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107
Q

Parietal cells produce?

A

HCl, Intrinsic Factor

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108
Q

Chief cells produce?

A

Pepsinogen

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109
Q

D cells produce?

A

Somatostatin

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110
Q

Oesophageal cancer risk factors

A

Achalasia
Alcohol
Obesity
Smoking

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111
Q

Bowel Cancer - Gold Standard Ix

A

Colonoscopy

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112
Q

Most common part of colon to get cancer

A

Distal colon (anus, sigmoid colon, rectum)

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113
Q

Risk factors for diverticula

A

Low fibre diet, obesity, smoking, NSAIDs

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114
Q

What else can be seen in Chron’s and Coeliac that shows malabsorption

A

Anaemia due to iron and folate deficiency

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115
Q

Causes of AKI

A 
Acute tubular necrosis
Hypovolaemia
Nephrotoxins
Prostatic hyperplasia
Sepsis
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116
Q 
Stages of renal failure
1
2
3a
3b
4
5
A

1) >90, w/ evidence or renal damage
2) 60-89, w/ evidence
3a) 45-59 w/ or w/o
3b) 30-44, w/ or w/o
4) 15-29 w/ or w/o
5) <15 = established renal failure

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117
Q

Pain on urinating, pain on ejaculation, no lumps/ irregularities on DRE, pelvic pain longer than 3 months. Trauma causing nerve damage in LUT = RF

A

Chronic prostatitis

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118
Q

When can’t you prescribe Trimethoprim?

A

In pregnancy

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119
Q

Reiter’s syndrome

A

Can’t see, cant pee, cant climb a tree

Reactive arthritis

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120
Q

PKD - pattern of inheritance

A

Autosomal Dominant

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121
Q

Complications of PKD

A

HTN
Kidney stones
Polycystic liver disease
Berry’s aneurysms

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122
Q

What cells are seen in Hodgkins Lymphoma

A

Reed Sternberg cells

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123
Q

Risk factors for DVT

A 
Recent surgery
Immobilisation
Oestrogens
Malignancy
History of DVT or PE
Long haul flights/travel
inherited thrombophilia
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124
Q

TTP urgent treatment

A

Plasma exchange

DO NOT GIVE PLATELETS - increases thrombosis

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125
Q

Score for PE and DVT

A

Wells score

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126
Q

Score for stroke risk in patients with AF

A

CHA2S2VASc

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127
Q

Score for 10 year probability of fracture

A

FRAX

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128
Q

Score for risk of developing heart attack or stroke in 10 years

A

QRISK3 algorithm

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129
Q 
Staging of Hodgkins Lymphoma
I
II
III
IV
a or b?
A

I - single lymph node region
II - 2 or more nodal areas on same side of diaphragm
III - nodes both sides of diaphragm
IV - mets beyond lymph nodes
a - priuritis
b - systemically unwell - loss of appetite, wt loss, night sweats

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130
Q

Management of post surgery patient to reduce DVT risk

A

Dalteparin acutely, then maintenance treatment with apixaban

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131
Q

What cells does Rituximab (monoclonal antibody) target

A

CD20 cells

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132
Q

Severe/complicated malaria - first line Tx

A

IV Artesunate

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133
Q

Striated muscle neoplasm
Benign
Malignant

A

Benign: Rhabdomyoma
Malignant: Rhabdomyosarcoma

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134
Q

Smooth muscle neoplasm
Benign
Malignant

A

Benign: Leiomyoma
Malignant: Leiomyosarcoma

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135
Q

Malignant adipose tissue neoplasm

A

Liposarcoma

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136
Q

What is definition of granuloma?

A

Aggregate of epithelioid histiocytes

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137
Q

Acute inflammation cells

A

Neutrophil polymorphs

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138
Q

Chronic inflammation cells

A

Lymphocytes

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139
Q

Contents of atherosclerotic plaque

A 
Connective tissue
Foam cells
Lipid laden macrophages
T lymphocytes
Smooth muscle cells
Cholesterol
Lipid deposits
Fragments of destroyed internal elastic lamina
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140
Q

Barrett’s Oesophagus cell change

A

Stratified squamous cells -> simple columnar cells

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141
Q

1st line treatment for paracetamol overdose

A

N- acetyl cystine

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142
Q

Kayser-Fleischer rings, seen in?

A

Wilson’s disease

not in liver failure

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143
Q

Pain in epigastric region, radiating THROUGH to the back, elevated amylase
Dx?

A

Acute pancreatitis

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144
Q

Primary Biliary Cholangitis
what is it?
px?
tx?

A

Autoimmune condition damaging the interlobular bile ducts in the liver

Px - slow to present, often found incidentally due to raised ALP. Priuritis

treat priuritis with rifampicin

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145
Q

Upper GI bleed symptoms

A 
Coffee ground vomit
Melaena - dark blood in faeces
Hypotension
Tachycardia
Not characteristic - diarrhoea
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146
Q

Causes of acute pancreatitis

A 
Gall stones
Ethanol excess
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidaemia
ERCP/ emboli
Drugs
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147
Q

RUQ pain, made worse by eating fatty meals, jaundice, FEVER WITH RIGORS

A

Ascending cholangitis - same Px as biliary colic but has fever with rigors as extra

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148
Q

Wernicke’s Encephalopathy - which vitamin is deficient?

A

Vit B1 (Thiamine)

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149
Q

Side effect of Bisphosphonates e.g. Alendronic acid

and advice to avoid?

A

Oesophagitis - why you tell patients to take them first thing in the morning and remain upright for at least 30 mins

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150
Q

Ankylosing Spondylitis
1st line
2nd line

A

NSAIDs

DMARDS(methotrexate), anti TNF drugs(infliximab)

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151
Q

1st line for generalised seizures

A

Sodium valproate

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152
Q

Parkinsons triad

A

Resting tremor, Bradykinesia,

rigidity

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153
Q

Giant cell arteritis w/ polymyalgia rheumatica

1st line

A

Oral prednisolone

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154
Q

inability to open bowels/urinate, reduced anal tone, saddle anaesthesia
Dx?

A

Cauda equina

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155
Q

Myasthenia Gravis
What is low?
What does it cause? Where?
Mx?

A

Acetylcholine is low in synaptic cleft
Causes loss of control of skeletal muscles
especially eyes, mouth, throat and limbs
Mx = Acetylcholinesterase inhibitors

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156
Q

Most common bacterial organisms that cause infective exacerbations of COPD

A

Haemophilus Influenzae

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157
Q

Exacerbation of COPD - initial investigation

A

ABG sampling

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158
Q

Moderate acute asthma

A

Increasing symptoms
PEF>50-75% best or predicted
No features of acute severe asthma

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159
Q

Acute severe asthma

A

Inability to complete sentences in one breath
PEF 33-50%
RR >25/min
HR>110

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160
Q

Life threatening asthma

A 
Altered consciousness, exhaustion, arrhythmia, low BP, cyanosis, silent chest
PEF <33%
SpO2 <92%
PaO2 <8kPa
Normal PaCO2 (4.6-6.0)
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161
Q

Side effects of salbutamol inhaler

A

Tachycardia, tremor

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162
Q

Most common type of primary lung cancer among non smokers

A

Adenocarcinoma

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163
Q

Lung cancer most associated with Asbestos exposure

A

Mesothelioma

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164
Q

Pleuritic chest pain, worse on deep breaths, SOB, haemoptysis, pregnant
Dx?

A

PE

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165
Q

What score is used to assess pneumonia risk?

Numbers?

A 
CURB65
Confusion
Urea >7
RR >30
BP systolic <90, diastolic <60
65
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166
Q

Productive cough for 4 months, sputum with blood, night sweats, fatigue, decreased appetite, lost 4kg. Homeless. Chest signs sound good, X ray shows cavitating lesion in upper left lobe and hilar lymphadenopathy.
Sputum sample - ACID-FAST BACILLI

A

TB

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167
Q

MI Tx

A 
Morphine
Oxygen
Nitrates (GTN)
Aspirin 
\+
Antiplatelet therapy = clopidogrel, ticagrelor, prasugrel
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168
Q

Name K+ sparing diuretic

How does it work?

A

Spironolactone

Inhibition of aldosterone receptor in DISTAL TUBULE

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169
Q

Name Loop diuretic

How does it work?

A

Furosemide

Act on ASCENDING limb in loop of Henle, inhibit the Na-K-Cl cotransporter

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170
Q

Name Thiazide diuretic

How does it work?

A

Bendroflumethiazide

Inhibit reabsorption of sodium and chloride from distal convoluted tubule

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171
Q

Aortic problems Px:
Mitral problems Px:
Tricuspid Px:

A

A - syncope and angina
M - SOB and fatigue
T - right sided heart failure

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172
Q

MI ECG

A

Will see ST depression after acute attack

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173
Q

ACEi
example?
Mechanism?

A

Ramipril
all the ‘prils’
Inhibit formation of angiotensin II
1st line <55, white

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174
Q

CBB
example?
Mechanism?

A

Amlodipine
all the ‘pines’ and verapamil
Block calcium channels, means blood vessels relax and open

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175
Q

ARB
example?
mechanism?

A

Losartan
all the ‘artans’
Block angiotensin II action by blocking AT1 receptors, helps lower blood vessel

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176
Q

‘patient is having adrenalectomy, what would need to be prescribed to stabilise BP and K before surgery?’

A

Spironolactone, because its K sparing

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177
Q

Hypokalaemia and HTN even if you’re on 3+ antihypertensives or below 40 years old, wouldn’t expect HTN
Dx?

A

Conns

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178
Q

Decreased renin, increased aldosterone

A

Primary hyperaldosteronism/ Conns

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179
Q

Increased renin, increased aldosterone

A

Secondary hyperaldosteronism

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180
Q

Causes of hypercalcaemia

A 
Familial benign hypocalciuric hypercalcaemia
Malignancy
Sarcoidosis
Thyrotoxicosis
Hyperparathyroidism
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181
Q

Carcinoid syndrome triad:

what do the tumour cells produce?

A

Cardiac stuff e.g. palpitations
Diarrhoea
Flushing

5-HT - serotonin

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182
Q

Progressive dysphagia

A

Oesophageal cancer

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183
Q

Pharyngeal pouch

A

No blood in vomit, gurgling in neck on palpitation and halitosis

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184
Q

H. Pylori stomach ulcer
Ix?
Mx?

A

Ix
Carbon Urea breath test
Stool antigen test
Endoscopy and biopsy

Mx
PAC-MAN
PPI + Amoxicillin + Clarithromycin/ Metronidazole

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185
Q

What cells do PPIs act on?

A

Parietal cells

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186
Q

Renal colic

Gold standard Ix?

A

Non-contrast CT kidney, ureter, bladder

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187
Q

BPH
Haematuria?
Mx? S/E?

A

No haematuria
Tamsulosin
Postural hypotension

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188
Q

UTI causative organisms?

A 
Klebsiella Pnuemonia
E.COLI
Enterococcus
Proteus/ pseudomonas
Staph saprophyticus
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189
Q

Proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia and lipidaemia
Dx?

A

Minimal change disease

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190
Q

Most concerning thing in blood test?

A

POTASSIUM

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191
Q

Chronic myeloid leukaemia FBC results

A

LOW Hb, Increased or decreased platelets, INCREASED WCC

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192
Q

DVT Gold standard Ix

A

Doppler USS

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193
Q

Brittle hair and nails, koilonychia, pale conjunctiva, systolic flow murmur

A

Iron deficiency anaemia

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194
Q

Reduced reflexes due to hypothyroidism - which anaemia?

A

Macrocytic anaemia specifically B12 deficiency

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195
Q

Urine with haemolysis?

A

Dark urine

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196
Q

Causes of iron deficiency anaemia

A

CKD, GI bleed, NSAIDs, pregnancy

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197
Q

Pharmacokinetics

A

Action of BODY on DRUG

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198
Q

Pharmacodynamics

A

Action of DRUG on BODY

199
Q

Tricyclic antidepressant e.g. Amitriptyline S/E

A

Blurred vision, confusion, dry mouth, urinary retention

200
Q

Warfarin:
spinach?
Grapefruit?

A

Spinach - decreases effect

Grapefruit, cranberries, alcohol - increase effect

201
Q

When is Co-amoxiclav contraindicated?

A

In penicillin allergies

202
Q

Pheochromocytoma surgery
What do you give before surgery?
Why?

A

Give phenoxybenzamine - alpha blocker diuretic, decreases HTN

203
Q

C. Difficile complications

A

Pseudomembranous colitis

204
Q

Valve most commonly affected by IE

A

Tricuspid

205
Q

Most common cause of bacterial pneumoniae

Second most common

A

1 - Strep pneumonia

2- H. influenzae

206
Q

Boutonniere, ulnar deviation, swan neck deformity, z thumb

features of what?

A

RA

207
Q

Osteoporosis Mx
1st line
2nd line

A 
1 - 
Alendronic acid
Oral bisphosphonates
Vit b and Ca supplement
2-
Denosumbab
208
Q

How do bisphosphonates work?

A

Inhibit bone resorption through inhibition of enzyme which reduces osteoclast activity

209
Q

Acute gout

Prevention of gout

A

Acute - Colchicine

Prevent - Allopurinol

210
Q

Lemon shaped bleed on scan
Lucid period
Dx?
Which artery ruptured

A

Extradural haemorrhage

Middle meningeal artery rupture

211
Q

Migraine
1st line
2nd line
3rd line

A

1 - NSAIDS
2 - Topiramate (prophylactic)
3 - Amitriptyline and prophylactic

212
Q

Carpal Tunnel -
which nerve
px

A

Median nerve

pain and pins and needles in hand, not as bad in palm, worse in morning, numb, relieved by hanging off the bed

213
Q

Increased reflexes
Increased tone
No fasiculations
Babinski reflex

A

UMN

214
Q

Decreased reflexes
Decreased tone
Fasiculations

A

LMN

215
Q

What do you prescribe to control the jerky movements in Huntingtons

A

Risperidone

216
Q

Guillian Barre syndrome Mx

A

IV immunoglobulins - its an immune problem

217
Q

What can cause clubbing?

A

Lung cancer, pulmonary fibrosis, bronchiectasis

218
Q

Pneumocystitis Jiroveci

A

Fungus - typically associated with AIDs

219
Q

Emergency Mx of spontaneous pneumothorax -> tension pneumothorax

A

Immediate decompression via large bore cannula

chest drain if patient is unstable or if needle aspiration fails twice

220
Q

Hypercalcaemia, dry cough, SOB, persistent rash on skin, CXR - bilateral hilar lymphadenopathy, biopsy = non caseating granulomas with epitheliod cells

A

Sarcoidosis

221
Q

Alcohol units

A

ABV X Volume / 1000

222
Q

What is in the 6 in 1 vaccine

A 
Diptheria
Tetanus
Polio
hep b
Hib
whooping cough
223
Q

Middle aged woman, low grade fever, 3 day Hx of pain in her neck. slightly enlarged thyroid. CBC is normal. Biopsy of the thyroid reveals granulomatous inflammation and the presence of giant cells.
Recent viral upper resp tract infection
Dx?
What is it?
What is the clinical course of the disease like? (phases)
ESR and iodine uptake?

A

Subacute (de Quervain) thyroiditis
= transient patchy inflammation of the thyroid gland, associated with granuloma formation
usually happens after viral upper resp tract infection

Triphasic clinical course, classically transitions from hyperthyroidism to hypothyroidism to euthyroid phase. Goiter is tender.

Raised ESR, Decreased iodine uptake

224
Q

X ray signs of chronic heart failure

A 
'ABCDE'
A - Alveolar oedema
B - Kerley B lines
C - Cardiomegaly
D - Dilation of the upper lobe vessels
E - pleural Effusions
225
Q

Moderate acute asthma

A

Increasing symptoms
Peak flow >50-75%
No features of acute severe asthma

226
Q

Severe acute asthma

A

Peak flow 33-55%
RR >25
HR >100
Inability to complete sentences in one breath

227
Q

Life threatening acute asthma

A 
Peak flow <33%
SpO2 <8kPa
Normal PaCO2 (4.6-6.0)
Silent chest
Cyanosis
Poor respiratory effort
Arrhythmia 
Exhaustion
Altered conscious level
Hypotension
228
Q

Near fatal acute asthma

A

Raised PaCO2
and/ or
need for the mechanical ventilation with raised inflation pressures

229
Q

ABCD2 score
used for?
Breakdown:

A

Identifies patient at high risk of stroke following TIA

Age >60 (1)
BP >140/90 (1)
Clinical features: speech disturbance without weakness (1), unilateral weakness (2)
Duration of symptoms: 10-59 mins (1), >1hr (2)
D(2)iabetes (1)

230
Q

Blood test for heart failure

what is it?

A

NT-proBNP
released from ventricles in response to stretch
ANP - released by atria

231
Q

Antibody for RA

A

Anti CCP

RF

232
Q

Antibody for SLE

A

Anti-dsDNA

233
Q

Antibody for Coeliac disease

A

Anti-TTG

Anti-endomysial is also associated

234
Q

Antibody to diagnose granulomatosis with polyangitis (GPA)

A

c-ANCA

235
Q

Antibody to diagnose every other small/medium vessel vasculitis except GPA

A

p-ANCA

236
Q

Antibody in Sjogren’s syndrome

A

Anti-Ro

237
Q

High TSH, Low T3/T4

A

Primary hypothyroidism

238
Q

Anticoagulant that activates antithrombin (factor III), deactivates factors Xa, IIa in clotting cascade

A

Unfractionated heparin

239
Q

Anticoagulant that activates antithrombin (factor III), deactivates factor Xa specifically in clotting cascade

A

LMWH (Dalteparin)

240
Q

Anticoagulant that acts on final common pathway of coagulation cascade - directly inhibits factor Xa

A

DOACs e.g. riveroXAban, apiXAban

241
Q

Anticoagulant - inhibits hepatic production of vitamin K dependent factors 2,7,9,10

A

Warfarin

242
Q

Difference between unfractionated heparin and LMWH

A

LMWH is smaller molecules, both target antithrombin - factor III, but LMWH only causes deactivation of Xa, so is more specific tan unfractionated heparin

243
Q

Anticoagulant - fibrinolytic drug, dissolves the already existing fibrinous clot, re-canalises occluded vessels, allows for tissue reperfusion

A

Alteplase

244
Q

Anticoagulant - antiplatelet agent, acts through irreversible inhibition of COX, reduces production of pro-aggregatory factor - thromboxane

A

Aspirin

245
Q

young man
aura - can hear strange noises, ‘funny feeling’
started fiddling with clothes and smacking lips for about 2 mins
then lost consciousness, arms become rigid and and move in jerky motions

A

Seizure
starts partial temporal lobe - smacking lips and fiddling with clothes
then ends up becoming secondary generalised tonic clonic seizure

246
Q

Acromegaly test

Why?

A

Insulin like growth factor levels

don’t measure growth hormone because its secreted in a pulsatile fashion

247
Q

Which nerve causes hoarseness of voice in oesophageal cancer

A

Recurrent laryngeal nerve

248
Q

Bony spurs that develop at the synovial margins of joints?

seen in?

A

Osteophytes

Osteoarthritis

249
Q

A and E, 65 y/o male, sudden onset chest pain that radiates to patient’s back. past medical history of T2DM and 30 pack year smoking history
Dx?
what would be seen on xray?
What would be seen on CT scan?

A

Aortic dissection
Widening of mediastinum
Mercedes Benz sign

250
Q

Murmur heard in patent ductus arteriosus

A

continuous crescendo-decrescendo machinery murmur, may continue during the second heart sound

251
Q

What do you measure to determine dose of Warfarin

A

INR

252
Q

Appendicitis but with signs of sepsis - especially confusion

DX?

A

Perforated appendix, very acutely unwell

253
Q

Periods stopped, milk production from breasts, headaches, affecting driving, lateral vision reduced
DDx?

A

Prolactin secreting pituitary tumour

254
Q

Hypokalaemia ECG changes

A

'’You have no Potassium and no Tea (no T wave), with a long PR and a long QT”

255
Q

Hyperkalaemia ECG changes

A

“Go, go long, go wide, go tall, gonner”

256
Q

Stonemasons, sand blasters, potter and ceramic workers
dyspnoea, cough, fatigue, tachypnoea, loss of appetite, fever
Diffuse nodular pattern in upper and mid zones of lung, thin streaks of calcification of the hilar nodes. restrictive ventilatory defect

A

Silicosis

257
Q

Drugs used to treat Alzheimers, examples?

A

Acetylcholinesterase inhibitor, Rivastigmine, Donepezil

258
Q

Risk factors for CKD

A

DM, overweight, HTN, afro-Carribean, ACEi, NSAIDs, BPH

259
Q

Signs of CKD

A

Haematuria
Fatigue
SOB,
Swollen ankles

260
Q

older female. left humerus fracture, abdominal pain, constipation, polyuria, wt loss, haematuria, anorexia. Recurrant infections, bruises easily, small skin cuts bleed profusely and heal slowly. Hypercalcaemia
Dx?
Easy way to remember it?

A

Multiple myeloma

‘CRAB’
Calcium - hypercalcaemia: abdo pain, constipation, polyuria, wt loss, U and E
Renal impairment - haematuria
Anaemia - neutropenia, thrombocytopenia, bleeding and infections
Bone - osteolytic bone lesions, abnormal fractures

261
Q

Resp symptoms, lymphadenopathy, hepatosplenomegaly, eye symptoms, electrolyte abnormalities, facial numbness, gland enlargement, renal stones, arrhythmias
ERYTHEMA NODOSUM - common symptom, rash on calves

A

Sarcoidosis

very mixed picture, usually will be resp symptoms, systemically unwell, and rash on calves

262
Q

GCA first line?

Why an emergency?

A

High dose prednisolone

prevents permanent loss of vision

263
Q

First line treatment for moderate-severe migraines

A

Triptans, e.g. Sumatriptan

264
Q

Urine dipstick results:

1) Positive for nitrate AND/OR leukocyte AND red blood cells?
2) Negative for nitrate and positive for leukocyte?
3) Urine dipstick negative for all nitrite, leukocyte, RBC?

A

1) UT is likely
2) UTI is equally likely to other diagnosis
3) UTI less likely

265
Q

10 year old, common chest, skin infections, fatigue, bruising, pancytopenia
Blood smear - multiple blast cells
Xray - hilar lymphadenopathy
Dx?

A

Acute lymphoblastic leukaemia

most common cancer of childhood

266
Q

Tissue groups for Reactive, psoriatic, ankylosing spondylitis

A

HLA B27

267
Q

Acute adrenal insufficiency: hyponatraemia, hyperkalaemia, hypoglycaemia
then, infected with Neisseria Meningitidis, produces ? syndrome
what is it complicated by?

A

Waterhouse-Friderichsen syndrome

Complicated by disseminated intravascular coagulopathy

268
Q

CURB score
Admission to hospital?
Which antibiotics?

A

CURB score = 0
Low severity, consider treating at home
AMOXICILLIN

CURB score = 1-2
Moderate severity pneumonia, hospital assessment
Amoxicillin with clarithromycin OR erythromycin

CURB score = 3+
High severity pneumonia
Urgent admission to hospital
Co-amoxiclav with clarithromycin OR erythromycin

269
Q

Rapid onset excruciating unilateral headache, over one eye

A

Cluster headache

270
Q

A and E - middle aged man has collapsed, episodes of haematemesis over the last 36 hours. History of AFLD and moderate cirrhosis, has been drinking between 40-50 units of alcohol a week for the last 6 years.
Dx?
1st line Tx?

A

Dx = oesophageal varices, secondary to undiagnosed liver cirrhosis and portal HTN

Terlipressin, Vasopressin, Octreotide

271
Q

60 y/o, admitted to cardio ward, 7 day Hx of progressive SOB. No chest pain. On auscultation- fine crackles in lower lobes bilaterally. Raised NT-proBNP.
ECHO cardiogram, reduced LV contraction, ejection fraction of 45%.
Dx?
Mx?

A 
Heart failure, reduced left ventricular ejection fraction
ACEi and BB - first line treatment 
ACEi = pril
BB = olol
Can then also give diuretic = Furosemide
272
Q

Cells associated with Chronic lymphocytic leukaemia

A

Smudge cells

Basket cells

273
Q

Chronic myeloid Leukaemia

Associated with?

A

Philadelphia Chromosome

274
Q

Acute Lymphoblastic leukaemia
Cells?
Age group?

A

Blast cells

Children

275
Q

Acute myeloid leukaemia

A

Auer rods

276
Q

Multiple myeloma

Formation associated?

A

Rouleaux formation

277
Q

N. meningitides
=+ve or -ve?
diplococci or bacillus?

A

Gram negative diplococci

278
Q

Strep pneumoniae
=+ve or -ve?
diplococci or bacillus?

A

Gram positive diplococci

279
Q

abdo pain, nausea, constipation for past 3 days. Confused and lower in mood, no palpable abdo masses, bowel sounds present. Lungs clear. HR 80, irregular rhythm
ECG - shortened QT, prolonged PR
Endoscopy - multiple 1cm diameter shallow ulcerations of gastric antrum
Dx?
Lab tests?
What is causing the symptoms?

A

Dx = parathyroid adenoma, secreting excessive parathyroid hormone

Increases serum calcium, decreases serum phosphorus

Increased calcium = increased gastrin production and peptic ulcer disease
also causes cardiac arrhythmias

280
Q

T2DM - diagnosis
Symptoms expect to see?
What is needed for a diagnosis?

A

Polyuria, unintentional weight loss, middle aged man usually

Random plasma glucose, >11.1 in presence of signs and symptoms = usually enough
If symptomatic, single HbA1c>48 or fasting plasma glucose >7 can be used, but repeat testing is sensible
Asymptomatic - do not diagnose based on single abnormal result - repeat testing

281
Q

Woman, overweight, A and E with severe, constant RUQ pain, N and V. No chest pain and diarrhoea. 3 month Hx of sharp RUQ pain, often after eating. Febrile with moderate RUQ tenderness, no jaundice
Dx?

A

Acute cholecystitis

secondary to gallstones cholelithiasis

282
Q

Old, pain and tenderness around ankle, erythema and tenderness around ankle. little hole where pus is draining out. PVD and T2DM
Dx?
Mx?

A

Chronic osteomyelitis - based on symptoms and PMH

Flucloxacillin

283
Q

Commonest cause of iron deficiency worldwide?

A

Hookworm

284
Q

Iron deficiency anaemia
Type?
Hyper or hypochromic RBC

A

Microcytic

hypochromic

285
Q

Painless jaundice, always rule out?

A

Pancreatic cancer

286
Q

First line investigation for pancreatic cancer?

A

Abdo Ultrasound

287
Q

Oral glucose lowering agents - primarily inhibit the breakdown of glucagon-like peptide 1?

A

DPP-4 inhibitors

288
Q

Management of tension pneumothorax

A

Immediate needle decompression - 2nd intercostal space, midclavicular line
Insert chain once initial needle decompression has been done

289
Q

Macrocytic Anaemias

causes

A 
'FAT RBC'
Folate deficiency 
Alcohol
Thyroid (hypothyroidism)
Reticulocytosis
B12 deficiency/ pernicious anaemia
Cytotoxic drugs
290
Q

Microcytic anaemia examples

A

Sickle cell disease
Thalassaemia
Iron deficiency anaemia

291
Q

Middle aged, extensive history of alcohol, develops jaundice and mild fever. Hepatomegaly and hepatic tenderness.
Dx?
LFTs?

A

Alcoholic fatty liver disease

INCREASED AST, INCREASED GGT, INCREASED bilirubin

292
Q

recent hospitalisation for bacterial pneumonia, presents to GP with recurrent bouts of watery diarrhoea, sometimes bloody. Raised yellowy white plaques and inflammation seen.
What organism?
Type?
What has caused this?

A 
C. difficile - causes pseudomembranous colitis
GRAM POSITIVE BACILLI
Antibiotics:
4 Cs
Clindamycin
Cephalosporins
Co-amoxiclav
Ciprofloxacin
293
Q

Gene mutation associated with Polycythaemia vera

A

JAK 2

294
Q

AKI risk factors

A 
ACEi
ARB
Haemorrhage during surgery
blocked catheter
dehydration due to op
Old age
295
Q

CF
gene?
chromosome?

A

CFTR

Chromosome 7

296
Q

Acute management for supraventricular tachycardia

A

Vagal manoeuvres e.g. carotid sinus massage

6mg IV adenosine, further 12mg if needed

297
Q

older, known bone disorder, new onset deafness in left ear, normally suffers with bone pain, fractures and deformity e.g. bowing of the tibias.
Takes regular analgesia and bisphosphonates to manage her bone disorder
Xray - sclerotic areas around her pelvic region and petrous portion of left temporal bone.
Dx?

A

Paget’s disease of the bone

= lots of weak bone formed, areas appear sclerotic - more dense, actually weaker = bone pain, fractures, deformity

298
Q

Young, 3 day drowsiness and abdo pain, high HR, bradycardia, heavy breathing and pale. Abdo was mildly tender, no rebound or peritonism
drinking more water and going to the toilet more often than normal
Bloods?

A

LOW sodium, HIGH potassium, REDUCED pH, LOW bicarbonate, LOW paCO2, HIGH ketones

299
Q

ST elevation in V2, V3, V4

A

LAD

300
Q

Score for DVT
1
2

A

Wells Score
1 - DVT unlikely
D-Dimer FIRST

2- DVT likely
Proximal leg vein USS FIRST

301
Q

Gout Mx
ACUTE
LONG TERM

A

A = COLCHICINE

C = ALLOPURINOL

302
Q

Hyponatraemia and decreased serum osmolality?

What can cause it?

A

SIADH

lung carcinoma

303
Q

Middle aged, fatigue, generalised priuritis, upper abdo pain. Found to have elevated serum alkaline phosphate, slightly elevated aminotransferases, normal bilirubin
positive for antimicrobial antibodies
No PMHx
Dx?

A

Primary biliary cholangitis

304
Q

AIDS
What are the lesions called?
what virus causes this?

A

Kaposi sarcoma

Human herpesvirus 8

305
Q

What age does the AAA screen begin?

A

65

306
Q

Main conclusion drawn by the Black Report

A

Demonstrated that although overall health had improved since the introduction of the welfare state, there were widespread health inequalities

307
Q

Weight loss, night sweats, cough, recent travel?, haemoptysis

A

TB

DDX lung cancer

308
Q

Abdo pain, priuritis, tender in RUQ, jaundiced. recent holiday in Turkey, local shellfish. Most likely cause?

A

Hep A

Shellfish, travel

309
Q

Bacterial cellulitis
What could be the cause?
What Abx

A

Staph Aureus -> Benzylpenicillin, Strep Pyogenes -> Flucloxacillin

310
Q

A and E, Generalised headache, one day, gradually worsened. Neck stiffness, CONFUSED and poorly orientated. Mild photophobia, and a temperature of 38.5 degrees.
Lumbar puncture demonstrates lymphocytic CSF and CT head scan shows abnormality in left temporal lobe. Dx? Most likely cause?

A

Dx = encephalitis

Cause = Herpes Simplex Virus

311
Q

RUQ pain, 6 weeks after trip to Central America
During last week, had blood tinged watery diarrhoea, subsided
moderate tenderness on palpitation on RUQ, liver span is increased.
Elevated bilirubin, elevated ALP
Abdo CT scan shows 7cm right hepatic mass, central necrosis and discrete borders
Cause?
What’s going on?

A

Entamoeba histolytica

caused amoebic liver abscess, complication of amebiasis

312
Q

cytotoxic t cells

what do they do?

A

destroy infected and damaged cells

313
Q

Anaphylaxis
Type?
Ig?
Cells?

A

Type 1 IgE mediated hypersensitivity reaction

Mast cells

314
Q

Gonorrhoea -
+ve or -ve
shape?

A

Gram negative diplococci

315
Q

What cell type engulfs the tubercle bacillus

A

Macrophage

316
Q

STEMI in V1-V4 (anterior leads) AND V5-V6, lead I, AVL (lateral leads)
Which artery?

A

LAD

317
Q

Initial management of STEMI?

Definitive management? When can you do each thing?

A 
MONA
Morphine
Oxygen - only if hypoxic
Nitrates - GTN
Aspirin - 300mg
\+ another antiplatelet e.g. clopidogrel, ticagrelor

Definitive management- after MONA
PCI - 1st line but needs to be done within 2 hours
Fibrinolysis with IV Tenecteplase within 12 hours

318
Q

1st line HTN tx

A

<55 - ACEi (ARB if CI)

>55 OR Afro-Caribbean CCB

319
Q

2nd line HTN tx

A

ACEi /ARB + CCB

320
Q

3rd line HTN tx

A

ACEi / ARB + CCB + Diuretic (THIAZIDE)

321
Q

4th line HTN tx

A

ACEi / ARB + CCB + Diuretic (thiazide) + Diuretic (loop)

322
Q

Early diastolic murmur

A

Aortic regurgitation

323
Q

Pansystolic murmur

A

Mitral regurgitation

324
Q

Rumbling mid-diastolic murmur

A

Mitral stenosis

325
Q

Ejection systolic murmur

A

Aortic stenosis

326
Q

Chest Xray signs for HF

A 
Alveolar oedema
Kerly B lines
Cardiomegaly
Dilated upper lobe vessels
pleural Effusion
'ABCDE'
327
Q

Score to measure risk of stroke in AF

A

Cha2Ds2-VaSc

328
Q

Score to measure 10 year probability of CV event

A

QRisk3

329
Q

Score to measure risk of stroke after TIA

A

ABCD2

330
Q

Score for risk of DVT or PE

A

Wells score

331
Q

Criteria for infective endocarditis

A

Modified Duke Criteria

332
Q

Most common side effect of ACEi

A

Dry Cough

333
Q

Gold standard for diagnosing valvular disease

A

Echocardiogram

334
Q

When do you measure Troponin T

A

ACS

335
Q

ECG changes seen in AF?

A

Absent P waves
Narrow QRS
Irregularly irregular ventricle rhythm

336
Q

Sawtooth flutter waves on ECG?

A

Atrial flutter

337
Q

Delta waves seen on ECG?

A

Wolff-Parkinson-White syndrome

338
Q

Saddle shaped ST segment elevation seen on ECG?

A

Acute pericarditis

339
Q

ST segment depression seen on ECG?

A

Seen in Myocardial ischaemia

340
Q

Why do DKA patients sometimes present with Kussmaul’s breathing?

A

Attempt to ‘blow off CO2’, respiratory compensation for the metabolic acidosis caused by increased ketones, which are acidic

341
Q

How does insulin affect K+
Low insulin?
High insulin?
What do you see on ECG with DKA?

A

Low insulin - Hyperkalaemia
High insulin, Hypokalaemia
Remember, insulin and K is opposite
ECG - signs of Hyperkalaemia: absent P wave, Long PR, Wide QRS, Tall tented T waves

342
Q

Types of cardiomyopathy?

A

Dilated
Restrictive
Hypertrophic
Most are congenital, can also be idiopathic

343
Q

Criteria for diagnosing postural hypotension? How is it measured?

A

Systolic drop of >20 or if systolic BP drops to less than 90

Get patient to lie down for 5 mins, measure BP
Then get them to stand up, measure BP after 1 min and 3 min

344
Q

Types of shock - signs
Septic:
Cardiogenic:
Anaphylactic:

A

Septic - pyrexic, bounding pulse
Cardiogenic - bradycardia
Anaphylactic - reduced airway

345
Q

Causes of hypovolaemic shock

A 
Anything that causes fluid/blood loss
GI bleeding
Severe diarrhoea/ vomiting
Burns
Pancreatitis
346
Q

Tearing/shearing pain which radiates to the back

DDx?

A

Aortic dissection

Aortic aneurysm

347
Q

Central crushing chest pain

A

MI

348
Q

Cardiac tamponade

A

Build up of fluid in pericardial cavity, does not typically cause pain

349
Q

Pulmonary embolism

A

Pleuritic chest pain, SOB, haemoptysis

350
Q

Infective exacerbation of COPD

A

SOB and productive cough

351
Q

Hyperthyroid symptoms with ophthalmology - diplopia, eye pain

A

Grave’s disease

352
Q

A transient condition, due to viral infection. Causes hyperthyroidism

A

De Quervain’s

353
Q

Overproduction of thyroid hormones, non eye related symptoms such as palpitations, delirium, hyperpyrexia

A

Thyrotoxicosis

354
Q

Primary hypothyroidism blood results

A

HIGH TSH, LOW T3/T4

355
Q

Primary hyperthyroidism blood results

A

LOW TSH, HIGH T3/T4

356
Q

Gold standard test for acromegaly

A

Oral glucose tolerance test

357
Q

Number one cause of secondary hypoadrenalism

A

Long term corticosteroid usage

358
Q

Addison’s disease
What is it?
Symptoms?
Test?

A

Autoimmune condition, entire adrenal cortex is destroyed
Causes reduced cortisol, aldosterone and sex hormones
‘TONED, TANNED, TIRED, TEARFUL’
Synacthen test - ACTH

359
Q

Causes of SIADH

A

Alcohol withdrawal
Head injury
Pneumonia
Small cell lung cancer

360
Q 
Carcinoid syndrome
What is it?
What do the tumours secrete?
Symptoms?
How do you treat a crisis?
A

Tumour of enterochromaffin cells
5-HT (serotonin), also insulin, substance P, ACTH, bradykinin
TRIAD: Palpitations, diarrhoea, flushing
Crisis - somatostatin analogue

361
Q

Numbness and tingling of extremities, Wrist flexion following inflation of BP cuff - called?
Tapping facial nerve in parotid gland, ipsilateral facial muscle twitching, called?
What is causing it?

A

Trousseau’s sign
Chvostek’s sign

HYPOCALCAEMIA

362
Q

Bones stones groans and moans

A

Hypercalcaemia

363
Q

Primary hypercalcaemia blood results?

A

PTH - HIGH
CA - HIGH
PO4 - LOW
alk phos - HIGH

364
Q

Secondary hypercalcaemia blood results?

A

PTH - HIGH
CA - LOW
PO4 - HIGH
alk phos - HIGH

365
Q

Tertiary hypercalcaemia blood results?

A

PTH - HIGH
CA - HIGH
PO4 - HIGH
alk phos - HIGH

366
Q

GORD Tx

A

Alginates - physical barrier - neutral floating gel raft on top of stomach

Antacids - neutralises HCl in stomach

Histamine receptor antagonists - bind to H2 receptors of parietal cells, less acid can be produced

PPI - inhibit gastric acid secretion, block H+/K+ ATPase enzyme

367
Q

Most common causes of small bowel obstruction

A

Surgical adhesions

368
Q

Enlarged Virchow’s Node - Trosier’s sign

Associated with which type of cancer

A

Gastric cancer

369
Q

Px of oesophageal cancer

A

Lymphadenopathy
Progressive dysphagia
Retrosternal chest pain
Weight loss

370
Q 
Tx for UC
Mild 
Moderate
Severe
Severe and other treatments exhausted
A

Mesalazine

Oral prednisolone

IV Hydrocortisone

Colectomy

371
Q

Most common form of anaemia
Type?
Tx?

A

Iron deficiency anaemia
Microcytic
Iron supplements

372
Q

MGUS
What is it?
What is it a precursor to?

A

Overproduction of a monoclonal immunoglobulin, found incidentally on blood tests
Myeloma / Multiple myeloma

373
Q

Do you usually see raised white cell count in Hodgkin’s Lymphoma

A

No

374
Q

Polycythaemia Vera (PCV)
What is it?
Complications/features?

A

Bone marrow overproduces blood cells - caused by JAK2 mutation mostly

Dizziness, Itching, Haemorrhage

375
Q

Major risk factors for DVT

A

Immobility
Trauma
Surgery
Malignancy

376
Q

Iron deficiency anaemia

Cells?

A

Pale
Small
Abnormal shapes
Vary wildly in size

377
Q

Signs of liver failure

A

Asterixis - jerking movement of hand aka ‘liver flap’
Spider Naevi
Jaundice
Gynaecomastia - males develop breast tissue, imbalanced oestrogen

378
Q

Acute Liver failure definition

A

INR greater than 1.5
Onset of less than 26 weeks duration
Mental alteration without pre existing cirrhosis
No previous liver disease

379
Q 
Acute pancreatitis
Px?
Cullen's sign?
Grey Turner's sign?
Why not pancreatic cancer?
A

Abdominal pain that radiates to the back
‘through’
Severe pain
Cullen’s - periumbilical bruising
Grey Turner’s - flank bruising, both sides, 2, 2 words in name
Bruising, pretty sure its acute pancreatitis

Cancer usually presents with no pain, except in later stages when it impinges on other structures

380
Q

Red flag for cancer of the pancreatic head?

Why does this occur?

A

Painless jaundice

Obstructs the common bile duct, causes obstructive jaundice

381
Q

Benzene exposure a risk factor for?

A

Renal carcinoma

382
Q

Risk factors for liver cancer

A

Hep B
Chronic alcohol use
NAFLD
Aflatoxin - toxin produced by fungus

383
Q

Gold standard Ix for Wilson’s disease

A

Liver biopsy

384
Q

Alpha 1 antitrypsin deficiency

Autosomal?

A

Autosomal recessive

385
Q

Rice water stools?

Tx?

A

Cholera

Rehydrate with IV fluids

386
Q

Young boy
Diarrhoea
Bloody?
Non bloody?

A

Bloody - Campylobacter Jejuni

Non-bloody - Rotavirus

387
Q

Middle aged, feeling particularly tired, pain in joints, polyuria, difficulty getting an erection, signs of chronic liver disease. Looks tanned.
Dx?

A

Haemochromatosis

388
Q

beta-haemolytic gram positive strep with Lancefield grouping A

A

Strep. Pyogenes

389
Q

UTI
most common causative organism?
Tx?
In pregnancy, alternative?

A

E coli
Trimethoprim
Nitrofurantoin

390
Q

Triad for encephalitis
Common causative organism?
Mx in community
Mx in hospital

A

FEVER, ALTERED MENTAL STATE, HEADACHE
Herpes simplex virus
IM Benpen
ACYCLOVIR

391
Q

What agar is used to culture TB?

A

Lowenstein-Jensen

392
Q

Non lactose fermenting aerobic bacilli with positive oxidase test?

A

Pseudomonas

393
Q

Most common cause of infective endocarditis?

Type of bacteria?

A

Strep. Viridans

Optochin resistant alpha-haemolytic strep

394
Q

Optochin sensitive alpha haemolytic strep

A

Strep Pneumoniae

395
Q

How do you separate strep from staph? which ones which?

A

Catalase test
+ve = staph
-ve = strep

396
Q

MRC scale of stages of COPD

A

Grade 1: Breathless with strenuous exercise.
Grade 2: Short of breath when hurrying or when walking up hill.
Grade 3: Walks slower than people of the
same age or stops for breath when walking at own pace on flat.
Grade 4: Stops for breath after
walking 100m on flat.
Grade 5: Too breathless to leave the house/ Breathlessness on changing
clothes

397
Q

1st line Ix lung cancer

A

CXR

398
Q

Pleural effusion
What causes?
Presentation on xray?

A

Pneumonia - parapneumonic pleural effusion
Stony dull percussion
‘blunting of the right costophrenic angle, homogenous opacity of lower zone of right lung’

399
Q

Von-Willebrand disease - type of inheritance

A

AUTOSOMAL DOMINANT

400
Q

Bronchiectasis
What is it?
Causes?

A

chronic infection leading to permanent dilatation of the airways

causes: bronchogenic carcinoma, cystic fibrosis, immotile ciliary syndrome, pneumonia

401
Q

Asthma Tx

A

Always lifestyle, stop smoking and vaccinate

1) SABA / SAMA
2) *If steroid responsive/asthmatic = Add LABA + ICS (inhaled corticosteroid)
2) *If not steroid responsive / non-asthmatic= Add LABA + LAMA
3) Oral theophylline
4) Long term oxygen therapy

402
Q

Example of ICS

What line Tx

A

Beclometasone

2nd line

403
Q

Most common organism in CAP

A

CAP - Strep pneumoniae

404
Q

Ix for diagnosis of Sarcoidosis

A

Tissue biopsy

405
Q

TB drugs and S/E

A

Rifampicin- red urine, hepatitis, drug interaction (‘R’-red urine)
Isoniazid – hepatitis, neuropathy
Pyrazinamide- hepatitis, arthralgia/gout, rash
Ethambutol- optic neuritis

406
Q

Extrapulmonary manifestations of CF

A

Pancreatic insufficiency, steatorrhea, infertility

407
Q

What type of hypersensitivity reaction is hypersensitivity pneumonitis

A

Type 3

408
Q

Upper respiratory tract infection, diffuse pulmonary haemorrhage (haemoptysis), glomerulitis (bloody, frothy urine)
Dx?

A

Goodpasteure’s syndrome

409
Q

Sub arachnoid haemorrhage

CT?

A

Thunderclap, sudden onset, sever, occipital, meningism, neck stiffness, vomiting, photophobia
Berry aneurysm common - PKD

star sign in ventricles

410
Q

Subdural haemorrhage

CT?

A

elderly, alcoholics, those on anticoagulation. More chronic headache, fluctuating consciousness, cognitive decline

BANANA

411
Q

Extradural haemorrhage

CT?

A

Trauma to temple - MIDDLE MENINGEAL ARTERY
Brief loss of consciousness, lucid period, rapid deterioration, headache, vomiting, confusion, focal neurology

LEMON

412
Q

Frontal lobe seizure

A
  • Seizures in the frontal lobe may cause ‘Jacksonian motor seizures’ (Proximal spread of
    clonic jerking- begins in finger / toe / corner of mouth, spreads proximally as abnormal epileptic discharge
    moves along motor cortex). Post-ictal Todd’s paralysis- Affected limb(s) may remain temporarily weak
413
Q

Occipital lobe seizure

A

typically cause floaters / flashes in the eyes

414
Q

Parietal lobe seizure

A

typically cause non-specific sensory symptoms (tingling / pain / numbness / prickling)

415
Q

Temporal lobe seizure

A

Pre-seizure aura- rising epigastric sensation, fear / anger, déjà vu, hallucinations - olfactory /
gustatory

Seizure- Automatisms: lip smacking, chewing, grimacing, fidgeting, picking at clothes

Post-ictal confusion= common

416
Q

Gram positive diplococci, severe meningitis

A

Strep pneumoniae

417
Q

Stroke - which artery?

Basilar artery

A

Locked in syndrome

418
Q

Stroke - which artery?

Left anterior cerebral artery

A

Right sided hemiparesis/ sensory loss, LOWER extremities affected

419
Q

Stroke - which artery?

Left middle cerebral artery

A

Right sided hemiparesis/ sensory loss, UPPER extremities affected
UMN facial weakness, forehead sparing
Right sided homonymous hemianopia
Dysphagia - speech probs because dominant lobe

420
Q

Stroke - which artery?

Right anterior cerebral artery

A

Left sided hemiparesis / sensory loss, LOWER extremities affected

421
Q

Stroke - which artery?

Right middle cerebral artery

A

Left sided hemiparesis/ sensory loss, UPPER extremities affected, UMN facial weakness, forehead sparing. Left sided homonymous hemianopia

422
Q

A and E, lower back pain, increasing weakness and numbness in both lower limbs
2 days prev, he had pain shooting down both his legs after moving heavy boxes at home. No Hx of incontinence or impotence
Power in lower right limb is reduced, power in left lower limb is normal
Reflexes in right were absent, normal on left
Anal sphincter tone reduced
Sensation broadly reduced on right side, not on left
Dx?

A

Cauda Equnia

Keeps comparing sides

423
Q 
Spirometry results for COPD
FEV %
FEC/FVC <
Obstructive or restrictive?
e.g. of obstructive
A

FEV <80%
FEV1/FVC<0.7
FEV1 falls disproportionately greater than FVC, causes decreased ratio. <0.7 = obstructive disease
e.g. COPD, asthma, bronchiectasis

424
Q

Spirometry for restrictive disease

e.g.

A

Both FEV and FVC are LOW, means FEV/FVC ratio remains high/normal
e.g. asbestosis, sarcoidosis, pulmonary fibrosis

425
Q 
Hyper resonant percussion
Decreased air entry
Hyper inflated chest
Tachypnoea
Signs of?
A

Asthma

426
Q

Order of asthma Tx

A 
SABA - salbutamol
Low ICS - beclomethasone
LTRA - Montelukast
LABA - salmeterol
MART - spiromax
Mod ICS 
High ICS
427
Q

Most common type of lung cancer in non smokers

A

Adenocarcinoma

428
Q

Common sites for lung cancer to metastasise to

A

Adrenal glands
Bone
Brain
Liver

429
Q

Gold standard for diagnosing a PE

A

CT pulmonary angiogram

430
Q

Bacteria that causes atypical pneumonia

A

Mycoplasma pneumonia
Chlamydophila pneumoniae
Legionella pneumonia

431
Q

5 moments for hand hygiene

A 
before touching a patient
before clean/aseptic procedures
after body fluid exposure / risk
after touching a patient
after touching a patient surroundings
432
Q

Best abx for primary syphilis

A

Benpen

433
Q

What is given as prophylactic ABx for contacts of meningitis cases?

A

Ciprofloxacin and Rifampicin

434
Q

What is given as first line Tx for meningococcal meningitis once in hospital?

A

Ceftriaxone

435
Q

What group of conditions has biggest impact in UK on work health/ time off etc

A

Stress, anxiety, depression

436
Q

Sensitivity =?

A

The proportion of patients who have the disease and test positive

437
Q

Specificity =?

A

The portion of patients who don’t have the disease and test negative

438
Q

Positive predicted value

A

Proportion of patients who test positive who have the condition

439
Q

Negative predictive value

A

Proportion of patients who test negative who don’t have the condition

440
Q

Primary prevention

A

Reduce the initial occurrence of the disease

441
Q

Secondary prevention

A

Treat the disease as soon as possible to halt the disease progress and try and prevent long term problems

442
Q

Tertiary prevention

A

Aims to reduce the impact of an ongoing problem and improve quality of life

443
Q

Ataxia, headache, vertigo, vomiting?

Cardinal symptoms of what?

A

Cerebellar stroke

444
Q

Stroke present - what first?

Why?

A

CT

Need to decide if its haemorrhagic or ischaemic before giving aspirin/ alteplase

445
Q

Fatiguability, sped up due to infection, pre-existing AI condition
Needs to rest after walking gently.
Dx?

A

Myasthenia Gravis

GB tends to be weakness spreading from bottom to top, doesn’t seem to be as much about fatiguability

446
Q

What can bring on Temporal / GCA

Tx?

A

Change in temp, shaving, combing hair, eating

PREDNISOLONE

447
Q

NSAIDs mode of action

A

Non-selective inhibitor COX1 and COX2 enzymes

448
Q

Gram negative, aerobic, MacConkey pink - lactose fermenter

A

E. Coli

449
Q

Gram negative bacilli, aerobic, fastidious growth requirements

A

Haemophilus influenzae

450
Q

Gram negative, aerobic, MacConkey pale - non lactose fermenter

A

Salmonella

451
Q

Gram positive cocci, catalase positive, coagulase positive

A

Staph Aureus

452
Q

Gram positive cocci, catalase negative, alpha haemolytic

A

Strep Pneumoniae

453
Q

Dark urine, pale stool, raised ALP
ALT, AST only mildly raised
No weight loss
Dx?

A

Know its obstructive jaundice because of dark urine, pale stools and raised ALP
ALT and AST only slightly raised, would be very raised in alcoholic hepatitis, AI hepatitis, Viral hepatitis
Weight loss would ?pancreatic cancer

Dx? Gallstones

454
Q

Chronic alcoholism/ liver disease effect on RBC?

A

Macrocytosis, raised MCV

455
Q

Most common cause of hepatitis in travellers?

A

Hep A

456
Q

What do levels of Hep B antigens mean?

A

Surface antigens (HBsAg)- indicate active infection or just been vaccinated

E antigen (HBeAg)- marker of viral replication, implies high infectivity

Core antibody (HBcAb)- implies past or current infection

Surface antibody (HBsAb)- implies vaccination or past or current infection

457
Q

Causes of ascites?

A 
Acute pancreatitis
HF
Hypoalbuminaemia
Malignancy
Meig's syndrome
458
Q

Typical gallstones patient?

A 
4Fs
Fat
Female
Forty
Fertile
459
Q

Existing liver cirrhosis with FEVER
Dx?
Organisms?

A

Spontaneous bacterial peritonitis

E.Coli, Klebsiella, Strep Pneumoniae

460
Q

? Gallstones

first line tests

A

LFTs

Ultrasound

461
Q

Causes of neutrophilia

A

CML
Appendicitis
MI
Strep Pyogenes

462
Q

How does AIDs effect WCC

A

Decreases it, causes neutropenia

463
Q

Women, aged 60, classic anaemia symptoms, peripheral neuropathy, lemon tinged skin, mouth ulcers, depression, dementia
Dx?

A

Pernicious anaemia, prevents uptake of vitamin B12/ folate in the bowel
Vitamin B12 injections

464
Q

Post menopausal, tired, lost appetite, bowel movements have increased in frequency. FBC - shows microcytic, hypochromic RBCs
What do you do next? Why?

A

Refer urgently for colonoscopy
Showing red flags for bowel cancer, concerning cause of iron deficiency anaemia in postmenopausal women

If she was pre menopausal and had no red flags, treat with ferrous sulphate and dietary advice

465
Q

Haemophillia A and B factors?

A

A=8

B=9

466
Q

What is polycythaemia?
Primary?
Secondary?

A

Increase in RBC production
Primary / polycythaemia Rubra Vera = RBC overproduction
Secondary = underlying cause, e.g. chronic hypoxia

467
Q

What can precipitate a painful sickle cell crisis?

A

Parovirus B19
N and V
Dehydration secondary to viral illness
Local tissue hypoxia

468
Q

When is diagnosis of CKD made?

A

2 measurements, > 3 months apart, eGFR <60

469
Q

What type of drug is Tamsulosin?
Used for?
What S/E

A

Alpha blocker
BPH - relaxes muscles around the bladder neck / prostate to allow better urinary flow
S/E = postural HTN

470
Q

Commonest cell type involved in renal carcinoma

A

Clear cell

471
Q

Management of acute pulmonary oedema

A 
High flow oxygen
IV furosemide
IV morphine
GTN
CXR!
472
Q

What makes a UTI complicated?

A 
Man
Pregnant
Child
Immunocompromised
Recurrent UTIs
Structural abnormality
473
Q

1st line Tx for primary hypothyroidism

Tx for hyperthyroidism?

A

Levothyroxine

Carbimazole

474
Q

Primary hyperthyroidism thyroid function tests

A

Low TSH, raised T3, T4

475
Q 
Exophthalmos 
Increased appetite
Lid lag
Tachycardia
All features of?
A

Graves’ Disease

476
Q

Amenorrhoea, decreased libido, acral enlargement (ring doesn’t fit)
Dx?
Diagnostic test?

A

Acromegaly

Oral glucose tolerance test

477
Q

What would be seen in bloods for primary hyperparathyroidism?
Secondary hyperparathyroidism?
How do you know which one the Q is asking about?

Tertiary bloods?

A

Primary:
HIGH PTH, HIGH Ca, LOW PO4

Secondary:
HIGH PTH, LOW Ca, LOW PO4

If secondary, they will have bones stones groans and moans, but will probs have another pre-existing condition in their history, e.g. CKD, vit D deficiency

Tertiary: HIGH PTH, HIGH Ca, HIGH PO4

478
Q

Severe hypercalcaemia
Px?
Mx?

A

Px? dehydration, confusion, risk of cardiac arrest and death

Mx? IV fluids, bisphosphonates, measure U+Es, Ca, and give prednisolone

479
Q

Tx for Graves disease?
What happens if you withdraw Tx?
Px of this?

A

Carbimazole
Hyperthyroid crisis
High fever, high HR, AF, hypotensive, vomiting, confused

480
Q

Addisons disease

Px?

A

Tanned, tired, tearful, tones, throwing up

causes hypotension

481
Q

Complications of long term steroid use?

A 
Thinning skin, easy bruising
DM
Immunosuppression
Osteoporosis
Proximal muscle weakness
482
Q

Wolf-Parkinson White
What is it?
Type?
ECG?

A

Supraventricular tachycardia, caused by an accessory pathway causing a re-entrant loop
Atrioventricular re-entry tachycardia
Wide QRS, short PR, Delta wave (slurred upstroke to the QRS)

483
Q

Heart failure
Used to treat SYMPTOMS?
Used to improve PROGNOSIS?

A

Diuretics

B blocker and ACEi

484
Q

ST elevation in V1-V6 aVL and I
What territory?
What artery most likely?

A

Anterolateral

LAD

485
Q

Method of action for clopidogrel?

A

P2Y12 inhibitor

486
Q

Method of action for NSAIDs?

A

COX inhibitors

487
Q

Method of action for Statins

A

HMG coA reductase inhibitors

488
Q

Method of action for Warfarin

A

Vitamin K antagonists

489
Q

Diarrhoea, abdo pain, wt loss and macrocytic anaemia
Dx?
Why?

A

Coeliac disease

Malabsorption - wt loss and Folate/B12 deficiency

490
Q

Angular stomatitis, sign of what?

A

Iron deficiency anaemia

491
Q

What is classes as severe UC?

Mx?

A

Truelove and Witt’s criteria - >6 stools passed in a day

+ 1 of: >HR90, Temp >37.5, Hv<10.5, ESR>30

492
Q

Ongoing diarrhoea, for e.g. due to IBS, good Tx?

A

Loperamide

493
Q

Where is vitamin B12 absorbed?

A

Terminal ileum

2a Exam (3 decks)

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